Volume 32, Issue 3 (Fall 2019)

child sneezing

Handling Picky Eaters

Picky eating is a common challenge families encounter. For a variety of reasons, some children are very selective about the foods they will eat. Children may not like certain textures, colors, shapes, or flavors. Children may refuse to try new or unfamiliar foods.

Picky eating is also a common cause of worry and tension for parents and caregivers who may worry about whether young children are getting the nutrition they need to grow and thrive. The amount of food and number of servings a child needs from each food group depends on that child’s age and activity level. A child who is growing well is getting enough to eat. Your child’s health care provider can best answer questions about how much a child needs to eat.

Instead of focusing on how much a child eats, author and dietician Ellyn Satter encourages parents to consider what she describes as the division of responsibility in feeding. She explains, “Parents are responsible for the what, when, and where of feeding; children are responsible for the how much and whether of eating.” Using this division of responsibility can help parents focus on what they can influence about picky eating and can help children listen to their hunger cues and explore new foods when interested without pressure from caregivers. Here are some what, when, and where ideas to get you started.

  • What: Try varying foods within food groups. If your child refuses specific foods from one food group, try others from the same food group. We eat with our eyes in addition to our mouths. Try to vary the colors of fruits and vegetables. Allow children to taste sweet fruits such as pears and melons alongside tart flavors such as lemons or oranges. Try proteins such as eggs, tofu, or a different type of meat or fish. For dairy, remember that yogurt, low-fat flavored milk, or a milk and fruit smoothie can provide needed calcium. Caregivers can add additional nutritional value to some prepared dishes with extra ingredients. Add nonfat dry milk or nonfat plain yogurt to cream soups, milk shakes, and puddings. Mix grated zucchini, carrots, or puréed pumpkin into quick breads, muffins, meat loaf, lasagna, and soups. Use dip such as catsup, ranch dressing, or yogurt to entice a child to try a new fruit or vegetable. Praise your child even if they simply lick the dip or dressing off the fruit or vegetable. Exploring the new food in their mouth is also step toward accepting a new food.
  • When: Model the eating behavior you would like to see your child have. Set a good example by eating well yourself. Ideally, eat at least one meal together as a family every day or try for three to four times per week. Keep mealtimes consistent and discourage heavy snacking before meals so children come to the mealtime feeling hungry. If a child is particularly hungry before a meal, serve one part of the meal, such as the vegetable or fruit, while you continue to prepare the rest of the meal.
  • Where: Develop a routine by having all your meals about the same time every day and in the same place. Get rid of distractions by turning off the television and other devices during meals, not allowing toys at the table, and minimizing table decorations (children can turn anything into a toy). However, if the kitchen table has become a place of power struggles, try offering healthy foods in a different space, such as a picnic at the park or even just on a picnic blanket inside your living room.

As a caregiver, you can share positive messages about healthy eating and trying new foods through play and participation in food preparation. Pretend to feed dolls and stuffed animals a variety of different foods during play time, read stories that talk about different types of foods, and include your child in cooking by having them try simple tasks such as stirring pancake batter or washing apples.

With time and patience, you and your EI team can work through the challenges of picky eating. Occupational and speech therapists, nutritionists, and developmental therapists all have expertise to share regarding sensory, emotional, and physical challenges that can contribute to picky eating.

Food to Grow

We, as parents, want our children to have it all. We want health and happiness for them. While there are some things that we cannot control, we can make the choice early in our children’s lives to provide a variety of food options that will provide the building blocks to build a healthy mind and body.

Infants from birth to 6 months receive all of their nutrients either from breast milk or formula. There is typically no need to supplement, unless it is recommended by your child’s doctor or a dietician. As your child grows and is ready for solid foods, you may have questions: What comes first? How do I do this? How do I know my child is eating enough, but not too much? How much is too much?

Here are important ideas to remember about the food you eat and serve:

  • Balance: Be sure that your child gets enough, but not too much, of each type of food.
  • Variety: Offer a wide selection of foods within each food group.
  • Moderation: Limit the intake of foods high in added sugars, salt, saturated and trans fats, and cholesterol.
  • Adequacy: Ensure the foods provide enough energy and nutrients to meet your child’s dietary needs.
  • Education: Food labels tell the story about the food you eat. Nutrition information on the labels is written for one serving, but more than one serving may be in the container. You can find nutrient, fat, sodium, and carbohydrate content on the label, along with vitamins and minerals.
  • Creativity: Arrange food in shapes on the plate or use a skewer. Provide dipping sauce for vegetables or fruit. Garlic or parmesan cheese can be sprinkled on top.
  • Independence: Young children can serve themselves, with your supervision. An appropriately sized serving utensil can help with portion control.
  • Patience: New foods can take time to catch on. Present them multiple times and your kids might start asking for them.
  • Safety: Watch out for foods that may cause choking, including hot dogs, chips, nuts, seeds, popcorn, raisins, grapes, cherries, marshmallows, pretzels, peanut butter, and hard candy.

Proper nutrition is important for everyone. By starting early, positive habits can be established that can impact a child for life.

The Role of Nutrition in Early Intervention

Feeding, weight gain, and diet are consistently high on parent’s priority list for their infant/child and can be a source of stress when they feel unable to meet these needs on an ongoing basis. We now know that nutrition is the biggest environmental influence in an infant and young child’s brain development.

Balanced nutrition with adequate iron, in particular, is essential for optimal brain growth and development in a child’s formative years. Docosahexaenoic acid (DHA) supplements at ages 1–3 have been found to bring consistent, positive results in cognitive and language development.

A nutrition assessment can identify needs or gaps in child’s nutrition that may be directly affecting developmental progress. Nutrition consultation can provide options and guidance to parents with nutrition information that is targeted toward their child’s individual needs.

Early intervention can effectively work alongside a public health and/or a medical model of care in the home setting to adapt strategies to a family’s individual culture and schedule. Nutrition services in early intervention can bring adaptations and accommodations that meet an infant or toddler’s individual needs in their diet that can promote strength, attention, comfort level, and independence.

Written with assistance from Jo Sue Stine, RN.

EI Nutrition Services

Nutrition services in early intervention are provided by licensed dieticians. These services can include:

  1. Conducting individual assessments in nutritional history and dietary intake, feeding skills and feeding problems, and food habits and food preferences.
  2. Developing and monitoring appropriate plans to address the nutritional needs of eligible children based upon individual assessment.
  3. Making referrals to appropriate community resources to achieve individual planned nutrition outcomes.
  4. Family training, education, and support provided to assist the family of a child eligible for EI services in understanding the special needs of the child as related to nutritional services and enhancing the child’s development are integral to this service.

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Early Intervention Clearinghouse is funded by the Illinois Department of Human Services Bureau of Early Intervention. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the Illinois Department of Human Services, Bureau of Early Intervention, or the University of Illinois at Urbana-Champaign. Early Intervention Clearinghouse (ISSN 1058-8396) is published quarterly.