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Chicken Nugget Dilemma — When to Worry About Your Kid’s Eating

We’ve all heard it from friends or family, or maybe in our own household: the kid who eats only peanut butter. Or cereal. Or chicken nuggets. As a parent, you know children go through phases, and that’s not a bad thing — a child expressing preferences is experimenting with independence. But when should you worry about the impact on your child’s growth and nutrition?

Picky Is Normal — To a Point

Let’s be honest: It’s hard to find kids who like green vegetables. Pediatricians see so many picky eaters that it’s more or less normal and can make it harder to identify kids who have real issues. That’s where parents come in. They are the ones doing the feeding day after day and are the experts on what’s going on with their kid.

Ultra-restrictive eating — what would be categorized as a pediatric feeding disorder — is an extreme version of picky or selective eating, and much less common than the typical food jags that children and toddlers grow out of with practice and exposure. Extreme cases — seen in only about 4 percent of kids, fewer for children under 5 — are associated with some kind of medical condition, nutritional need or psycho-social dysfunction.

Alarm bells for parents include:

  • Kids who will eat only one texture (often pureed) or color (beige is common) or only one flavor profile
  • Along with food refusal, gagging, vomiting, hitting, crying or running away from the table
  • Poor appetite that seems to affect growth or energy levels
  • Difficulty chewing or progressing past the bottle stage or pureed foods
  • Eating only in certain environments, like the car or stroller

All of these are signals that it might be time to consult a pediatrician, GI physician or a multidisciplinary team that specializes in feeding difficulties.

What’s the Harm?

Anyone who’s skipping whole food groups is missing out on key nutrients, vitamins, minerals, fiber, healthy fats and even sufficient calories. If your child is only eating beige crunchy foods that come in a package, they may not be getting enough protein, micronutrients or fiber — so much so that it can affect growth and development.

This kind of eating also can give kids problems with constipation because they’re not eating whole, nutrient-dense foods like fruits, vegetables and whole grains. When they naturally associate those unpleasant feelings with a certain food, they are more likely to become averse — which leads to a vicious cycle because constipation reduces appetite.

The gut-brain connection, which impacts our emotional well-being, is evident especially with children with autism. Eating-related problems with bowel movements contribute to mental dysregulation as well. When those problems are cleared up, there can be a significant improvement in mood and self-regulation.

The remedy? Variety

Yes, it’s a bit exhausting for parents, but it can take at least eight to 10 tries to get a child to accept a new food. Before you even get to tasting, your child may need to tolerate being around the food or interact with it in other ways before eating it — slow and steady is the way to go. If a child needs additional reinforcement or incentive, a feeding therapist can help with beneficial strategies.

It’s also important for the child to see the food as it is — hiding it (by blending, say, spinach into a muffin or pancake) is not a true exposure to that food. Tastebuds do adapt and change over time — although “time” can mean years. (But think of all the tastes your adult child will have learned to enjoy!)

Be intentional, persistent and consistent: Choose a food and work on it for a week, maybe longer, based on the child. It’s OK to offer a new food alongside a preferred food. If that new food isn’t being accepted after five to 10 introductions, take a break and work on adding a different food instead. Aim for around three planned, structured meals and two to three planned snacks per day, including one or two foods the child usually prefers, but also the food the family is eating. Minimize unplanned snacks or grazing, so your child is hungry but not starved at mealtimes.

Modeling also is key — parents who want their children to eat more fruits and vegetables should be seen joyfully eating those things. (The joy part counts — kids pick up on a negative attitude.) Talk factually about the food and how it looks, feels or smells instead of talking about how much you love it; this allows for repeated, neutral exposure.

For more extreme cases, there are feeding-therapy programs, where multidisciplinary teams treat the child as a whole, including any underlying medical conditions. The family collaborates with therapists and others to determine what to work on.

Feeding a kid can be hard, stressful, never-ending work. Parents sometimes unintentionally reinforce selectivity by going along with those desires, or even by consistently buying specific brands. If a picky kid is used to a food in a certain package, or packaged food in general, anything that’s not absolutely uniform — blueberries, for instance — is not going to seem as safe or comfortable.

There’s often no right or wrong answer — every kid is different, and you just have to experiment. (And remember consistence and persistence.)

At the end of the day everyone has likes, dislikes and preferences, and you can’t compare what one child is eating to the next. It’s not really about food intake in a particular moment — it’s about supporting your child through exposure to eating experiences that will help them enjoy a healthy relationship with food throughout a lifetime.

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