The picky eater guide: Part 3. The Rule

The Pediatric Insider

© 2012 Roy Benaroch, MD

As we’ve seen, the problem isn’t the picky eating, per se. Kids are getting enough calories, and they’re certainly growing big enough. Even the skinniest kids in today’s world are far healthier and have far better nutrition than most of the kids from previous generations. And I certainly haven’t seen health problems in the slender kids in my practice. What I see very commonly, though, are health problems from overweight: diabetes, high blood pressure, depression, and social isolation.

So, no matter what else, the first principle of healthy family eating should be to help foster a child’s own normal sense of appetite and hunger. This is The Rule of mealtimes. It’s The Truth, and The One Ring to rule them all:

• If you’re hungry, eat.
• If you’re not hungry, don’t eat.

(OK, so it’s two rules. Close enough.)

Humans have a built-in mechanism to control food intake, and it works well at every age. It’s called “hunger.” Often, though, we unintentionally raise our kids in ways that teach them to ignore their appetite cues and eat for all sorts of other reasons.

Think about it. In American culture we don’t just eat when we’re hungry. We eat to celebrate. We eat when we watch a movie, we eat when we’re on the phone. We eat when we’re upset, and we eat when we’re bored. We eat when we’re happy and we eat when we’re sad. Often, we eat because others encourage us to eat. Family and friends ply us with food, and mom loads up our plate. We also have to contend with an ever-present marketing effort to get us to eat even more. Most two-year-olds already recognize “The Golden Arches”, and TV and computer banner ads are a near-constant barrage encouraging us to eat. And eat. And eat.

In a way, I’m surprised obesity isn’t more common.

Let’s not make matters worse. From a very early age, encourage your children to manage their own appetite. This means that a nine-month-old who becomes less interested in nursing should be allowed to wean. And a two-year-old who wants to explore instead of cleaning his plate should be allowed to leave the table. When a child doesn’t have an appetite to eat more, do not try to trick or fool or guilt or otherwise “get him” to continue eating. Lacking hunger means the child has eaten enough. Meals shouldn’t end when mom or dad thinks Junior has had enough; meals should end when Junior thinks he’s had enough.

In fact, from The Rule flows two other rules which guide the roles of children and parents at mealtimes:

• Parents should offer healthful foods in an appropriate manner.
• Children decide which foods to eat, and how much to eat.

Simple! Or at least simple to say, and simple to understand. That doesn’t necessarily mean it’s always easy to do!

Next up: more about the job that parents and kids have at mealtimes.

 

The picky eater guide: The whole enchilada:

Part 1. What’s the problem?

Part 2. The “Don’ts”

Part 3. The Rule

Part 4. The jobs of parents and kids

Part 5. Special circumstances, vitamins, and a muffin bonus

The picky eater guide: Part 2. The “Don’ts”

The Pediatric Insider

© 2012 Roy Benaroch, MD

Last post, the Picky Eater Guide started with some history and perspective. The bottom line: there is a huge nutritional problem in the developed world, and it’s causing huge health problems. But it’s not that kids don’t eat their veggies, or that kids don’t eat what their parents want them to eat. It’s that kids, and adults, eat too much. Unfortunately, some things parents do to try to get their kids to “eat healthy” might in the long run be contributing to the warped sense of appetite that seems to be a major cause of the obesity epidemic. This post is about what parents shouldn’t do—the “don’t” list of things that in the long run may end up doing far more harm than good. Got a picky eater? Let’s not make things worse by creating a picky eater with a weight problem.

Do not make food contingencies. That means, don’t make the availability of one food depend on whether another food is eaten first. Think about this common scene:

Mom: “Boscoe, if you eat your broccoli, you can have a brownie.”

Boscoe eats the broccoli, then eats the brownie.

What mom thinks: Good! I got him to eat the broccoli!

What Boscoe thinks: Wow, a brownie must be extra special—it’s a reward food! And broccoli must be some kind of horror. After all, I got a brownie for eating that dreck. I’ll keep in mind that no one in their right mind would voluntarily eat broccoli. I wonder if I can make some kind of deal to get more brownies?

So, net, after this scene, Boscoe did in fact eat some broccoli. But the cost of this was to reinforce how special and wonderful brownies are, and to encourage him to continue to crave them—while at the same time teaching Boscoe how nasty and unloved broccoli must be.

Remember: the point of a meal isn’t to get a serving of broccoli inside a child. (If that were the case, we could just sedate the kids and feed them through tubes.) The point is to 1) enjoy the meal as a family and 2) help reinforce healthy social and eating habits to last a lifetime.

Another big don’t: don’t force feed anything. You’ll create food aversions and a warped sense of anxiety and power struggles at meal time. If you’re forcing anything, you’re causing problems. Stop it. You also shouldn’t distract and fool children into eating, by, say, leaving a television on while you shovel the food in. Junior might continue to eat (kind of like a little bird, just opening up that mouth), but that’s not a way to teach children how to choose foods and modulate their own food intake. It’s also, well, creepy.

Next: how to reinforce The Rule, a Universal Truth and simple philosophy that should be the guiding principle of mealtime. When you’re hungry, eat. When you’re not hungry, don’t eat.

 

The picky eater guide: The whole enchilada:

Part 1. What’s the problem?

Part 2. The “Don’ts”

Part 3. The Rule

Part 4. The jobs of parents and kids

Part 5. Special circumstances, vitamins, and a muffin bonus

The Anti-Clean-Plate Club

A study published in the October, 2008 issue of Archives of Pediatric and Adolescent Medicine reinforces two important principles that can encourage healthy eating habits in preschoolers.

The researchers studied 63 children, offering them as much cereal as they wanted in two different-sized bowls. They had also asked if each child’s mother had been asking them to clean their plates. They found that children asked for much more cereal if it were served in a bigger bowl, and also asked for more cereal if they were from households where mom encouraged them to clean their plate.

Baby disinterested at mealtimes

“My daughter who is one does not seem interested in feeding herself. Whenever I sit down and eat with her – I try to guide her fingers into her mouth while she is holding a piece of food. She starts crying hysterically. After 30 min of sitting there and playing with her food, I end up feeding her jarred baby food. She has even gone as far as handing the finger foods back to me and then opening her mouth to show me that she wants me to put it in her mouth. The same goes for sippy cup vs. bottle.”

You’ve got some ingrained habits that may not be quickly fixable, but I’ll answer the question in a general way that should help you and other families. You should talk with your pediatrician for more specific advice, and consider asking for a referral to a “feeding center” which works with children to establish better eating and feeding routines. I don’t know if your child is unable to feed herself, or unwilling. You didn’t mention any sort of motor delay or oral-motor problem, so I suspect it is more a matter of habit. However, you two are certainly locked in a battle of wills at this point, and you may need more hands-on expertise to work your way out of it.

Pregnancy: Foods to avoid, foods to enjoy

A study published in January, 2008 confirmed a strong link between a common item in many women’s diets and miscarriage. This inspired me to do some research outside of my usual field. I’m a pediatrician, not an obstetrician– but as they say, “An ounce of prevention is worth a pound of cure.” Since pregnant women are said to be eating for two, I figured we might just be able to get the equivalent of two pounds of cure out of a few simple dietary steps. Along the way, I also found some intriguing studies with new information about what pregnant women should eat more of—and the news is good. Eating more of your favorite foods might really be able to help your unborn baby.