I was asked the other day, “How do I get my 5-year-old to eat more than the five foods she eats?” Can you relate to this? Is your child a picky eater? Do you struggle with getting him to eat his vegetables? Do you worry she is not eating enough?

If so, you are not alone. As a dietitian for the Arnold Palmer Hospital Feeding Difficulty Center, I speak to many parents of young children who have these concerns. In fact, there are many eating behaviors that are common amongst children, but cause parents to worry.

Establishing healthy eating behaviors

Toddlers and preschool children tend to be afraid of new foods, which can lead to their picky behaviors. Research has shown us that it can take as many as 20 or more presentations of a food before a child willingly accepts it. Children should be allowed to explore food when it is new to them. A child who touches a new food in one presentation, may put it into his mouth to taste it the next time, and after a few more presentations will swallow it. Of course this is messy, but messiness at mealtime is something to accept as your child learns how to eat new foods.

Don’t forget the importance of demonstrating eating fruits and vegetables! Children imitate those they love, and if they see you enjoying vegetables, they will be more willing to give them a try. A note about those vegetables you want your child to eat: research has shown that giving a reward for eating a particular food (i.e. giving dessert for eating broccoli) causes children to like that food less.

The most common concern I hear is “Is my child eating enough?” Most of the time, the answer is “yes.” Serving sizes for children are much smaller than adult serving sizes, so it is easy for us to expect a child to eat more than is reasonable for their age. A good “rule of thumb” to remember is that a serving of any given food is about one tablespoon per year of age. Following this rule, a serving of vegetable for a 4-year-old child, is four tablespoons, which is equal to ¼ cup or two ounces. Children naturally regulate their appetite by eating when they are hungry and stopping when they are full. Pushing children to finish the food on their plate teaches them to eat after they are full and can result in too much weight gain.

Here are some principles of normal healthy eating I teach all the families I see in the Feeding Difficulty Center:

  • Meals and snacks should be on a regular schedule, take place at a table or high-chair, and be no longer than 20-30 minutes.
  • Offer at least one preferred food at a meal or snack. For example, if your child likes bread, serve this with each meal to ensure there is something on the table your child is willing to eat.
  • If your child does not eat what is offered, allow him/her to be done after sitting with the family for 20-30 minutes, but do not give foods that were not part of the offered meal or snack.  Becoming a “short-order cook” only encourages children to continue their picky behaviors.
  • If there has been concern that your child isn’t growing well, consider offering a larger variety of foods at meals (i.e. two or three fruit options). More variety helps increase intake.
  • Offer a beverage (milk, juice, water) with all meals and snacks.
  • Do not offer any food between scheduled meal and snack times.  Don’t give in to grazing – let your child know there will be another meal or snack in an hour or two.
  • Give water between meals and snacks not milk or juice or any other beverages with calories.
  • Parent/caregiver determines what is offered, where it is offered, and when.  Your child gets to decide how much is eaten and even if he eats.

When is picky eating a problem?

It is important to know that there is a point when picky eating becomes problem eating.  It is problem eating when the diet of the child is limited to a small handful of foods or only a supplemental drink like Pediasure. Problem eating is when the child throws a tantrum when he sees a food he doesn’t want to eat or cannot stand to even have the food in the same room. Picky eating is a problem if it leads to gagging and vomiting at most or all meals when food is presented. 

There are many underlying issues that can lead to these problem eating behaviors from weak oral muscles to reflux disease to food allergies to a feeding tube that was placed to help the child survive as an infant. Fortunately, there is help for these children with problem eating in Central Florida.

In the Arnold Palmer Hospital Feeding Difficulty Center, we see children from 18 months to 11 years who are problem eaters. We have a multidisciplinary team that includes gastroenterologists, occupational therapists, a dietitian, and a mental health professional. We evaluate each child that is referred to us and determine if they are appropriate for our intensive feeding program.

The intensive program consists of feeding-focused therapy three to four times daily, five days a week, for about four weeks. During those four weeks, I help parents and caregivers know when and by how much we are reducing the tube feeding or supplement drink their child takes while I teach them about healthy meal and snack patterns. Our mental health professional provides behavioral-focused counseling and interventions, and our gastroenterologists provide medical supervision and treat digestive issues.

If you think your child is a problem eater, you can call 321.843.2206 for more information about the Feeding Difficulty Center.

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