Week after week, Kaden Hansen's menu looks like this: macaroni and cheese, cheddar-cheese slices, chicken nuggets, and plain cheese pizza. Breakfast is cold cereal with rice milk, never cow's milk. He'll eat a certain brand of angel-hair pasta with butter but won't touch spaghetti. He loathes vegetables and most fruits. Salad or casserole? Not a chance. The foods on his plate must never, ever touch one another.
Preschoolers are notoriously picky, sometimes living on noodles and crackers for months at a time and rejecting just about everything with protein, fiber, vitamins, or minerals. However, Kaden (we've given him a pseudonym at his mom's request) isn't 3, he's 11 -- and he still refuses to try anything new.
"When he was little I thought I could just wait it out, but his diet hasn't gotten any better," says his mother, Suzanne, who lives near Portland, Oregon. "Our pediatrician doesn't seem worried because he's basically healthy, but it's so frustrating. I love food, and I know that nutrition is important."
When every bite seems like a battle, it's stressful for the whole family. And it doesn't matter whether your child is 12 months old or 12 years old. If you're not fighting with your kid, you're often feeling guilty about giving in to his demands and embarrassed when you have to tell your in-laws that their grandchild won't eat what they are serving for dinner. "Parents cry in our office because they're so exasperated," says Mark Fishbein, M.D., a pediatric gastroenterologist at Children's Memorial Hospital, in Chicago, and coauthor of Food Chaining: The Proven 6-Step Plan to Stop Picky Eating, Solve Feeding Problems, and Expand Your Child's Diet. Indeed, when we asked Parents readers on Facebook about their picky eaters, more than 1,200 moms complained about the struggles over meals in their own home.
It's hard to know if you should simply pray that your child's eating habits will eventually improve, or be more proactive about the situation. Experts say don't give up: "The longer a child continues to be picky, the more likely it is that he'll always be picky," says Dr. Fishbein. "However, parents shouldn't feel helpless." The best strategies for inspiring healthier dining habits are often the most subtle. Although there's no quick fix, the first step is to rethink the conventional wisdom that you've heard about fussy eaters.
"He'll Grow Out of It"
Kaden's genuine fear of new foods, known as neophobia, is typical in children ages 2 through 5. "Most of them outgrow that stage if they're exposed to a variety of choices, but about 25 percent of kids don't outgrow their reluctance to try new foods," says Andrea Vazzana, Ph.D., a psychologist who specializes in problematic eating at the New York University Child Study Center. Experts use the term "selective eater" to describe a kid who eats a very limited number of items and has a strong negative reaction to unwanted foods. It is often considered to be a feeding disorder rather than an eating disorder; unlike people with bulimia or anorexia, selective eaters aren't worried about their weight. However, without the right encouragement to try new foods, these kids may be picky for the rest of their life, says Dr. Vazzana. No one knows how many adults are finicky eaters, but experts at Duke University, in Durham, North Carolina, and Western Psychiatric Institute, in Pittsburgh, have more than 29,000 of them registered online for a new study.
Most picky kids appear to be healthy, but children who reject entire food groups aren't doing their body any favors. Ditching dairy could mean not getting enough bone-building calcium. Skipping vitamin- and fiber-rich fruits and veggies might lead to deficiencies or constipation. And a poor diet over the long term is known to boost the risk of everything from heart disease to cancer. Supplements might help an undernourished child, but they can't fully replace the value of whole foods.
"It's not just nutrition that parents need to be concerned about," says Tamar Kahane, Psy.D., a child psychologist in Englewood, New Jersey, who has developed a program to treat selective eaters. "A child who has a limited diet may feel anxious about eating lunch at school or participating in social activities." Kaden often leaves playdates early to avoid eating with friends' families and once went without food all day on a field trip.
"She's Just Being Difficult"
People tend to assume that pickiness is a child's way of asserting control, but choosy kids aren't simply trying to drive their parents nuts. This behavior runs deep. It's tough to blame nature or nurture because a child's likes and dislikes develop in a complex stew of innate characteristics, environmental factors, individual experiences, and learned behaviors, but heredity certainly does play a role. One large British study of 8- to 11-year-old twins found that the tendency to continue to avoid new foods is about 75 percent genetically determined.
However, some siblings, such as 5-year-old Leo and his 6-year-old brother, Oliver, are total opposites. "Leo started grabbing our food when he was 4 months old, and he likes pesto, guacamole, and salmon," says their mom, Anna Rosenblum Palmer, of Shelburne, Vermont, who is an intrepid eater herself, as is the boys' father. "Oliver didn't show any interest in food as a baby. He now eats only 30 or 40 foods, but if it's not a bread product he won't try it the first 25 times he sees it."
Sometimes, a medical problem can taint a child's early experiences with food. Oliver had gastroesophageal reflux disease (GERD), which can lead to a painfully irritated esophagus. The sensory components of eating are also a common stumbling block -- many children are turned off by the taste, smell, or texture of certain foods. Experts speculate that these kids may have extra taste buds or other sensory receptors that make eating a more intense experience, but the problem isn't well understood. Selective eating can be an early sign of autism, and children with developmental delays may be more likely to have eating issues in general. Certainly, every hard-to-feed kid doesn't have an identifiable problem, but it's important not to dismiss the possibility that there might be something more going on, in case your child needs treatment.
"He'll Eat When He's Hungry"
There's a common notion that parents of picky kids are pushovers and that the solution is to let a child get hungry enough. According to this line of thinking, a child will eventually eat whatever you serve as long as there's no other option on the table. In truth, simply being hungry won't make a kid overcome his fears about eating foods he doesn't like, and his anxiety can make him feel even less hungry, says Nancy Zucker, Ph.D., director of the Duke Eating Disorders Center.
Parents routinely resort to begging or bribing at the table, but forcing your child to take a few bites will be a short-term win at best. "These types of power plays create an adversarial relationship between the two of you and turn the entire process of eating into even more of a negative experience for your child," says Dr. Kahane.
However, that doesn't mean you should give in to your kid's every wish either. If you only serve him his favorite foods, he won't have any incentive to eat anything else. Parents are often pushy one minute and accommodating the next: They might insist that a child clean his plate at lunch but then make him a special meal for dinner if he doesn't like what the family is having. Unfortunately, this just reinforces rigid eating habits. Instead, consider these better ways to slowly but surely help your kid expand his repertoire.
Plan the menu yourself. Instead of asking your child what she wants, serve a range of meals and always include foods you know she'll eat. Pairing fave foods with new foods can help her feel safer trying a new food. Put a spoonful of everything the family is having on her plate. Try to eat as a family so you can model enjoying different dishes.
Make food seem less scary. The best approach is similar to the gradual desensitization that psychologists use with someone who has a phobia of, say, spiders. First, your child can simply look at a food. Over time, you can gently encourage him to smell it, then touch it, and lick it. "When he's ready to bite the food, give him the choice of spitting it into a cup afterward if he doesn't want to swallow it yet," says Tania Stegen-Hanson, OTD, a pediatric occupational therapist and coauthor of Finicky Eaters: What to Do When Kids Won't Eat. "Taking the pressure off makes a tremendous difference." Once he finally tastes a nibble, don't encourage him to eat more. Praise him, and be grateful for the small victory. If you're lucky, he'll eat two nibbles next time.
Serve it, don't push it. This should be your mealtime mantra. Your job is to offer a variety of foods, and your child's job is to make choices for herself. Aim for a neutral attitude whenever you present food; don't tell her how much she'll love it or warn that she might not like it. Also be prepared to try and try again. "Parents typically offer a food a couple of times and if their child doesn't taste it, they stop serving it," says Dr. Kahane. "But it often takes ten to 15 tastes before a child will accept a new food."
More Ways to Help A Picky Eater
Build on your progress. Your goal shouldn't be to immediately move your kid from "junk" food to "healthy" food but to help him feel comfortable eating a wider variety of foods. Dr. Fishbein recommends using the technique called "food chaining," in which you slowly introduce different foods that are similar in taste or texture to ones your child already likes. So if he loves peanut butter, try serving it on crackers, toast, mini bagels, and thin apple slices. "Do it in a nonthreatening way, and offer a lot of positive reinforcement," says Dr. Fishbein. "Most parents report having success within several weeks."
Add, don't replace. If she prefers her pasta buttered, make it that way but also put red sauce on a few noodles in the corner of her plate. Only purple grapes will do? Throw in one green one. Put the other choice there every time, even if it means throwing it out.
Explore, no eating required. Count the types of apples at the store. Plant tomatoes on your patio or compare the scents of fresh herbs. Plan a menu and cook it together. Read about foods of other cultures. Close your eyes and let your kid pick things for you to taste and guess.
Change the presentation. Look for small ways to vary your child's favorite foods. Buy yogurt in tubes, drinks, or cups, and serve it frozen. Buy different brands of whole-grain crackers and pasta shapes. Offer fruits and veggies raw one day, roasted the next. If your child is sensitive to the smell of foods, try serving them at room temperature.
Cut back on snacking. When you're worried about your child's caloric intake, it's common to let him graze all day long. Instead, serve snacks and meals on a consistent schedule so your child knows when to expect the next one, and offer water if he complains of hunger in the meantime. Don't offer any snacks within an hour of mealtimes to preserve his appetite.
Get professional help. Selective eating is an emotional problem that can erode your child's self-esteem, says Dr. Kahane. If her eating habits are causing significant stress for her or for you, that's reason enough to evaluate what's working and what isn't. Especially if the problem seems to be getting worse or if it's preventing her from enjoying and living life, it's important to get help. Ask your pediatrician for a referral to a child psychologist or a medical professional who specializes in feeding disorders. Your best bet is often a clinic with a multidisciplinary team; check with a nearby children's hospital or search online for "feeding-disorders clinic."
Think long-term. Help your child tune in to his own hunger and look at food as something that helps his body do things he likes to do. "We talk to Oliver about how carrots are important for good eyesight so he can see the puck in hockey," says Palmer. It's totally normal to feel frustrated by your kid's stubbornness, but do your best to be patient and low-key. Says Dr. Fishbein, "The time you take to understand your child's problems and address them appropriately will eventually lead to less dinner-table tension for your whole family."
Originally published in the March 2012 issue of Parents magazine.
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