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Encouraging a healthier diet for your picky eater

By Marlene Cimons For the Washington Post

Megan Pesch has three daughters – ages 2, 3 and 5, all of them fussy about their food.

“They want chicken nuggets. They want hot dogs. They want mac and cheese and sweets too, of course,” she says. “It drives me nuts.”

As a pediatrician who also studies childhood picky eating, she finds this especially frustrating, if not somewhat ironic.

“I look at their diet, then think about my (professional) role … and I cringe,” says Pesch, a developmental and behavioral pediatrician at the University of Michigan’s C.S. Mott Children’s Hospital. “But I wonder what else could I have done? I felt like I did everything right. I introduced vegetables at the right time. I was very careful about the food I brought into the house. Yet, here we are.”

Pesch isn’t alone. She and many other parents frequently contend with children who stubbornly refuse to try new foods or shy away from healthy vegetables and fruits in favor of high fat, salt and sugar-laden choices – and constantly feel tense and anxious about it.

While some children are picky to the extreme, it is, for many, a developmentally normal phase and one, as pediatricians often say, they eventually will outgrow. Studies indicate that picky eating ranges from 14% to 50% in preschool children and from 7% to 27% in older children.

Pesch thinks many parents worry unnecessarily about their children’s eating behaviors and urges them to be patient. She says her daughters actually illustrate one of her theories about picky eating, which is that some children might have an inherent “picky eating temperament,” much as being a natural extravert or introvert, or having a sense of humor, or not. Regardless, “I try not to stress about it. They are growing beautifully, and all have healthy BMIs,” she says, referring to body mass index.

If parents think they must do something, there are actions they can take to encourage their children to try new foods, including healthier ones.

First, be sure kids are hungry at mealtime, which means skipping midafternoon snacks. Continue to offer new foods even if the child rejects them. Involve kids in food preparation, from shopping (albeit easier in pre-pandemic days) to growing their own vegetables in a family garden. Let them help wash and cut them – if it’s age-appropriate and safe – and let them stir the pot when the vegetables cook or have them tap in the numbers on the microwave screen.

“All this increases their positive emotional relationship to these foods so they seem less averse and more familiar,” Pesch says. “Anything that gets them to take ownership is great.”

Pesch’s research has found that not all picky eaters leave this behavior behind as they grow older, although most remain healthy and are of normal weight, she says. With childhood and adult obesity reaching alarming levels in this country, picky eating might be protective against an unhealthy BMI and excessive weight gain, she says.

“While some research suggests that kids may be low in some nutrients as a result of picky eating, overall most of them do just fine – they aren’t underweight or suffering from reduced growth or any serious negative health consequences,” she says.

Nevertheless, “We need more research to better understand how children’s limited food choices impact healthy weight gain and growth long term.”

Some picky-eater children become picky-eater adults, but usually without ill health effects, experts say.

“When I talk with adult picky eaters, they are not unhappy,” says Katherine Dahlsgaard, a clinical psychologist who directs the food allergy clinic at Children’s Hospital of Philadelphia. “They have found a way to live and travel and go to restaurants and find something they would like to eat. This is not the case, however, for all teenagers and adults who are extremely picky eaters.”

Dahlsgaard, however, points out that there is a significant difference between typical picky eaters who might be going through a phase and “extremely” picky eaters whose behavior seriously impairs their lives.

Extremely picky eaters eat only a narrow range of foods and often find foods with layers and textures – lasagna, for example – “disgusting and repulsive,” she says. They have trouble eating in restaurants, traveling and going to social events, she says. Some can suffer from malnutrition.

This disorder has a name: Avoidant Restrictive Food Intake Disorder.

The actual prevalence of ARFID is still under study, but some research suggests it might affect at least 5% of children.

“It’s extremely hard for parents of these kids to get them to accept new foods without professional intervention,” Dahlsgaard says.

“They are extremely resistant and inflexible and have been throughout childhood and are unmotivated to change.”

Children with ARFID are different from typical picky eaters, she says. It is evident in early childhood and persists.

“When I interview a parent of a 12-year-old who only eats two meats, no vegetables and one yogurt drink, and I ask how he was when he was younger, she tells me that the level of stress was so high – and would last for so long – she didn’t know what to do,” Dahlsgaard says.

Most parents of these kids try all the recommendations for typical picky eaters. “But they already have a kid on hand who is so far worse than typical,” Dahlsgaard says. “Those techniques don’t work, and they feel very guilty about it.”

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