Overcoming Picky Eating: Proven Strategies for Parents S5|125

Overcoming Picky Eating: Proven Strategies for Parents S5|125

Is your dinner table a battleground? Well, if it is, and if you’re finding that your little one is a picky eater, we are going to be doing a very deep dive into the topic of picky eating with paediatric dietician Cath McGaw. As many parents know, navigating a child’s eating habits can really be a huge challenge, especially with picky eating. And today we’re going to be looking at the profound influences that will shape these behaviours.

Cath talks about the effect of parenting styles, something that I’d never thought about when it comes to picky eating. And also the influence that parental anxiety can actually have on picky eating. So if you’re feeling like an anxious parent, or if you’re wondering about your parenting style, this is not an episode that you should miss.

Cath offers really valuable insights and shares three key strategies for managing the less severe cases of picky eating. And one of those is the role of supplements. So whether it is medications or mixtures, or whether it is actually the shakes themselves, she looks at the role of supplements and the importance in ensuring nutritional gaps are met.

And then we also look at limiting fun foods during the first three years of life and why that’s so important as a foundation for healthy eating habits. And then Cath also goes to have a look at how do you actually start to increase repertoire of food. So if you have got a picky eater, this one is definitely for you.

For me, one of the most standout moments from our conversation was when Cath referred to the good food journey. And she spoke about how there’s this incredible impact of these first 6,000 days of a child’s life. And certainly, one of the most incredible practical tips to come out of the episode was Cath’s absolutely innovative idea of using treat boxes for children.

Now, I’ve never used a treat box for my children. And having listened to this episode, I really wish I had. It is a strategy that promises to transform not just mealtime battles, but actually self-regulation in general.

So please stick around. It is an absolutely incredible episode. And let’s get going with Cath.

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Each week, we’re going to spend time with new mums and dads just like you to chat about the week’s wins, the challenges, and the questions of the moment. Subscribe to the podcast, download the Parent Sense app, and catch Meg here every week to make the most of that first year of your little one’s life. And now, meet your host.

Welcome back, mums and dads. This is Sense by Meg Fora. I am Meg Fora, and I have a regular guest here for us today.

It’s Cath McGaw, who is the pediatric dietitian, who is the advisor in the Parent Sense app. And she’s also been a partner of mine in many, many of my little ventures, including books and webinars and conferences. And Cath really is, I think, one of the really world authorities on the subject of infant feeding.

So whenever we have a feeding topic, I call Cath in. So welcome, Cath. Thanks, Meg.

Always love being here. Yeah, always great to chat with you. And today’s a really kind of thorny topic.

It’s a very increasingly busy topic, you know, more common. And that’s the topic of picky eating. I’m sure that a big percentage of your practice is probably made up of little kids who are picky eaters.

It is, and from all ages. So from infants right through to kids at school. So it really does cover a range of ages.

And do you feel like in the last 20 years of being in practice that you’ve seen an increase in the incidence of picky eating? Yeah, I would definitely say in the last decade specifically, there’s been a dramatic increase in picky eating. And what would you put that down to? I think there are a number of factors. I think that it comes along with the different style that we find parents are parenting with today.

I’m finding that parents don’t really feel as empowered. And maybe it’s a little bit of a backlash to the strictness of how parents parented maybe in our generation. And now parents are like, you know what, actually, I don’t want my kids to be forced to eat.

I don’t want them to have to feel that under pressure. I don’t want food to be negative, which are all really good things. And I totally support that.

But then there’s a bit of an extreme kind of, you know, we tend to then go a bit extreme. And it’s almost like they can choose and, you know, if I will kind of be available to see what they like, and if they don’t like it, that’s okay. And, you know, and I think we’ve almost gone, we’ve jumped off a cliff a bit with it and lost the point of that we still need to guide, we still need to champion the process as parents.

And ultimately, they can’t hold all the responsibility for their feeding, because they’re not capable of that from a cognitive level, from a practical level, they can’t go to the shop and buy food. And, you know, they can’t prepare their food. So we do have to play an active role in the feeding and not just kind of leave it up to them to eat.

And I think that’s one of the elements. I also think there’s the level of anxiety around parenting has definitely increased. And like the general level of anxiety in general in the world, you know, we do have a more anxious generation and a generation that is a lot more, you know, focused around doing it right, or this person says this, or Instagram is this, and you know, we’ve got a lot more voices out there to speak to our parenting than what we’ve ever had before.

And when it comes to food, it is huge, and nutrition, and it’s big. And so it brings in a lot of anxiety. We know that in the place of feeding a child, if there’s an anxious environment and space, it will make feeding a little bit more challenging and difficult.

So I think it’s multifactorial why we have seen an increase. Yeah, and I think there’s also there’s this that I also have noticed, but that’s probably even more recently, I’d say in the last five years, I’ve noticed a pressure on children feeding themselves and reaching their feeding milestones a lot quicker than what maybe they’re able to, what we would have expected them to do in the past. And I think that has created pressure in the feeding space as well.

And pressure on children with eating, when it’s a skill that you need to learn how to do, doesn’t bode well for a child being motivated to want to learn to do it. And then sadly, sometimes the repercussion of that can be picky eating. So interesting, Kath, because I mean, you’re speaking more about kind of almost like the parenting styles in many respects than you are even speaking about things that are deeply ingrained in, you know, in physiology, I guess.

So it’s very, very interesting. And I had a podcast episode just two episodes ago with Professor Mark Tomlinson from the Department of Medicine at Stellenbosch University. And him and I were speaking about permissive parenting versus kind of controlled crying when it came to sleep.

And it’s really interesting because there is this kind of slant towards being, you know, very attachment focused, very led by the child focused, you know, kind of almost, I don’t know if you can call it even permissive parenting, maybe, you know. And I think that in some respects, a lot of these things actually do have their roots in little ones needing to be co-regulated and having parents actually take the reins. And so it’s really, really interesting.

But then on the flip side of it, on the far end, when you take that to the extreme, you’ve then got authoritarian parenting, which is where, you know, you will sit and eat every last mouthful that is on your plate, which, of course, is what this backlash is against. And we don’t want to go there either. So it’s finding this middle ground, isn’t it? It is.

And I think it’s also just having an understanding and insight around what feeding takes. And I always really try and explain that to parents, that it’s, you know, when a baby learns to suck and suck at the breast and suck on the bottle, it’s quite a primitive skill that a child is using. And it must be primitive because they need to survive.

And so they need to do that easily. But as you get into the feeding space of solids and complementary foods, you require much higher cognitive skills around feeding. And that really cannot be rushed because every child develops at their own pace like they do when they crawl and when they sit and when they smile and when they eventually talk and when they walk and things like that, you know.

And I always explain to parents that at a point, children are going to get onto the same kind of continuum. You don’t look at a bunch of kids running around a soccer field at school and going, oh, I can see that child walked when they were 18 months and that child walked when they were nine months. You know, generally for the normal developing child, they were all pretty much look like they’re all running around and you wouldn’t be able to tell when exactly they walked.

And with feeding, it’s very similar. But yet with feeding, I find there’s a pressure that at this age, they need to be holding a spoon. At this age, there must be self-feeding.

At this age, and it can be quite specific and that and they must be eating these types of food by this age and they must be doing these types of things. And we don’t allow as much of a continuous and as much grace around the feeding development. And yet it’s as much of a high level cognitive skill as what the other things that I’ve mentioned are.

Very interesting. You also mentioned something just now about how globally anxiety has increased and there’s no doubt. I mean, post-COVID, we’re seeing it in adolescents, we’re seeing it in adults, just an increase of anxiety.

And of course, the kind of amount of food a child eats has always historically been a source of anxiety for parents. It’s just now obviously exacerbated. So if I’m a mom listening to this podcast now, and I think I might have a picky eater, but I’m not sure if it’s actually just my anxiety around the quantity they’re eating.

How do you kind of define a picky eater? And, you know, could we guide parents to know, your kid’s a picky eater or no, you’re actually, just let it go. Your kid’s not a picky eater. This is normal.

So, yeah, I think we get, you know, your picky eaters that require professional help and then your picky eaters that are just normal developmentally picky in a phase of pickiness, which is okay. So if a child is eating maybe less foods than what they were historically during like their early weaning days, because generally they will eat quite a bigger variety and they’ll try different things. And then when they get to that kind of a typical 18 month, 24 month age group, they start to develop different tastes, but profiles and different preferences and a voice and ego and things like that, which are all normal and good.

And they might reduce some of the repertoire of food variety that they were eating. But if they continue to eat a variety of food groups and at least one or two from each of the food groups consistently and not consistently removing foods, but slowly adding maybe different foods, then I would say they might be going through a bit of a picky eating phase, but then wouldn’t be classified as a problem picky eater that we would need to address more seriously. But when a child cuts out a whole food group, in other words, they’re going to have nutrient lack or their variety decreases so drastically that you end up with only one color of food, for example, the white foods, which is a very typical thing we see with severe picky eaters.

Then you are definitely heading for a bit of trouble from a nutritional point of view with your child and the eating. It’s very normal though in the age group between 18 and 24 months for children to be quite up and down around the quantities. So quantities are not necessarily a sign of picky eating.

I think if some days they eat less and other days they eat more, that’s very normal and we’re happy and we normally observe their eating over a period of two weeks. So if I do require food diaries, I normally want to see it kind of over a two-week period. But if their quantity, if they’re starting to avoid supper altogether or avoid breakfast altogether or not eat at all during the day or things like that, those are obviously huge areas of concern and that would be severe picky eating.

So you’re kind of milder to moderate picky eating when they’re removing a whole food group, but they’re still eating a fair amount of the foods that they do like. And then as they become more severe, they would be reducing the variety and the quantity of their food. Good.

Well, I quite like that. You’ve kind of given us almost two camps of picky eating in terms of severity. The one being that there is a lack of weight gain as well as the restrictive nutrients, restrictive variety.

And then on the other side, you’ve got a child who’s apparently thriving. It looks like they’re adequately covered. They’re not fat, but they’re adequately covered.

But they’ve cut out everything of color, as an example, or an entire food group. Now that’s very, very common. I mean, I would say that that category, 50% of the moms who are listening to this will go, oh yes, my kid eats all the processed carbs, dairy and maybe banana, and that’s it.

But is sleeping fine at night and is gaining weight adequately. Should that mom still be concerned? Yeah, well, I think if you’re going for the white food diet, you probably are missing out on quite a few micronutrients. So there we talk of macronutrients like our calories and our carbohydrates, our proteins, our fats, and that would be your macronutrients.

Those kids generally most of the time manage to cover their macronutrients, although protein is often a casualty. So because protein is hard work to chew, and it takes an elevated feeding skill to actually navigate protein specifically. So that might be potentially lacking, unless they’re living on eggs or something like that, then it’s generally not a fallout.

But the micronutrients, which come from a variety of fruits and vegetables, are often the ones that suffer. And it becomes a bit of a vicious cycle. So the body gets less, so the body actually desires less.

The body goes into almost a mode of, you know what, you’re not really giving me everything I need. So I’m going to request less and less and less, but eventually you need to break that cycle in order to get a child desiring more food. Very interesting.

So Kath, I’m going to take the most common kind of side of things for a little bit, and then we can go into the more complicated, but let’s go super common. And this I hear all the time in my practice and in the moms who get hold of me. Little ones on a carbs, dairy, banana, yogurt, and egg diet, scrambled egg.

And that’s pretty common. And then maybe some processed Viennas, but no other meats. First of all, how concerned should that mom be? And second of all, what can she do to start to increase that repertoire? This episode is brought to us by ParentSense, the all-in-one baby and parenting app that helps you make the most of your baby’s first year.

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First of all, how concerned should that mom be? And second of all, what can she do to start to increase that repertoire? So I would say first and foremost, always fix the nutrition in the easiest way possible. So that mom I would recommend getting a good multivitamin supplement and actually just tick in that box. And you can say, okay, the calories are fairly good.

The protein intake with my child’s eggs is great. I’m happy with that, but let’s just fix the micronutrients before we start seeing how we can bring in the different colors in the child’s diet. So that would be the first point, of course, always is nutritional rehab.

And I love that kind of term. So the second thing then would be to just see what other foods is the child eating? Because often what happens around the age of two, three, four, is they’re exposed to a more birthday party, school party, sweets, and that. And our taste buds, like children’s taste buds, are so kind of up and down and unpredictable in that if you eat a whole chocolate bar and then straight after that, I give you an apple to eat, the apple’s going to taste extremely bland.

And a lot of these kids’ taste buds almost get trained by the extra junk food that they were never exposed to before. And suddenly fruits and veggies don’t taste like they used to taste. So the fruits are bland, they’re not sweet anymore.

The veggies aren’t salty because they’re used to salty chips. And so suddenly you find in that the taste bud shift has forced them to become disinterested in that range of foods that we’re so desperate for them always to eat. So have a check-in with that.

And sometimes picky eating problems get solved by just being really strict and removing those treats quite strictly. And I’m talking especially in your younger age group, you know, removing a turkey out of the child’s diet and the child’s repertoire for about two weeks to just see how to correct the actual eating spontaneously. Because we always want to do it janky and do as much, you can never, the one thing with food which makes it so challenging is you can’t force a child to eat.

You don’t, and you never want to do that. You don’t want to be holding them down and trying to get them to eat. And say you do that, they will just throw it up or they’ll do something else with it.

So that there’s no way that you can do that. So you, and we don’t want you to, but the, what we want to do is we want to create an environment that’s going to encourage them to make those good choices. So one thing we can do in the taste bud environment is to reduce the refined sugars, the artificial salty foods.

And that’s why often kids get fixated on your kind of coated foods, your nuggets and those types of things because of those salty flavors that they have in them. And suddenly your veggie, which is natural salts in them, actually doesn’t taste that appetizing and appealing. So we want to get those and we want to remove those from the child’s diet.

And often in that, when they’re, and then having just natural fruits and veggies around, they’ll often go for those and try those then because they all desire something sweet. And that is the reality. And they’re going to need to fill it somewhere else.

And if they can’t fill in the way that they would really want to with a quick sweet boost, they’re going to then look towards the fruits. And I’ve seen that happen often in my practice, in these less severe cases. Very interesting.

So, I mean, you’ve mentioned two things there and it almost feels to me like this is a bit of a progression of home therapy. The one is put them onto a nice supplement. And just on that, do you recommend shake supplements or vitamin supplements? Shake supplements only if we are concerned about overall intake and calorie intake, because obviously it’s got extra calories in it.

And then so that I would definitely recommend, and if protein is lacking. So if protein is lacking, protein, because it’s such a challenging food to feed, if say a child hates eggs and doesn’t want to eat any chicken or fish or meat or even the vegetarian proteins, then I will definitely recommend a shake supplement because you would have protein in it. And I would normally do it right at the end of the day, after a day’s eating to fill the gap.

Then you wouldn’t have to add a multivitamin on top of that as well, especially on some of the good shakes that we have these days. And then if the child is getting sufficient calories and sufficient protein, then I would recommend a good multivitamin and mineral supplement that you would give your child in the mornings and you would do that. And are there brands of supplements, of vitamin supplements that you like? So the one I like is the, so you’ve got the one, well yeah, there’s a range of different ones.

So you get from your really pricey ones, like your Metagenics and they’ve got really good products and good absorbability. And then you’ve got your Viral Guard ranges, those choices, I know you like Biostrat, you’ve got that range. So you’ve got a mixture and a variety.

So it depends on the child, you know, sometimes they’re fussy and they won’t even choose something, they won’t take a syrup, then you might need a powder, like Mix Me is a very, very good powder here we have in South Africa, which you can put into, if they eat and say they’re happy to still eat porridge or they eat yogurt, then you can put it into that. They won’t know it’s there and you can feed it to them. And that’s got vitamins and minerals, Mix Me? That’s a vitamin and mineral range, yeah.

Okay, brilliant. So step number one that you mentioned was supplements and we’ve covered that off. Step number two is removing the fun foods or the sweet, empty calories as it were.

How do we deal with that? Because I mean, that I think is very important. I’ve always said, you know, you get to control what you feed your child. And, you know, we know that, I mean, even for us, if you eat a packet of chips, it activates your appetite even more an hour later, you know, and if you eat sugar, you know, spikes of sugar drops it and then you’re going to want to eat even more.

So how do we take sweet foods and fun foods out of children’s lives without making them feel like forbidden fruit, which then kind of makes them want it even more? So the age group I’m talking about when you, I would say remove it totally would be three and under, because I really don’t think, and this is a shout out to moms who have small babies and just happen to be watching the thought of interest, like try and avoid introduction of those foods for as long as possible, especially up to the age of three, because we’re going on, that’s our good food journey. That’s our thousand days. And we really want to give them the best foundation we can.

But if you have introduced them and life happens and I totally get that, and especially if they’re second children, then try and cut it out, you know, entirely. And you don’t have to make too much of a big deal about it because they’re really little and they can’t have, they’re not going to have, you know, they’re kind of instilling that out of sight, out of mind phase. However, if they’re older than three and now you’ve got the parties and you’ve got all of those things happening, I’ve got a concept that I use in my practice called the treat box, which I developed for when my youngest was four, because I was, he was relentless at asking me about, he wants, you know, he wants a biscuit.

Then just after that, he’d want something else. And there was always something he wanted. I could, it was just never enough and it’s exhausting.

And you do eventually, you’re like, okay, just have it because it’s over it. And so I developed the treat box, which has been amazing. And I’ve used it a lot with patients in my practice.

And that is really where a parent will give in the, you do this with your child. You can paint a box, you can use a shoe box, you can go and buy a box. It doesn’t matter.

Decorate it, which they love to do and enjoy doing it. And then say, we’re going to, on a Sunday, we’re going to pack seven treats for the week. And the important thing is that the treats don’t have to all be sugar treats.

Because you also want to help them learn that there are ways that we can have treats and fun stuff without food. So it might be like going to the park with dad. It might be going to visit granny and have granny read a story.

So little things like that, depending on the age group will depend what you would put in. It might be a little sticker pack that you pop in that treat box. And then it would be maybe a little packet of chips and a little packet of jelly tots.

And then you might write on the ice cream, could you put ice cream in a treat box? And that’s a treat for the week. And then as depending on the age will depend on whether you give them autonomy for the whole week to manage it. I love the autonomy elements because what that teaches them is that they’re not forbidden.

I could have it, but I can then see how long it lasts over the week. So now it’s no longer mom say, no, you can’t have a treat. And it works so well if you totally allow them, especially when they are about six years old and up, allow them to just have it.

And if they eat everything on Monday, they’ll very quickly realize that’s Tuesday, Wednesday, Thursday, Friday, Sunday takes a long time to come. And it works amazingly. You know why I just love that so much is it really speaks to the delayed gratification and self-regulation piece as well, which is a whole other aspect of, of course, feeding and all other areas of success in life.

We know that children that can delay gratification or self-regulate themselves actually do better long-term in all facets of life. And you actually instilling that almost like the marshmallow experiment with this little box. I love it.

I’ve never done it. And I think it’s an amazing idea. It works.

It works so well. I’ve seen countless success stories with it, with my own kids I saw and just the different, I’ve had, I’ve got three kids with very different personalities. It was very interesting to see how they each approached it very differently.

And I’ve even seen him having that mindset into adulthood, actually having my, my youngest actually has like a shelf in the freezer and I couldn’t figure it out. And he called it his shelf and I realized that he’s created his own treat box. So if I bake a batch of brownies or cookies, he’ll take one or two and pop it on the shelf.

And that’s how he manages it for the week. So I think that is exactly what you’re saying, Megan. That’s always been your, on my thing is what we do in these early years and early phases is respecting them up for skills for a lifetime.

And I always say to parents, you know, what our world is a treat box. And a lot of adults can’t even manage that. So if you can give the child a gift to manage a treat box, and you know what the amazing thing is, I noticed with my kids and parents report the same a few months down the line, I would go on a Sunday to fill the treat box and it would be full.

And why? Because it was no longer this wow thing, or I was trying to get it out of my mom and she was holding back the keys to these amazing things, you know, and it also avoids the temptation of using that for good eating behavior or other things like that, which, you know, that I’m not partial to at all. Yeah, I really love that, Kathy. . You know, one of the things I used to do with my kids was I had the timeout corner, not ever to do with food, but to do with, you know, when there was something really big going down, like my son had hit his sister or something like that, but I never put a time limit on it.

And I always said, you can come out when you want. And what was fascinating was that the first time you do that, they come straight out. And then you say to them, are you sure you finished? Are you sure you can go and say sorry to your sister? Do you understand you can’t do it again? And then a few weeks later, you’d say you can stay there for as long as you need to.

And then they stay there. They regroup, they sort themselves out. You know, it’s not this massive, terrible thing, but it is some place where they can go to kind of defrag and you are handing over that self-regulation to them.

So I really do love that, Kath. And, you know, your book Weaning Sense, there’s a whole chapter on that, you know, on that on that aspect of the kind of, I think we call it baby led, but it’s all around, you know, little ones being able to regulate themselves. Absolutely.

Yeah. Amazing. Well, Kath, I think that we can’t finish this episode without talking a little bit about the really severe picky eaters.

So the little one who is not gaining weight, where these lovely strategies that you’ve given us are not going to make a difference. They have not. They’re stuck on only one food.

They’re losing weight. They’re not well. They’re not thriving.

What do you say to those mums? Well, firstly, I think it’s really important to get a full medical check just to make sure there’s nothing underlying. I see I’m working now with a gastro and a pediatric gastroenterologist. We’ve created a pediatric gastroenterology clinic and we’re having a lot of fun with it, but we are seeing babies, children and babies, one thing, but children coming in with picky eating and we start to actually sort out reflux, sort out allergies.

You scope these children and you see they’re full of like cells in their throats and their esophagus due to an allergy to say cow’s milk protein or they’re struggling with silent reflux, but they’re just older now. So they’re coping. They’re not screaming up all night.

They’re coping. You treat that, you treat the cause and they start to learn to eat. And I say that very gently and slowly because it is still a process that doesn’t, it’s not a miracle cure and overnight they’re eating everything, but they start to learn to eat.

So that’s why I’m saying, I do think you need to tick the medical box. If everything is clear in that space, then what they might just have got into is you started off with a mild to moderate picky eater that we were talking about earlier. Maybe it wasn’t addressed, maybe kind of life just overwhelmed and you weren’t able to kind of focus in on that.

And slowly, slowly the child became more and more severe and they become malnourished. And then you actually have to do true rehabilitation of their nutrition. And that is normally requires a whole nutritional supplement.

And that might even be given two to three times in the day. People always say, oh, but then he won’t eat, but he’s not eating anyway. So let’s give him the nutrition his body deserves so that we can protect him and his growth and his brain growth and everything like that.

And then once he’s used to the nutrition, you’ve broken that cycle, we can start to slowly pull back on that. And then they start to develop a craving and wanting for food. And in the meantime, you put some good healthy principles like boundaries around eating in place, you know, not all day snacking where they never actually feel full, but they never actually full enough.

Little things like that. So you do the work with the parents while you do nutritional rehab. However, for the first month with a mom who’s got a severe picky eater, I normally give them a feed in holiday because I think the family are exhausted.

The child’s exhausted. Everything about the relationship between the parents and the child has been around food and not eating. And I actually say for one month that is not the focus in the home.

We’re going to do the supplement that’s going to give them the nutrition. You back off, you relax and do puzzles with your child or go and play in the park or do something totally different and develop. Find your relationship again with your child outside of the eating.

And then once they’ve done that and I’m on the path of nutritional rehab, we can start to work actually with the principles around how to feed and feed in again. Love it. Absolutely love it, Cath.

So many gems there. I think just for those moms where it is severe, I mean, the takeaway for me was don’t try and cope with it on your own. Get yourself a specialist.

People can get hold of you. Cath, how would people get hold of you? I think the best would be to go into Nutri-P’s website because there they can just send an email from there or just do an inquiry and then we always pick it up from there. Okay, brilliant.

Well, absolutely incredible gems. Things that I’ve learned today that were really exciting to learn about. A little bit about the supplements, which we don’t often actually talk about the names and I’m glad we did today because parents often ask for that.

So I really do appreciate it, Cath. Thank you for all that you do with moms and their little ones. Pleasure.

Thanks, Meg. Thanks for having me. Thanks, Cath.

Thanks to everyone who joined us. We will see you the same time next week. Until then, download ParentSense app and take the guesswork out of parenting.