This quote needs no introduction:
Telling me to eat broccoli is like me telling you to eat dog poop, and guess what, I wouldn’t do that. Gia, age 9.
Rarely do parents bring their child to see me because of picky eating. Instead, I often hear about picky eating as part of a larger constellation of inflexible behaviors. Other examples include difficulty tolerating changes of plans, frequent complaints about clothing being uncomfortable, and excessive concern with rules and rule violations. This is not to say that all picky eaters are challenging in other ways; I just don’t meet the happy, healthy, well-adjusted ones in my office.
Gia was brought to see me by her parents as a new third grader because she was having a great deal of trouble going to school. The first couple of months of treatment were focused on helping her overcome her many worries about attending a new school. What if no one likes me? What if the teacher is mean? What if I get sick and throw up? What if I can’t learn my times tables?
Gia worked really hard to use the tools she learned in therapy and was going to her new school without difficulty by the middle of October. She still had worries, but she knew how to cope with them. When I brought up the idea of bringing therapy to a close, Mom and Dad requested that we spend some time working on Gia’s very restricted diet. According to Mom, Gia’s diet consisted almost entirely of white foods. Here is the list Mom and Dad gave me of foods Gia eats:
Bananas, peeled apples and pears
Baked chicken and tilapia
White rice, mashed potatoes, and pasta
White bread, bagels, and rolls
American, provolone, cottage, and cream cheese
Hard-boiled egg whites
Vanilla yogurt and ice cream
Milk, white grape juice, water
Oh, and Gia would eat any type of chocolate or candy of any color and consistency.
Right up front, let me come clean. In very few cases do I think it is necessary or wise for parents to put a lot of emphasis on expanding a child’s diet. As long as the diet contains some degree of balance and variety, the child is maintaining a healthy weight and staying on her own growth trajectory, and there is no evidence of eating disordered behaviors or body image disturbance, then the risks of focusing on the child’s eating probably outweigh the benefits. Gia gets protein (chicken, fish, yogurt, cheese, egg whites) as well as fruit (juice, bananas, apples, pears), and carbohydrates (rice, potatoes, pasta, bread), and there is very little junk food that she enjoys. Her weight is at the 25th percentile where it has been since the age of two and which matches her 25th percentile height. And Gia has no concerns about her weight or eating habits.
Mom and Dad could identify two potential benefits of addressing Gia’s picky eating habits in therapy. First, they believed that their daughter would be healthier if she ate a more varied diet, especially if they could get her to eat vegetables. Second, they believed that broadening Gia’s diet would allow the family to enjoy outings to a greater variety of restaurants. Mom and Dad both described themselves as “foodies” who enjoy cooking and eating many ethnic foods, the spicier the better.
After a long discussion with Mom and Dad, we identified one major risk – the risk of intensifying an already problematic power struggle over food. This risk, we agreed, outweighed the potential benefits they had identified. Power struggles at mealtime can lead to all sorts of problems, but mostly, they displace what really should be happening during this important family time. This is the time when family members should be connecting to one another, hearing about each other’s days, talking about what is going on in the world. This is the time when parents find out what their children are thinking and feeling and the time when children are learning what their parents value. Mealtime needs to be pleasant or it loses its power as a moment of connection. Harping on what, how much, or how little a child is eating is a surefire way to spoil an opportunity for meaningful conversation. Plus, battling with a child about what he eats rarely leads to the desired outcome.
Using an approach I had previously taught the family known as Collaborative Problem Solving (see the work of Ross Greene), Mom, Dad, and Gia found an excellent, multi-pronged solution for the problem of Gia’s picky eating:
- Mom and Dad will make sure that there is at least one food (a protein, a carbohydrate, or a fruit/vegetable) that Gia likes at every meal. If she will not eat any of the other foods offered at the meal, she can choose one of each of the missing food categories from her list of preferred foods as long as she can prepare it without assistance. So, for example, if Mom and Dad serve baked chicken with corn on the cob and a green salad, Gia can supplement the chicken with a roll and a peeled pear. If they serve steak with mashed potatoes and asparagus, Gia can eat hard-boiled egg whites she prepares herself and drink a glass of grape juice in place of the meat and vegetable.
- Mom and Dad will let Gia know by lunchtime what they are preparing for dinner so she will have time to plan her meal and prepare foods as needed.
- There will be no talk of Gia’s picky eating habits at dinner. If, on her own, Gia decides to try a food she does not typically eat, she will be rewarded with a Hershey Kiss. The Kiss represents how much Mom and Dad love when Gia tries new or previously rejected foods. (Thinking ahead, Mom and Dad set a 2-Kiss/day limit in case Gia decided to go crazy and try a bunch of new foods all in one day!)
- When the family wants to eat in a restaurant that Gia does not enjoy, she is welcome to pack her own meal and take it to the restaurant with her. She is not allowed to complain about the choice of restaurant once the family has decided to go.
This was a win-win-win. Gia was happy that she would no longer be the focus of negative parental attention at meals, that she would be able to eat a balanced diet comprised of foods she enjoys, and that there was a positive incentive for trying foods when she chose to do so. Her parents were happy that they no longer had to worry about their daughter’s nutrition, that mealtime would be more about family connection than picky eating, and that Gia was taking responsibility for planning and preparing healthy meals. Gia’s siblings were pleased that the mealtime tension over their little sister’s food preferences was eliminated.
When I first discouraged Mom and Dad from taking a head-on approach to the problem of Gia’s picky eating, they were skeptical. They simply wanted me to tell them how to get (force?) Gia to eat a wider variety of foods. When I pointed out that they were already doing all they could by modeling healthy eating habits and serving healthy foods (you can lead a horse to water…), but that they could not coerce Gia to eat foods she does not like without risking serious detriment to the parent-child relationships (…but you cannot make it drink), they got it. The outcome achieved using a collaborative approach was so much more positive than what would have been achieved using coercive tactics.
For more helpful (and sometimes surprising) advice about feeding children, see the work of Ellyn Satter. Her website and books are full of information and suggestions that can lessen the challenge of helping children develop healthy eating habits.
[Names and potentially identifying information has been changed to protect privacy.]