Health Matters: The picky eater — tried and true solutions

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I am a pediatrician. I spend my days with children and I spend a lot of time discussing the ordinary things that affect their health.

More than half of parents report problems with their toddlers' eating habits and food choices and seek advice from their pediatrician about their "picky eaters." Many children refuse new foods and turn down familiar, once-liked foods. Others willingly eat white foods (noodles, potatoes, chicken nuggets, bread, cheese) and refuse the rest. This pickiness may disrupt family meals, lead to power struggles, and undermine the parent-child relationship. Under these circumstances, meal times are not much fun.

It is easy to understand the stress, and distress of the cook, who day after day finds their best efforts snubbed by a young person they love. The causes of "pickiness" are numerous. Children go through developmental phases when they are less hungry, or when their favorite word is "No!" They learn how to "push the buttons" of adults.

There are also genetic reasons why children might feel over-whelmed, even repulsed, by food. Just as some people see or hear better than others, there are people who have a more acute sense of taste. About 25 percent of us are genetically endowed with tongues that perceive several types of bitterness. The most sensitive tasters, those with "Super Palates," can distinguish even more subtle flavors. This ability can be both a curse and a blessing.

Children with super-sensitive palates can taste bitter flavors that their parents don't even know exist. Unfortunately, all the young child can usually say is "I don't like this." When they grow older, people with Super Palates explain that certain foods they tasted as children were actually painful to the tongue, as well as unpleasant tasting. These foods include spinach, kale, broccoli, Brussels sprouts.

Adults with Super Palates report that, with time, the bitter tastes are less of a problem due the "maturing" or "dulling" of the taste buds. They often acquire a liking for a huge variety of foods, including those that caused them pain when they were children, though they may still avoid bitter beer, coffee, and carbonated drinks. I joke with parents that the nay-saying tyrant who tries to rule the dinner menu may have "super-powers." He may be well become the family cook who seasons the Thanksgiving dinner. "We cannot wait two decades for him to eat a vegetable," the parents groan; I agree.

Here are some tricks for the "picky eaters" or "Super Palates."

Pay attention to what your child likes to eat. Make a list of your child's favorite foods and post it on the refrigerator to act as a reminder as you cook. As your child tries new foods, let her add them to the list.

Examine preferences. Look at the favorite foods and figure out what your child likes about them. Does he prefer softer textures and bland flavor? Use this knowledge to introduce new foods. Start simply. If your child likes elbow noodles, try spirals. Mashed potatoes? Try baked potatoes and then sweet potatoes. Are chicken nuggets a favorite? Try chicken breast.

Offer a new food repeatedly. Studies show that new foods have to be introduced an average of 10 times before they become familiar — and kids like familiar foods best. Consider the 9 month old. She is an explorer. She is probably more willing to accept new foods than she will be as a toddler, so introduce the family favorites while she is curious. You may have to puree the chili or cut the barbecue into tiny pieces, but the family foods will at least be familiar.

Try a "one bite" strategy. Put a teeny, tiny bite of each of the foods from the meal on your child's plate. Once the child tastes everything, let him choose more of whatever he wants.

Don't let this, or any other strategy, lead to a battle. Some children — and some parents — don't back down. There are times when a parent must be firm: "Hold my hand while we cross the street," for example, but forcing a preschooler to taste a pea isn't worth ruining an evening.

Do not become a short-order cook. You need not cook a special meal for each eater, nor do you need to eat macaroni and cheese every night — even if it seems easiest. Let your child observe his family enjoying a variety of foods. Try to include a side dish that your fussy eater enjoys. Otherwise, offer a simple alternative like apple slices, cheese sticks, or a peanut butter and jelly sandwich. Often, a child who refuses everything on the table simply isn't very hungry. Your child won't starve. It is OK if he gets bored with the substitute offerings. He might take the opportunity to try something from your plate.

Give your child a chance to interpret the feelings of being hungry and being full. Don't force a small child who isn't hungry to eat, and don't give a treat as an enticement to "eat something." If he gets hungry after the meal, reintroduce what was served or wait until the next meal. To establish good table manners, you can insist the child stay at the table for a few minutes while the others eat.

Notice what time of day your child likes to eat. Many children prefer breakfast and could go to bed without dinner every night. Others are not hungry in the morning. Be sure to offer protein and healthy food at the meals your child is most likely to eat. Think of learning to eat on a schedule as a process. Newborns need to eat every two to three hours. When they are full, they stop. Older children and adults have to wait for mealtimes. They may over-eat in order to finish a too-large meal or accept a treat even when they are full. Help your child understand what her body is telling her.

Let your child help. My mother always gave us the peas to shell, and she never got more than a small handful back to cook!

Make food beautiful or interesting. Peel a banana, spread peanut butter on the top, and decorate with raisins to make "Ants on a Log." Try ants on a "green log" with celery, or on an "orange log" with carrots. Get the extra-fancy party toothpicks and arrange a platter of hors-d'oeuvres with cheese cubes, grapes, diced tofu, chickpeas, or ravioli.

Dip it! Many children will eat vegetables dipped in salad dressing. It's easy to add new vegetables to the dipping platter for your child to try.

Separate foods. Some kids don't like a heavily-flavored soup but will eat the carrots and potatoes if they are separated. Or, you may puree all the vegetables together if your child prefers smooth-textured food.

Hide it. You can add pureed squash to muffins or even cupcakes. Keep it simple — Brussels sprouts cannot be hidden in pancakes. Kids are often able to taste the healthy additions, and if they feel tricked they may reject the camouflaged items.

Let your child develop an appetite. A person is more likely to try new foods if she hasn't been snacking all day. Some parents carry three or four little containers of snacks everywhere they go, and the food selection in their minivans resembles a rolling buffet!

I know children are cranky when they are hungry, but they are also cranky when they are bored, stressed, or tired. Treating boredom with crackers doesn't allow a child to learn from his own body and, as many over-weight adults can tell you, food habits can be hard to break.

Offer water between meals. Many children fill up on juice or milk and then don't want their meals.

Avoid nutritional supplements. The corporate world is happy to profit from "picky eaters." Television commercials persuade anxious parents to buy their children PediaSure, a special formula originally intended for children who, because of illness, require a high-calorie liquid diet. Instead, give your child a daily multivitamin if you are concerned that his diet doesn't have enough variety. And keep offering healthy foods.

Consult your child's clinician. At Just So Pediatrics, we record the growth of our patients and discuss their growth at every well visit and whenever there is a concern. The growth chart is the best way to see if the child is growing appropriately. As obesity is becoming more and more common, some children, who look "average" to our 2016 eyes, are actually over-weight and at higher risk for diabetes and hypertension. Sometimes adults worry that a child is "too skinny" and may try to fatten the child up with extra butter and sweet snacks. Often, the "skinny" child is growing well and would have been considered "average" just a couple of decades ago.

Enjoy mealtimes. For many of us, how much we enjoy food depends more on the company and the memories surrounding the food than the taste itself. Children who share their meals with people who find eating a pleasure are likely to develop healthy eating habits.

Bon App├ętit!

Susan Slowinski, MD, is a board-certified pediatrician at Just So Pediatrics, a department of Brattleboro Memorial Hospital. Just So Pediatrics is located at 19 Belmont Avenue, Brattleboro, VT. In addition to regular hours evening and Saturday hours are available, Tuesdays and Wednesdays open till 8 p.m. and Saturdays 8 a.m. to noon. Just So Pediatrics can be reached at 802-251-8626.

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