Toddlers are full of life and yet somehow they suck at eating: they flip out over former favorites, they don't want to eat when you do, and sometimes they even think their plate is a hat for the dog.
Totally normal. And yet. Yet. Feeding children can feel fraught. If you've ever wondered, Is my kid eating enough? How picky is TOO picky? How do I get maple syrup out of the dog's ears? this is for you.
Even a normally badass mama can feel a little alone, struggling through another dinnertime, wondering if her kid is truly the pickiest toddler of all time. What's normal and what's not?
We called the experts to discuss. Dr. Uma Pisharody, pediatric gastroenterologist at Swedish Medical Group in Seattle, is a doctor who sees many picky eaters in her work at the Pediatric Growth and Integrated Nutrition Service (GAINS) clinic.
Her job frequently demands that she judge whether a child has a medical issue or is simply your run-of-the-mill picky eater. While the former requires professional intervention, she also offers a few tips for parents of the latter.
When Pickiness Is Actually a Problem
Dr. Pisharody's first red flag for concern comes with the age of the child. Most of the kids referred to the GAINS clinic are between 2 and 3 years old, but when she sees kids under a year, she is automatically concerned.
"Most of the organic or anatomical medical issues [inhibiting eating] are likely there from birth," she explains. "So they'll have an aversion to eating from the get-go."
In other words, if a child's body lacks musculature or doesn't work properly, there will be no honeymoon phase where the eating is easy. It will be tough from day one, so you probably already know something's up.
Food allergies also usually manifest early: If a kid simply won't drink milk, for example, Pisharody looks for allergy-related symptoms such as eczema and asthma.
Major eating issues and food allergies should always prompt a parent to involve the experts — their child's pediatrician, and allergists and nutritionists when appropriate. We asked Pisharody how to know when to do this — what are some signs of an actual medical problem?
Assuming the child begins as a good eater, one of the main things that leads Pisharody to recommend treatment for a picky eater is the most obvious: "If these kids aren't growing properly, if they're not gaining weight, maybe there's an underlying medical issue causing this change in behavior."
She looks for gastrointestinal symptoms like bellyaches, bloating, constipation, or diarrhea. To identify potential developmental delays, she looks for neurological problems such as poor muscle tone, abnormal head shape, or lack of neck control.
Finally, she says, it's important to tease out if the picky eating is a sign of another social issue, such as autism. For that, she looks at regression of milestones — speech delay, repetitive movements, horrible emotional outbursts, and lots of stranger anxiety — signs that the picky eating habit could indicate "something bigger." Do they walk and talk appropriately for their age? Do they drool, hide food in their mouths to spit out later, or avoid eye contact? How do they interact with their food? Kids who don't like having anything slimy or sticky on their face concern her — it means they may have a texture problem or sensory aversion. "Most children love to make messes."
Bad news for the cleanup crew means good news, health-wise.
How to Deal with Good Old-Fashioned Pickiness
But absent these signs and any medical concerns from your pediatrician, Pisharody says that picky eating, in and of itself, is not something that should cause concern. "If they're meeting all their developmental milestones, and their growth is perfect, and they have no other symptoms of disease," she says not to fret.
"If they used to eat everything and now they have seven foods they like and won't eat anything else, I'm not really worried about that child."
Furthermore, she says to stop freaking out about what those seven foods are: "Worrying is only going to make things worse." She reminds parents that the child is likely in a phase, and if they can just leave the emotions aside, the kid should grow out of it soon.
But she knows leaving emotions out of toddler dinnertime is a bit like leaving the cheddar (or Velveeta!?) out of the mac and cheese, so she offers a few tips on how to deal with the picky kid.
1. Put the kid in charge.
Her first tip for parents of picky eaters is to divide up responsibility. "You're in charge of when the child eats and for how long. And that's it." Then the kid gets to decide whether they eat, how much they eat, and what they eat.
Parents plan mealtimes, get everyone seated at the table, offer an array of food (including, she recommends, at least one or two things the child usually eats), and remove any distractions. Then the kid gets to decide from there, until the end of mealtime, 30 to 45 minutes later.
In between mealtimes and snack times, they get only water — no nibbles, nothing else. But come mealtime, the kid is in control; the parent doesn't care what happens at the table.
2. Make food fun!
Her other recommendation is more typically popular: "Make the food colorful and fun. Cut the cheese into dinosaurs, use a rainbow of fruit." Make it look appealing, but, she cautions, lay off the pressure. No rewards, no punishments. "There should be nothing attributed to whether or not the child ate," she says.
Any parent who has ever sat through a meal while their toddler turned her nose up at anything from chicken nuggets to homemade lasagna will likely need a few acting classes to pretend they don't care about whether or not their kid digs in, but that's one of Pisharody's main recommendations.
And listening to her final comment, her advice seems sound and sage: "There's nothing to be gained by trying to win a fight with a toddler over food. It's always going to backfire." And that's something we can all agree on — even the dog.
How have you dealt with anxiety or concerns over how much your toddler is eating? Have you seen picky toddlers grow into good eaters over time? Tell us all about it!