Until about two years ago, 9-year-old Tyler Blatzheim's diet consisted mostly of milk, applesauce, crustless PB&J, and crackers. "His pediatrician kept telling me not to worry because Tyler was otherwise healthy -- even his weight and height were fine," recalls his mom, Jocelyn, of Gambrills, Maryland. "The doctor said he would grow out of being picky." But that didn't happen. By the time he turned 7, his pickiness escalated to the point where he started gagging when he tried a new food, even if it was a chocolate chip or a bite of mac 'n' cheese. Birthday parties and family get-togethers were nerve-racking. "He wouldn't eat the pizza or even the treats at his friends' parties," she says. "When we'd go for ice cream as a family, he would just ask for a cup of sprinkles."
With Tyler's eating habits only getting worse, Blatzheim researched options and ran across an outpatient program at Kennedy Krieger Institute, in Baltimore. "We see a wide range of kids -- from those who don't like vegetables to other kids who have never eaten solid food at all," says program director Peter A. Girolami, Ph.D. Some have autism, digestive troubles, or food allergies. But other kids are like Tyler -- ones without an underlying medical condition whose fussy eating habits are getting in the way of family life.
"Tyler would have to leave the table and go in another room to put a new food in his mouth," says Blatzheim. "He would get anxious and the whole process would take up almost the entire dinnertime." Some of the foods Tyler now enjoys in kid-size portions include meatballs, chicken, and cheese quesadillas. "We can give him a decent dinner instead of crackers and an applesauce cup," says Blatzheim. See what helps kids who are reluctant to try new foods:
Start very small. Sure, you're not giving your kid a giant bowl of peas. But Keith E. Williams, Ph.D., director of the feeding program at Penn State Hershey Medical Center, in Pennsylvania, says many parents offer a portion that's way too large. "We usually begin with pieces so small that they could literally be blown away," he says. At home, try a single pea, part of a noodle, or a crumble of cheese. Encourage your child by saying something like, "This is easy -- you could be done in a second." Once your child eats it, give him a food he does like. Then, at subsequent meals, increase the portion of the new food and phase out the follow-up food.
Dr. Williams's strategy worked for 4-year-old Gavin Lipp, of Hellertown, Pennsylvania, who would only eat pretzels, potato chips, applesauce, and a handful of other foods before he began appointments at Hershey. "We gave him a sliver of apple and immediately afterward, he got a few pretzels," explains his mom, Eilidh. "Every day we increased the amount of apple and decreased the amount of pretzels." In the six weeks since Gavin started, he has tried 13 new fruits and veggies and has even found several that he likes a lot. "Now he asks me for strawberries and blueberries," she says. "There's light at the end of the tunnel."
Stick with it. You've probably heard it before: A child has to try something ten to 15 times before he likes it. "While that sounds daunting to many parents who have a hard time getting their kids to try something once, it does get easier," says Dr. Williams. His research shows that once you get the ball rolling on tasting new foods, it takes on average only six attempts for kids to accept them. "Still, a lot of parents don't want to introduce new foods at lunch or dinner because it may ruin the meal for the whole family," he says. "Instead, offer them during snacktime."
Scale back on snacks and drinks. Before the appointment, most feeding clinics ask parents to record what their child has eaten and drunk for at least the last three days. "When we look at these records, we see that a lot of kids who resist new foods eat snack foods or drink all day long, which limits their hunger for foods at meals," says Nancy Entgelmeier, a pediatric nurse practitioner in the feeding clinic at Children's Hospitals and Clinics of Minnesota in Minneapolis. Once families cut back to three meals and one to three snacks at relatively consistent times, Entgelmeier says they find that their kids are more receptive to trying something new because they're truly hungry." Ditto for drinks: "We saw one toddler who consumed 60 ounces of milk and 12 ounces of juice every day," she says. "Because he filled up on liquids, he didn't want to eat anything."
Invite an adventurous friend. While feeding-clinic sessions generally take place one-on-one, Dr. Williams says that at home you can harness the power of peers. "You and your spouse do influence what your child tries, but no one can make a bigger difference than his friends," says Dr. Williams. A study by a Penn State colleague, Helen Hendy, Ph.D., found that preschoolers were more likely to taste mango when they saw a classmate do it. "Sometimes all it takes is for a friend to snatch a piece of broccoli for your kid to want to nibble on it," he says. Of course, one taste probably won't make him a broccoli fan, but it will help him get over the hump of trying it, which is half the battle.
If your child is okay with trying foods but never seems to like any of them even after multiple attempts, he may experience flavors or textures more acutely. These suggestions work especially well for children with sensory problems although all picky eaters may benefit from trying them.
Keep your cool. Some food avoiders relish the attention that it brings them. "We had one patient who told his mom that he wanted to try a bagel," recalls Dr. Girolami. "She sent her husband out for bagels and played with her son the whole time they waited. When Dad came home with every flavor of bagel the bakery sold, their son wasn't interested in eating anything despite lots of coaxing." The message: Don't necessarily make a huge deal when your child wants to try something -- the more casual you are about it (offer him a piece, but don't watch him eat it for instance), the more likely it is that he'll actually follow through, says Dr. Girolami.
Record progress. At some feeding clinics, the staff takes pictures or video of accomplishments for parents to show their child at home as a reminder that he or she liked a new food. "We encourage parents to casually say something like, 'Oh, look at the day you tried baby carrots at the clinic and thought they were okay. We're having carrots and dip for snack,' " says Kerry Glidewell, a pediatric speech language pathologist in the Little Bites Feeding Program at Wolfson Children's Hospital, in Jacksonville, Florida.
Go slow and steady. You may think it's ridiculous to puree foods for your 5-year-old. But that's exactly what they sometimes do at feeding clinics. "We might try reducing the texture to a smooth consistency, which makes it easier for the child to consume a new flavor," says Dr. Girolami. "As the sessions go by, we make the puree chunkier and chunkier until a couple of months later, she's able to eat the actual foods." The experts work on color preferences in the same way: "We have mixed mashed sweet potatoes and mashed white potatoes together," he says. "At first, it's 95 percent white and kids can't detect a difference. But as the weeks go by, the color starts to change. When it begins to look orange, they generally don't freak out because the progress has been so gradual." If your child doesn't like potatoes, you can try this at home with other foods, like plain yogurt (stir in a small bit of fruit sauce or jam) or pancakes (add pureed fruit or veggies to the batter).
Focus on flavor. Not all picky eaters want bland food. Some seek flavor and/or crunch, says Nicole Lidyard, R.D., a clinical dietitian at UH Rainbow Babies & Children's Hospital, in Cleveland. "One mom told me that her son licked her Buffalo chicken wing and he loved it," says Lidyard. If your child prefers sweetness, glaze carrots with a little honey or ketchup (try Simply Heinz Ketchup, which is made with cane sugar instead of high-fructose corn syrup). If he likes spice, season crab cakes or chicken with chili powder.
Build on success. Some feeding clinics follow a strategy called food chaining, fading, or graduated exposure, using a food that the child prefers to get her to try something similar. For instance, if your kid is obsessed with chicken nuggets, it's likely going to be harder to introduce shrimp than another kind of chicken. "We might go from chicken nuggets to the same kind of nuggets with less breading, or a different brand of chicken nugget or chicken strip, to pieces of a grilled chicken breast," says Entgelmeier. "And then we'll move on to chicken with noodles or rice." If you've got a pizza fan, you might progress from pizza to pasta with tomato sauce and cheese, to grilled cheese with tomato soup, to a cheese quesadilla with salsa. You can also select foods based on shape or texture (crispy french fries to sweet-potato fries, chicken sticks to fish sticks) or color (plain pancakes or waffles to waffles with jelly or peanut butter to PB&J). "Don't rush from one food or texture to the next," says Dr. Girolami. "Give it at least a week or two until the gains seem maintained. A few months from now, you'll be rewarded with a healthier eater."
Perhaps the typical picky eater isn't as picky as you thought. Write down all the foods your child eats; closely related ones, like string cheese and American cheese, count separately. Disordered or extreme picky eaters accept only 20 or fewer foods and are often sensitive to texture, temperature, or color, explains Nicole Lidyard, R.D. If your child really only eats 20 or fewer foods, ask her doctor to refer you to a local dietitian or feeding program.