Kids, Food, and Picky Eating

Today’s post is on kids, food, and picky eating. This is largely excerpted from Cribsheet so if you like it, you might like the whole book! I will say at the outset: this is a piece focused largely on what we’d see as standard picky-eating-I-only-want-pasta-and-carbs-and-white-food. I will not focus on eating patterns which truly put kids at risk of undernourishment. That is a problem for a pediatrician and for children who are malnourished, there is a whole other set of guidelines, most of which are more intense and involved, for increasing eating. Here, I’ll really dig into the basic, everyday world of my-kid-wants-nuggets-for-all-meals. Obviously, I wrote most of this before the pandemic. However, I suspect for many of us some of the issues touched on here will seem more salient in the post-pandemic-world. When we had more bandwidth, it may have been easier to encourage our kids to eat squid and vegetables and quinoa. When they objected and threw a tantrum and refused to eat, we had more patience to deal with it. In the same way we may be relying more on screens (what, me?) our diets may have moved a bit more to the pasta-bread-hot dog world. So it may be a time — if you care about this — to think about how to get back. This phrase, “If you care about this” is important here. Getting your kid to not be a picky eater may not be important to everyone. You may care that your child is willing to eat some vegetables, but you may not particularly care if they eat different ones. There is nothing wrong with a child who eats only broccoli and pasta, as long as that works for your family. Going further, you may not care if the child eats only pasta, figuring they’ll get into broccoli when they grow up. You will need to think more carefully, in this case, about how your child will get the necessary vitamins, but otherwise this is not obviously problematic. But let’s imagine that you do care about promoting a particular diet. Usually people try to promote what is seen as “healthy diet” — one with lots of fruit and vegetables. Question: how can you get your kid to eat like this? The good news is that there is plenty of research on this question. The bad news is that a lot of it is not very good. Consider a paper from 2017 that got a lot of media attention. The authors followed 911 children from age nine months to six years and related their early diet to their later diet. They found that children who ate a varied diet at nine months —and in particular those who consume a wide variety of fruits and vegetables— were also more likely to eat a varied diet with vegetables at age six. The researchers concluded that tastes are formed early, and it is therefore important to expose children to a variety of foods early in life. This is certainly one possible explanation for the results. But it is by no means the most likely one. A much more plausible explanation is that the kind of people who feed their children vegetables at age one are also likely to feed them vegetables at age six. This is just a very basic causality problem, and it is difficult to learn anything here. However, we can get some clues about the true underlying relationships from smaller, more indirect studies. Consider the following quite neat example. Researchers recruited a group of moms and randomized them into a “high-carrot” or “low-carrot” diet during pregnancy and lactation. The high-carrot moms were drinking a lot of carrot juice. When their children were ready for rice cereal, the researchers offered them (the babies, not the moms) cereal made with water, or one flavored with carrots. The kids whose moms had eaten more carrots were more likely to prefer the carrot cereal (as evidenced by their consumption and their facial expressions, and presumably also whether they picked up the dish and threw it on the floor). This suggests that flavor exposure—in this case, thorough the placenta and through breast milk—affects whether children are receptive to new flavors. Related to this, once children are starting to eat solid foods, there is randomized evidence that repeated exposure to a food—say, giving kids pears every day for a week—increases their liking of it. This works for fruits, but also for vegetables, even bitter ones. It reinforces the idea that children can get used to different flavors and that they like familiar ones. This shouldn’t be too surprising. People eat differently in different cultures, and we know people continue to express preferences for the foods they ate as a child, even if they move to another location. Putting this together, on one hand, from a global public health perspective, I would be extremely hesitant to conclude that lack of exposure to vegetables at age one was the problem with older children’s diets. The problem was much more likely to be with the foods kid were offered at both ages. On the other hand, from the standpoint of an individual parent, if you want your child to eat a variety of foods, this suggests it is beneficial to expose them—repeatedly—to these flavors. However, even if you eat all kinds of weird stuff while breastfeeding, and carefully expose your child to Brussels sprouts for weeks on end, they may still end up being somewhat picky about their food. Researchers classify this pickiness into two groups: food neophobia (fear of new foods) and picky/fussy eating, in which the child just doesn’t like a lot of different foods. Before getting into these, and how you might fix them (hard), you should know that most kids become more picky around two and then slowly grow out of it in their elementary school years. This is sometimes a surprise to parents—your eighteen-month-old eats like a horse, then all of a sudden around two, they start being very selective and just generally not eating much. I have sat at many a dinner where one of my kids has taken one bite and said, “I’m done!” This change can lead to unrealistic expectations from parents about how much their toddler and young child will eat. As a review article from 2012 notes, “The majority of children between one and five years of age who are brought in by their parents for refusing to eat are healthy and have an appetite that is appropriate for their age and growth rate.” The article goes on to note that the most useful treatment for this problem is parental counseling, not anything to do with the child. Thanks for the judgment, researchers. This suggests that even if your child doesn’t eat that much some of the time, you probably shouldn’t be overly concerned, but it doesn’t answer the question of how you can treat or avoid general pickiness. This is a topic of some research interest. One study I like a lot followed sixty families of kids aged twelve to thirty-six months as they tried introducing a new food. The families videotaped their dinner interactions for a night, so researchers could study what seemed to influence the new food adoption. This study reported what parents actually do rather than what they say they do. This is good, since none of us are especially good at reporting our actual behavior. The primary finding relates to how parents talk about the new food. Kids are more likely to try and eat it with what researchers call “autonomy-supportive prompts”—things like “Try your hot dog” or “Prunes are like big raisins, so you might like them.” In contrast, they are less likely to try things if parents use “coercive-controlling prompts”—things like “If you finish your pasta, you can have ice cream” or “If you won’t eat, I’m taking away your iPad!!” Other studies show that parental pressure to try new foods or to eat in general is associated with more food refusal, not less. The study also shows that food refusals are more common in families where parents offer an alternative. That is, if your kid doesn’t eat broccoli and then you offer him chicken nuggets instead, he may learn that this is always the reward for not eating new foods. This problem is exacerbated by parents’ concern that their child isn’t eating enough (which, see above, is probably not true). Putting this together leads to some general advice: offer your very young child a wide variety of foods, and keep offering them even if the child rejects them at first. As they get a little older, do not freak out if they don’t eat as much as you expect, and keep offering them new and varied foods. If they won’t eat the new foods, don’t replace the foods with something else that they do like or will eat. And don’t use threats or rewards to coerce them to eat. This advice is easy to give but it can be hard to take. It is frustrating to sit at a meal that you know to be delicious with a four-year-old who screams that they hate it and will not eat anything. I don’t have a great solution for this, other than earplugs. I also tried to train Finn to say, “I don’t care for pot roast” rather than “I HATE POT ROAST,” since it at least sounds more polite, even if still combined with pushing the plate away and putting on an angry pouty face. (Parenting: It’s a long game.)

Kids, Food, and Picky Eating

How to deal with it, and how much it matters

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