Beyond Digestion

Just Two More Bites!: Helping Picky Eaters Say Yes to Food
by Linda Piette, MS, RD,

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Physiological conditions that can affect a child's eating are

• Prematurity
• Allergies
• Cerebral palsy
• Chronic infections
• Cystic fibrosis
• Congenital heart disease

See chapter 12, "Feeding a Child with Special Needs," for details.

Personality and Life Experience

In one study, parents of picky eaters cited personality traits that are common among difficult-to-feed children. Again and again, different parents used the same words: "stubborn," "moody," "socially intense," and "easily distracted."

Such common personality traits among difficult-to-feed children suggest that some are born to be fussy eaters. Of course, this knowledge doesn't help parents deal with day-to-day issues. In this study, learning techniques for handling food refusals eased the problem. (For examples of these techniques, read chapter 10, "Mealtime Do's and Don'ts." There's no doubt that biology influences a child's personality. From an academic perspective, the problem is pinpointing where this influence begins and ends.

Generally, researchers point to how life experiences affect eating. These experiences begin at birth. Miraculous, life-saving experiences for newborns and young children are more common than ever. But there is a downside. Medical interventions around the mouth (ventilators, tracheotomies, or nasogastric tubes) can cause discomfort that leads to kids rejecting food or anything that comes into or near the mouth. Professionals call this avoidance behavior. To help children overcome food refusals, therapists often use techniques based on theories of sensory integration dysfunction. For more information on how sensory integration affects eating, see chapter 8, "Food Textures and Flavors."

Family, Friends, and Peers

Defying a long-standing family tradition, five-year-old Song Woo turns up her nose at rice every day. Despite generations of rice-eating ancestors and years of bribes and threats, Song's refusal to eat rice is still going strong. She prefers pizza and spaghetti.

Song's family can't understand why she refuses rice when everyone else in her house eats it daily. Her grandmother won't give up. She uses various tactics to entice Song. Most of the time, her grandmother employs a simple bribe: "If you eat your rice, I will buy you a toy."

Song Woo's grandmother is not alone. Countless caregivers use games, tricks, and bribes to help a child eat, and in the short term they often work. But those well-intentioned bribes and cute games have unintentional consequences: over time, these kids tend to turn away from the food again. Song Woo's grandmother may convince her granddaughter to eat rice in order to get a new toy, but in the long run it increases the odds that Song will like toys and dislike rice.

For young children, eating is never solely about food or nourishment. Meals are a setting for social and physical development. Children learn whether eating is pleasant or unpleasant, which foods to like or dislike, and the consequences of eating or not eating. Sometimes adults teach these lessons without knowing it.

If a father consistently ignores his baby's signals for "no more" and persists in prying extra spoonfuls of peas through his pursed lips, the baby learns that eating is no fun. He associates tension and discomfort with eating peas, and possibly eating in general.

If a toddler refuses waffles and his mom offers cereal, or if when he refuses peas his mom offers carrots, a pattern emerges. Soon a toddler learns that if he refuses one food he will get another.

A preschooler realizes that if she doesn't finish her pancakes, her mother becomes upset. This makes it harder for her to recognize whether she should eat the pancakes because she is hungry or to please her mother.

Even before they begin to talk, young children learn by watching and listening, and are amazingly aware of the social rules and expectations surrounding food. Most two-years-olds recognize cake as a party food and know that desserts are eaten after vegetables. They know which foods are popular in the family and learn the consequences of eating or refusing foods.

Because children learn about food by mimicking others, role models are important. Young children often act as mirrors, reflecting back what they see or don't see. When parents want to make meals better, watching what a child reflects back is a good place to begin.

One mother, Lisa, came to see me when her fourteen-month-old son, Gregory, was not attempting to feed himself like other children his age. From talking to her friends, she knew that other children Gregory's age behaved differently at meals; they were at least trying to eat by themselves. Gregory's play skills were typical for his age, suggesting he had the motor skills he needed to feed himself. Yet when Lisa described Gregory's meals, it seemed that Gregory rarely watched anyone else eat.

Copyright © 2006 by Linda Piette.

About the Author

Linda Piette, MS, RD, is a pediatric nutritionist and registered dietitian with twenty-five years of experience. You can find out more about her at lindapiette.net.