The Wellness Roundup With Dr. Jill

It’s Ok To Be Picky: New research shows that being a picky eater may be a natural and protective phase of child development

I have been meaning to write this article for some time now since the topic of picky eating is a daily conversation during visits at Healthy Kids Pediatrics. The more I have been learning about ancestral living the more I realize how we can trace so much of our bodies’ and minds’ reactions to our current environment back to the way our cavemen ancestors reacted to their environment. Most notably for me as a pediatrician surrounds the concept of feeding our children, mainly because we need food to survive and the job of a pediatrician is to guide growth and development which hopefully ensures survival. I am also intrigued by the reaction of a parent when a child is not a “good eater”. Parents (and yes, mostly mothers and grandmothers) get very concerned and want to “fix” their child’s eating habits. When we think about it, what was one of, or maybe THE, largest threat to our ancestors’ survival? Famine, starvation, and death which would surely threaten the survival of the human species. So, it is not that difficult to understand how we have so firmly programmed into the primitive parts of our brains the notion that when a child does not eat he or she may die.

There is so much new understanding and research being conducted surrounding how stress affects modern day people. We are now realizing that our brains do not actually know or care that there is a difference between the stressors we face today in our relatively safe environment (like sitting in a traffic jam when we are already late or waiting impatiently for a reply text) and a tiger chasing and trying to kill us. That same level of understanding can be applied to the reaction of a parent when a formerly wonderful and varied eater at 12 months old quickly becomes an 18-month-old master of consuming a total of about four foods, none of which have much nutritional value. While I know that a picky toddler will eventually start to expand his palate, it has always been a challenge to convince the worried parent that if he or she just hangs in there, continues to offer healthy choices, and maintains food rules and boundaries with the child, he will come around.  I admit that I used to quietly become frustrated at the end of a visit when I did not feel as if I convincingly reassured the parents of a picky eater enough that this, too, shall pass. I am now more understanding of parents and I know that their fear is more than just an anxious parent and that the uprising of our ancestral patterning is playing a powerful role. I was happy to see a recent article from May 2020 in the journal Pediatrics citing research suggesting that “picky eating at age 4 years is stable over an approximately 4-year period and that it is associated with a lower body mass index (BMI).”

The study was conducted by Carmen Fernandez, MPH, and colleagues to specifically examine picky eating in a low-income population of children since children of lower-income households are at greater risk for being both overweight and picky. The study found that “picky eating was associated with lower average BMI, in the healthy BMI range, suggesting that picky eating could be a protective factor against overweight and obesity,” said Fernandez. She went on to note that “we did not find evidence that picky eating was associated with being underweight”, but we do know that the low-income population results may not apply to other populations and moreover, we definitely need future research to determine the long-term weight gain trajectories of picky eaters into adulthood.

The results of the study do suggest that if parents intervene earlier than 24 months old when children are more receptive to exploring new tastes they may be able to blunt or altogether avoid the picky eating stage, but that is definitely easier said than done! I always reference a mom at my practice who is a chef by trade. During the first year of life, her twin boys enjoyed a diet that rivaled the most sophisticated Michelin star restaurants in quality, flavor, and variety which often made her husband jealous! Well, by the time those boys hit toddlerhood one continued to eat relatively well, but the other boycotted most foods and became the epitome of a picky eater! Given the information from the small research study by Fernandez et al, I find myself reassured that passing through a picky stage may enable a child to maintain a healthy BMI while still having enough energy to grow, gain weight, and develop both physically and cognitively. Our bodies are so much more intelligent than we think and while young children have not yet lost the innate understanding of hunger and satiety it may just be best to allow them to dictate when and how much they need to eat in order to survive and thrive.

On the other hand, experts recommend that researchers explore and examine the impact of an “authoritarian feeding style”, which combines elements of authoritarian and indulgent feeding styles, on a child’s willingness to explore foods. A style such as this one allows for structure and guidance while also being sensitive to the child’s needs without judging or constantly correcting the child. Researchers Dr. Nancy Zucker, PhD, and Dr. Sheryl Hughes, PhD in the department of psychiatry and behavioral sciences out of the Children’s Nutrition Research Center at Baylor College of Medicine in Houston, note that “we can think of children with elevated picky eating as having thousands of negative memories about food (e.g., conflict, unexpected tastes, discomfort) and so caregivers can work to create positive memories and experiences around food (e.g., cooking, gardening) to help picky eaters expand their preferences. However, it is critical that caregivers let go of their need for a child to taste something and instead focus on accumulating pleasant experiences.”

My take on this research publication is that parents I work with at Healthy Kids Pediatrics are doing the best they can to keep our children well fed, healthy, and happy. Parents are battling multiple barriers in their quest to ensure adequate nutrition for their children, including a fast-paced life filled with easily accessible fast-food meals on the go, a pandemic that has amplified the habits of sedentary screen time and snacking, and the food industry’s crippling hold over the choices, overall processing, and marketing of the food available to all of us. Add to all these factors our underlying and subconscious ancestral reflex of viewing a picky toddler as a potential threat to the continuation of the human species! I support encouraging our infants to eat what the family is eating whether it be through baby led weaning or the “traditional” style of starting with purees. I support encouraging parents to take a deep breath and give themselves the freedom to relax when a two-year-old refuses to eat the avocado and salmon dinner they once enjoyed six months before. I advocate for parents to not give in to offering unhealthy food choices when a child refused to eat all day, but is now hungry for a cookie at bedtime…all too often I hear “at least he had something in his belly when he went to bed”. Imagine if a parent allowed herself to believe that her child will, indeed, NOT go hungry by not eating for a day or two because first, we are in a society where there is a constant abundance of food and second, the child has a primitive instinct to survive and will eventually eat the healthy food when he is hungry enough and the healthy food is the only option? When parents of my patients experiment by offering healthy choices (the toddler often needs a choice in order to feel in control, but the parent gets to choose the options!) and then wait their child out for a few days they are amazed by the results.

I will finish with some take home points:

  • Children are very smart and manipulative.
  • The body knows how to keep itself functioning despite the toxins that are constantly bombarding us in our food, air, water, and environment.
  • Modern day children perhaps unwittingly take advantage of their parents’ innate desire to feed them and when much of our food is laden with chemicals and sugar that drive hunger and cravings a child’s persistence and tenacity can overcome even the most well-intended parent.
  • The picky eater is a natural and protective phase of child development that, in many cases, passes as childhood progresses.
  • From the very first meal an infant consumes, being mindful of creating a calm and happy environment devoid of judgment and criticism of the child or parent may be a very powerful way to prevent the physical and emotional outcomes we so often see regarding the health of the future of our human race.

– Dr. Jill

Dr. Jill Garripoli Pedalino is an award-winning Pediatrician and owner of Healthy Kids Pediatrics in New Jersey. She strives for open communication with parents so together they may guide their children to be the most successful, healthy, and productive adults possible. She works hard to be a role model for her patients and knows she’s in the right profession when a parent tells her, “Doctor Jill, you make a difference.”

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