We all know that feeding kids in a healthful way that takes into account their individual tastes and preferences can be a challenge at any time. But with increased entertaining, celebrating and traveling this time of year, the challenges can mount—especially for a child who is considered "picky" or who has (or is at risk for) a feeding disorder. Of course being out of a normal eating routine and being exposed to unfamiliar foods can turn an otherwise joyful holiday party or family gathering into a battleground. To prevent this, it's up to parents to find ways to help kids stay on track when it comes to eating so that they—and the entire family—can get the most joy out of the holiday season.
To help parents move in a better direction when it comes to feeding their kids this time of year—or at any time—I interviewed Peter A. Girolami, PhD, Clinical Director of the Pediatric Feeding Disorders Program at Kennedy Krieger Institute. Below are some highlights from our conversation.
EZ: What is the difference between a picky eater and a child with a feeding disorder? Are there any red flags parents need to look for?
PG: Many young children demonstrate eating behavior that can be considered "picky" including distinct food type or texture preferences and episodes of limited intake. Although for many children this is a perfectly normal phase of development, sometimes being picky develops into a more serious feeding problem (or disorder). In general, a child has a feeding disorder when he/she has significant difficulty consuming adequate nutrition by mouth. Feeding disorders are caused by a variety of factors including medical, developmental, psychosocial and environmental factors and they often leading to problematic feeding/eating behaviors. Feeding problems can contribute to poor weight gain, malnutrition and abnormal development when it comes to feeding skills. It can also cause a lot of disruption, especially during mealtimes, for the family.
EZ: Now that the holidays are here, parents of picky eaters may feel extra pressure when feeding their children with relatives and friends around. Should parents surrender to the situation and accept that all bets are off or should they still try to help their kids have better and more nutritious eating habits?
PG: Great question. Parents often report that they feel some pressure during the holidays and/or special events to get their kids to eat a well-balanced meal. I can relate. I come from a family where eating is one of the main activities of the holiday and for the most part we (the adults) probably eat too much. However, as both a parent and practitioner, I do not recommend using holiday dinners or special events as the setting to initiate the trying of new foods/textures or increase consumption. First, if you are having trouble with your child's picky eating and it's become a battle, it may be increasingly difficult to implement any plan with all the relatives sitting around the table adding their two cents and encouragement. If you have been using some strategies successfully and want to generalize them to the group gathering, that's great. But I'd suggest having an "exit" plan so that the holiday meal doesn't become all about children not eating their food.
EZ: You suggest offering kids who are picky/selective small portions. I, too, think this is a good rule of thumb for all kids, whether they're picky or not. Why do you think offering small portions is so important for kids?
PG: I once worked with a child who was reported to be very anxious about trying new foods so we prepared such a small bite of food that I was worried it would blow away. Eventually, we were able to increase the size of the bites of food and gradually introduce new foods using smaller bite sizes.
EZ: You also say decreasing texture and blending food can help. How so?
PG: Sometimes referred to as "sneaking food in," blending and mixing non-preferred foods into preferred foods can be an effective way to expose a child to new tastes and smell and open up the variety. Similar to the idea of smaller portions, start with small amounts that may not be detectable and gradually increase the ratio. This can also be applied to condiments. You may not get to 100% of the target food, but consumption of the target food(s) in smaller amounts may be enough to lay the foundation for future gains.
EZ: You're not a big fan of grazing, which is something so many kids—and parents—do. Why don't you recommend it for kids?
PG: I think it's important to limit grazing. It's difficult to get someone (including typical eaters) to try something new if they aren't hungry, especially if you're asking them to try something they report they don't like. In some more serious feeding situations, this may be difficult to apply because parents may feel that the only way to get in enough calories is to offer food/drink throughout the day. However, trying to set scheduled meals and limiting food in between is a strategy that could at least be tried (if it doesn't work, you can always go back to the old system) since it may contribute to hunger and encourage the child to eat the food that's offered.
EZ: You also recommend making kids part of the feeding process. What are your tips parents can use to do this?
PG: I'm a firm believer in modeling, sharing, and involving kids in eating and feeding as much as possible. There's something to be said about trying to set a good example for your child. If you're not eating the targeted foods, there's a good chance the child's exposure to the food may be more limited. Sometimes getting kids involved in the preparation of the food and cooking may also be associated with increased interest and squeezing in an extra bite or two.
EZ: Although many nutrition experts (present company included) have always urged parents to not use food as a reward, you encourage them to. Please explain.
PG: Some people are against providing some incentive to children to encourage them to try new foods/textures because they feel that children should intrinsically like food so they don't provide reinforcement for eating. However, many children have increased their variety by systematically being given access to something preferred contingent on trying something novel. If you think the issue is "you'll never know unless you try it" and exposure to new tastes and textures is important, then using a reward-based system to get them to try something new may be worth a shot. Keep in mind that for many children reinforcement can be faded out over time.
EZ: You encourage parents to be calm and patient when feeding kids—and I think that's great advice as it keeps mealtimes more pleasant and enjoyable. You also think it's important to have a plan and stick to it. Why is that so vital?
PG: It's important for kids to have some predictability, especially if trying new foods seem to be distressing to them. I encourage parents to try to avoid excessive coaxing, wheeling-dealing, and verbal battles. Typically, these strategies don't work and may make things worse. Getting kids to try new foods can be a long process. If parents do see some gains, they can then try to think about where they could be down the road if some of that progress continues on its current trajectory.
EZ: Finally, what should parents do if they suspect their child has a feeding disorder? Can you recommend any resources?
PG: Feeding problems are a source of great stress for parents because of the potential negative impact they may have on their child. Also, parents whose children have more severe problems often find it hard to relate or connect with other parents whose children's issues are more of the traditionally "picky" variety. Parents of children with severe feeding problems often report that they are given advice from "everyone under the sun" and provided with suggestions that they've already tried. Parents who have tried all kinds of strategies and have had limited success, or see that things have gotten worse, may need some extra specialized help with your problem, such as the Pediatric Feeding Disorders Program at the Kennedy Krieger Institute. An evaluation may be a good first start to determine if your child's problem meets the criteria of a feeding disorder. Generally, I would recommend finding a feeding clinic/program that encompasses a full team of professionals to rule out the variety of factors that may be associated with the onset and maintenance of the feeding problems. You also want to make sure that the feeding clinic/program has experience with the problems you're reporting and can discuss various outcomes—aka "success stories"—they've had with similar children.
Image of Multi Generation Family Celebrating With Christmas Meal via shutterstock.