Podcast

Picky eating explained with Kath Megaw

Picky eating explained with Kath Megaw | S2 Ep28

Guests on this show

Kath Megaw

Kath Megaw, Clinical Dietician & Founder of Nutripaeds

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Picky eating explained

Intro

Welcome to Sense by Meg Faure, the podcast that’s brought to you by Parent Sense, the app that takes guesswork out of parenting. If you are a new parent, then you are a good company; your host Meg Faure is a well-known OT, infant specialist, and the author of eight parenting books. Each week, we are going to spend time with new moms 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.

Meg: Welcome back mums and dads. I am always delighted to be here, each week with you. And as you know, some weeks we spend time chatting to new mums, we often chat to Cassidy, and have been watching her journey with little Max. And then other times we have Bailey Georgiades asking me a whole lot of questions that you’ve sent through, which of course the sessions I absolutely love. And we did one early this year on picky eating, but now, today, I have got the real expert and that is Kath Megaw, she’s a pediatric dietician, she works daily with moms with picky eaters, and she’s my go-to person for all things feeding, she’s also the dietary expert on the app, she feeds into all of the questions and makes sure that the information we give you on infant feeding is absolutely accurate and up with the latest science; and so I’m really, really delighted to welcome Kath to join us here today. Welcome Kath.

Kath: Thanks so much Meg, lovely to be here.

Meg: Kath, I think just for the purposes of the audience, could you just give us a tiny little background on your education, I know you at John Hopkins University, your kids and your practice.

Kath: Yes, I qualified in 95 and did that in South Africa, and then had an absolute passion to move into pediatrics, unfortunately, there wasn’t any way in South Africa to further my knowledge, so I applied for a fellowship overseas and then it got accepted at John Hopkins and studied further in pediatric dietetics, they qualified me as a pediatric dietitian, and came back to South Africa and started probably one of the first pediatric dietetic practices in the country, and then went on and had my own children and realized I actually didn’t know much at all. So, put in the theory into practice, took on a whole new meaning when I had my own children and feeding my own kids of which I’ve got Joshua who’s now 23, Ticks is 19 and my youngest is 16.

So, they have really challenged me and all my thoughts and ideas, with my 23 year old being my picky eater, so he’s kind of the first child for picky eating, and today I can say he really has a good, healthy attitude about food, still bit sensory when it comes to food that I would say is able to eat very comfortably, so he really taught me a lot on my journey and he’s always my picture of hope for moms who really are struggling.

Meg: That’s so interesting, Kath, I mean, our children are the same age, and my first born was also my picky eater. Although, while Josh’s story has to do with his own sensory personality, mine had to do with my personal journey with actually wanting control, and how that played out in meal times. And so, it’s really interesting because there can be a myriad of reasons why little ones become picky or are defined as picky. And I think before we get into those reasons, I think picky eating has become an absolute buzzword in the media. I mean, it’s all over the place you go and Google picky eating every other, baby’s a picky eater, and I guess there is picky eating as the media defines it, and then there’s probably picky eating when a dietician would become concerned, would you just kind of sketch the picture and the kind of continuum between those two for us?

Kath: I think that’s such a brilliant point to start with because there are, there’s actually no one standard definition of picky eating that all professionals agree on, and that makes it also so difficult, because what one healthcare professional would deem a child picky Eating and another is quite different, and then when a mother deems for child picky eating. So, when they did a survey amongst a group of children just fairly recently done, and they took, it was about a thousand children across the UK, and they did a survey as to how many were deem picky eating, 80% of those children were deemed to be picky eats by their moms, and that same group of children only 40% were deem picky eaters by the healthcare professionals, so there was a great discrepancy between a mom saying my child’s a picky eater and the healthcare professional being concerned about the child’s eating behavior.

My thoughts is that, if a mother is concerned that her child is a picky eater, and sees it as a potential problem or roadblock for healthy feeding, it is a concern, and whether we see it on the top end of the spectrum of risk for weight loss, malnutrition, poor growth, et cetera, or whether we don’t, and the child we see seemingly seems to be thriving and healthy, If a mother deems it has picky eating as a concern, it is a concern and it is something that we need to help mom address. And I feel very strongly about that.

Meg: Absolutely, because even on the thin end of the wage, it causes so much anxiety for moms that if we can give them strategies to cope, and to increase their little one’s repertoire, we’re just going in the right direction.

Kath: Yeah, and I think one of the things is that, we have seen the escalation in the amounts of perceiving their children as picky eaters, is that they are measuring their children against much wider groups of children than what moms would do in the past. So in the past, they would really measure their children just against the mom and truck group, or the mom and babe group, or the little social group that they would interact with, or the antenatal group. Now, the moms are measuring it against children across the world, over social media, on big social media platforms and groups which has got so much wider. So, there’s a lot more noise and information out there, than for example, when you and I, who are first having our children.

So the standards by which moms are measuring where their children should be at in the eating journey has changed a lot, and their expectations has changed a lot, which is one of the areas I actually start with when working with the mom with picky eating, is to first and foremost establish what her expectations are that her child should be doing at the stage with eating, whether it’s feeding themselves, whether it’s eating every single fruit and vegetable, chewing to a piece of steak, whether—what is it that she’s wanting her child to do that she sees her child is not doing, and that’s normally my starting point, when I start helping them.

Meg: So, when you talk about these kind of individual ages and stages, are there ages where we do see little ones becoming classically more picky, and then kind of moving through it, are they kind of those, kind of little patches that really they’re at risk more, more so for picky eating?

Kath: Yeah. So, if you look across the ages, and you look even back to when we were growing up, around about the age between 18 months and three years old was that picky eating age group, and it’s normally when the child starts toddling around and starts walking. And there’s a very specific reason why children are more cautious around food, to the old, the old, old dark ages, where we had to be protective and protect our bodies, and so suddenly when they’re babies, they don’t need to protect themselves, the moms they’re protecting them, but as they are basically getting older, their taste buds, the bitter taste buds, increase the number in their mouth, and they therefore taste that bitter oils which are mostly present in vegetables and plants. And so, that is why they often go off the green plants and veggies, and it’s actually there to protect them.

Now we know they’re not going to die from broccoli, but they might look like they’re going to die from eating broccoli, and that is just instinctive mouth taste. And so, taste by training becomes really important in this age group, but it’s very difficult to do it when they visually look and perceive that broccoli as bitter, whereas they—when they were a baby, they tasted the sweetness of the broccoli, They didn’t taste the bitterness and that’s why moms all say, but they ate everything, and then they suddenly don’t. And so, that’s one of, that’s one of the physiological reasons and a more psychological, emotional reason is that they are now developing the ego itself, who am I, I actually have control a bit of my world, and the biggest area of control they have is how much food they’re actually going to ingest, because that is their full autonomy.

They can’t really decide when they’re going to go to bed, they can’t really decide about all the other things, and they do push the boundaries in everything, but the one area that they can be quite successful in pushing the boundary is in food. And then of course, as moms and dads, we get very anxious, and that we kind of show them how important food is. And that just makes it seem like it even soft, a bigger target for them to go for. So, that’s why around that age group, you do find that there is this exponential increase in picky eating, and why we need to start to put certain things into place around that age group.

Meg: So that’s fascinating. So, the one big stage then when we can expect picky eating is in those toddler years, the 18 months to three years old that you mentioned, and it has to do with our taste buds and it has to do with control issues. Is there another age and stage where we see an increase in picky eating, or is it really just a toddler thing? I mean, is there a time at around nine months or somewhere between six and 12 months where mums can see picky eating arise or is it really a toddler issue?

Kath: So, I am actually interested in that, I’ve seen it a bit early in previous years, of decades maybe, and there’s various thoughts that I have around this, I think the anxiety that mom comes to the table with, or dad comes to the table with definitely can play a role. And this is something I’m really bringing more and more into when I give talks, and when I consult, is to just ask parents to be aware and mindful of what environment they’re creating around food, because without even knowing it or realizing it, the more anxiety or busyness or activity around the feeding time, it can detract and make feed in seemingly more unpleasant for the child. And if all of us, anything that’s pleasant, we want to go towards, something that’s unpleasant we move away from. And so I think, it’s really important when it comes to eating that there’s got to be a motivation and a reason why a child would want to eat.

So, that can then have an impact earlier than 18 months in the child’s environment possibly, and then, because I think it’s also really important, we’ve given a age group range, but I think some children can develop those taste buds and be more sensitive to those taste buds earlier on, they’ve sent—their different sensory personalities as you and I discussed often can have a huge impact as well as to the pickiness and the choosing around foods. And so we mustn’t discount that, the early feeding, and I think different children respond to different methods of introducing solids. And so, if we haven’t quite understood our child, and what works for them, it might come across that they’re being picky, meanwhile, they just need a different way of actually being introduced to food.

Interlude

If you enjoy my podcast, I would like to share one of my favorite podcasts with you, The Honest Hour, Christina Masuariek is mom to two boys and a third little boy on the way, she’s an American expat living in Cape town, South Africa, since 2008, and decided to start sharing her experiences in parenting since 2017. Having grown up in a dysfunctional family environment in her own childhood, which led to her adoption at the age of 10, Christina is passionate about finding purpose and presence in parenting, as well as exploring our own opportunity for healing and personal growth, as we navigate the world of parenting our own children. Christina believes in ending the trauma cycle and that in parenting our own children, we can learn how to re-parent ourselves. So, pop on over to Christina’s podcast, The Honest Hour.

Meg: So, we’ve kind of got these ages and stages where we tend to see picky eating, you’ve touched very nicely on what can contribute to, or cause picky eating, and we’ve spoken about the bitterness taste buds coming out; we have spoken about pushing boundaries in the toddler years, you have now alluded to the sensory personalities. You mentioned something interesting there, around the way in which children were weaned, and I think there—is that plus other impacts on the likelihood of picky eating, can you talk a little bit about that?

Yeah, so I think in the past, we’ve gone through huge difference, ways of weaning children over the years from the age that we wean children, to how we wean children, we settled for many, many years on a very professional lead approach where we would kind of decide on the amount of food, periods of, gives spoonful’s of it, to then kind of a kickback to that approach, which was the baby led weaning approach where basically no food is mashed, no food is measured, babies kind of just are free to choose and eat how and what they are, what foods they’re exposed to, and both hold value and both hold risks. And I think that’s very important. And I think bringing the two approaches together with these elements of order is quite helpful, but at the same time, a level of autonomy with child can explore food because that’s what food is about.

And I actually, when we’re encouraging parents, and they’re starting their weaning journey, I encourage them to start off with exploration before we get to the very, very standard approach of a case; starting with this meal, the next meal. So, just let your child be around food, give your child a taste, a lick of your apple, mush a bit of the Batina to pop it in their mouth, let them just smell the food that’s going on in the home, if you are sitting eating, let them sit on your lap with you, see what’s going on and remembering that it’s a skill, so feeding is a skill that needs to be learned. And the more they’re around watching you eat, and watching you feed yourself, the better they’re going to be at learning that skill themselves. And I think the professional lead approach had a very much isolated feeling,

you pop the child in a high chief, separate from you; the only person eating in the house is the child at that time, and you’ve got this closed ball which they can’t see the contents of, and you feed in it. And that approach has many risks to it, In that it’s disengaged in the social impact of food, the child can’t mimic you eating because they’re not watching you eat, so they’re not learning from you with that skill, and the child is not able to participate and see. So if you’ve got a child that’s a bit more hesitant, as we call them the slow to warm up child, they’re not sure can they trust what you feed in because they don’t see you eating it. If you’ve got a child that wants to engage you socially, like a little social butterfly, they can’t engage in a joint eating,

There’s nothing worse than going out with a friend, and you said you want breakfast, and then the other person doesn’t want, and you end up eating that on your own; and you’re the only person eating at the table and it’s much fun, it’s much more fun if you’re all engaged and eating together. And for children, majority of them, that is exactly the case. So I think it’s very important that the feeding, the environment, whatever you are more comfortable with, if you like a bit more ordered approach, or if you like a bit more relaxed approach that you have your child engaged, whatever way your child needs to be engaged.

And like we often speak about the two bowl approach, where the child can participate in the feeding, either through touching the food, having the food on their little tray, or having the food in front of them. If they’re sitting on your lap, and you feed in at the same time, but very much a joint thing with them feeding and you eating is so, so important when it comes to weaning. And to set up a happy time, I really am encouraging parents to make feeding as this is a time of connection; this is a time of interaction between me and you, and I think if we make feed in more and more about that, we are going to find that the picky eating is going to become less and less over time, especially the picky eating that aren’t from a medical point of view. I’m not talking about those children that have had tragic hospitalizations, or born prematurely, or have certain disabilities that they aren’t able to feed, I’m talking about a child who has been developing, had a general normal journey, but just come in with this pickiness.

And so, having an environment where they look forward to mealtime is wonderful. And you often find in the toddler years, the sibling has come along, and so now the feeding can be one of two things, the feeding could bring attention to the toddler by being picky and difficult, and so they get their attention they feel that they’ve lost, because of the new sibling, or it could be a toddler—This is where I really say to moms and dads, use this as a time rather where it can be, where that’s your toddler’s time, where they can connect with you fully and engage with you fully, so that they look forward to meal times, because that’s when they get your attention because it’s positive.

Meg: Yeah, absolutely. Well, I mean, Kath, I think you’ve mentioned something very important there, that the weaning journey has a very massive impact on, whether or not a child will end up being picky eater as well. And I’d like to mention at this point that Kath has a course called weaning sense, which is inside the parent sense App. So if you pop onto your parent sense App, whether you’re on the freemium version or on the paid version, the courses button is there, and have a look in there and you’ll find the weaning sense course. Now, today we’re going to be doing a discount for all of Kath’s courses of 25%. You just have to use the voucher code, Kath podcast25, that’s all caps, Kath podcast25, and you can use it on Kath’s weaning sense course, and you can also use it on cat’s picky eating course, which is coming into the app shortly, probably by the time this podcast goes live, it’ll be in the app.

So, do go and have a look at that mums and dads, because there’s just a wealth of information. So Kath, having spoken a little bit about why it happens, the typical ages, and what it is, I think it’s time now to go ahead and have a look at what we need to do about it because that’s actually really what everyone wants to know; I mean, our mums who feel like they’ve got picky eaters, just want to know what they can do. So, let’s have a look at a couple of different types, one of the classic picky eating and probably maybe the most common picky eating that I come across are the beige diet babies, or the white diet babies, who just get very stuck on fried food, processed carbohydrates, and dairy; so, all of our beige and white foods. And we see that so commonly, what would you be saying to a mom who has got her little ones stuck in a beige diet?

Kath: Often with those children, where they’ve kind of avoided most of the protein and veggies and all the colors as you say, which are the veggies and fruit, there’s often at that point, depending how long it’s gone on for there could be a few deficiencies. So I always say, let’s start with doing a little bit of nutritional rehabilitation. Because if you break your leg, you might need crutches for a while before we can do get you walk in and remove the crutch. So, the crutch might be given a bit of a nutritional supplement, given a good multivitamin, and you will use that for a period of time, It’s not forever in a day, but you’re going to use that to restore the micronutrients that actually have been missing over a period of time, because the body’s very interesting, and I think it’s a survival mechanism, where the body doesn’t get something and eventually it just says, okay, I’m not going to plan on it,

so I’m not going to ask for I, I’m just not going to get it. And so there becomes this lack, almost apathy towards choosing foods, and that are what the bodies actually need in. So we actually need to give that nutrition, and then when you start to remove it, the body actually wants it. So that’s kind of the nutritional rehab just to restore that. The other thing that’s really important is, on those diet, have a look at how much sugary foods and refined carbohydrates you’re given and start to switch those over, and I think what we need to remember is that we are empowered as parents, we do actually have a lot of say in what comes into our homes, we have a choice when we go to the shop, we can make wise decisions and don’t be scared of them, don’t be scared of making those wiser choices with regard to less refined foods, less sugar, less fried, because children, they will push the boundaries, but eventually they will give in to the need to eat.

And that’s why I like to have the nutritional supplements often on board to give at the end of a day, And that could be lack a multi drink here, wherever you are in the world’s in all the countries, there will be some form of good pediatric nutritional supplement that you can use, and that’s nice to give at the end of the day, cause it gives someone peace of mind that if I’m going to put down some boundaries and maybe my child’s going to hunger strike a little bit, I will end the day with a good nutrition intake and they will be meeting their micronutrients, so I can give it a few days. And eventually you’ll see if you are consistent, and your child realizes you serious about it, and you start to create their happy environment that we’ve spoken about, they will start to want to engage and try some things new. Now, I’m not talking about putting a whole plate of broccoli and all the veggies in there, but what I’m talking about is creating first start, but just making healthy choices of the current foods that they do like.

So for example, if there are only equine bread, choose a healthier version of bread that they can start eating. If you were using a peanut butter, for example that had sugar in, change it to the peanut butter without sugar in. If they are—often a child who is a picky eater will be very happy to eat a range of sweets and chips and chocolates, so cuts out those treats altogether, and I’m really serious about that because, it’s not going to be—you’re not going to be deprived in them, you’re actually going to be benefiting them by doing that because, a recent study that came out of John Hopkins showed that by removing artificial sugars and refined sugars from a child’s diet, led them to actually seek out fruit. And they started to go towards the fruit bar, there was a phenomenal study with the large group, There were 4,000 families and they actually saw an amazing result across the board of them going for sweet of veggie and fruit from children who are not eating fruits and veggies.

So, because our bodies need sweetness, we all do but if we can get it in a form of a chocolate versus broccoli, Hey, who’s going to not choose the chocolate. Now remember for a child, they cannot distinguish the value of broccoli over chocolate, so it’s like me saying to you, Meg, if you eat broccoli or you eat this piece of chocolate, you’ll get the same amount of calories, they’re both calorie free they’re both have the same nutrition, they’re both going to do the same thing to your body you’re going to choose possibly the chocolate, unless you absolutely love broccoli, but you know what I’m saying; in their mind, there’s no differentiation between food, so they are making the choice based, purely on taste, and safety and security, what they know. So it’s really important that this advice is very much for that healthy neurotypical tip picky eater child, and they definitely will take on trying our different fruits and sweeter things that are more natural if you removing those other options from them in the beginning, especially while you transitioning on some healthier diet.

So set the boundaries, make food fun, remember your responsibility is when they’re going to eat, if it’s going to be way, so you’re going to decide on the environment; are we going to do a little picnic? Are we going to do sitting at the table I’m going to feed you? You’re going to set them up to win, so start with the familiar foods, and then have available a new food or food you would like them to have tried, or food you knew that they ate in the past, so you know that they had a taste for it and try those again. What they’re going to eat in that meal, then, and how much will be totally up to them, so you won’t be forced feeding them, but you also won’t be doing short order cooking, so if they don’t like what you present to them with, you are not going to go back into the kitchen and make another meal, because then you are basically being their short order cook, and that’s not sending them a good message, and know that they’ve got opportunities in the day to eat, so give them at least six opportunities to eat, and equally, so give them equal opportunities of not eating. When you and them engage, not eating, so do something outside of food with them so that their relationship is not entirely based on you trying to feed them, but you just engaging with them in other areas, and that they’re really, really important.

 

Interlude

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Meg: So I really love what you said Kath, and I’ve kind of broken down what you’ve said into three stages, or three phases of this. The first phase that I heard you say is, you’ve got to absolutely instantly pull back on the foods that your baby shouldn’t be having, or your child shouldn’t be having, so that’s your process carbs, you mentioned sugars, what you didn’t mention, but I know you and I on the same page is fruit juice, which babies can fill up on removing that. Watching how much milk they’re having so that the whole appetite’s not being taken up by that. So the first thing is, to get to remove what is standing in the way of them actually going for something that’s healthy.

The second stage, because that could then end up with them eating very little, and mom in a stage of absolute fear is to pop in the supplementation, once at night, not in the middle of the night, but once at bedtime only. And that just means that, if your baby, as they’re transitioning from having all these kind of calorie rich nutrient poor foods, and so you feel like they’re eating nothing you can know at the back of your mind, it doesn’t matter, we are going to give them a little supplementation bottle in the evening. And so, we rely on that, we lean on that a little bit as we remove all of the no foods.

And then, you move into phase three, which is the rehabilitation, which is giving them good, wholesome foods, they will now have an appetite watching the, watch wear and win, and not the how much; and so, all of those kind of tips that Kath gave in the last part of what she spoke about you then move onto+. And if you do these, these kind of in parallel working together, the removal, the supplementation, and then the putting in place, all the good habits you will make slow, slow, mature, transitions towards having a less picky eater.

Kath: Yeah. And I think it’s really important again, managing the expectations, because sometimes kids just get tired of eating. So I’ve developed an acronym that I use called, SME, which basically stands for Skill, Motivation and Endurance. And a child needs to have a skill at which takes time to develop, and they then need to be motivated. So, why would they want to eat, what would draw them to eat; so it would be a happy environment, would be something on the plate that appeals to them. And then over time, they’ll be able to build up their endurance, but if the skill is not a hundred percent there, you can’t expect them to be motivated long enough to build up that endurance, and that’s really important. And so, I often get moms come to me for a consult, because their child’s not self-feeding, and they’re only like 12 months, 14 months. Developmental feeding skills take a few years to really cement themselves; it takes a lot of energy to eat, feeding is like a 52 step process, and so your child needs to have the energy to be able to do that, and that’s often why breakfast is the most wonderful meal of the day, even for the picky eater, because they’ve had a rest the whole night and they’ve got all the energy, but by the end of the day, they’ve used up all their energy.

And so now, to set up straight, to maneuver utensils, to put food in their mouth, even if you still feed in, it’s a lot of chewing and it might mean having something really easier to eat towards the end of the day; so again, what are your expectations, do you want them to eat a full on colorful sensory overload meal at the end of the day, that’s going to require lots of chewing, lots of skill, and when they are tired, that’s going to be very demotivating and they’re not going to be able to build up their feeding endurance. And so it’s really important that you are able to give them their food, realistically, for the skill level that they’re at, and that they will remain motivated. So over time they will become, have a bed endurance to sit through a meal.

Meg: That’s brilliant. Kath, I’ve got a hundred more questions, which I’m not going to go through things like what to do when your baby’s gagging with everything, what happens if your baby really won’t eat anything at all, and what happens if your baby’s losing weight. And I know that these plus a lot more questions are covered in depth in your picky eating course, which is going into the parent sense app. Do you want to tell us a little bit about what that course covers?

Kath: Yeah. So on that course, we’re going to definitely be covering—we’ve covered some very general things today, but we’ll be covering all the challenges from those type of things, it’s going to be looking at the really challenging picking eater, to the general peaky eater, to children that like you say, won’t eat anything at all; how to nutritionally rehab your child very accurately, so you’ll come away knowing how to do that, and when to do that, and when to stop doing that, when to pull the easy kind of supplements and to start really trusting your child for food, as well as how do you engage with your child around meal times, how do you make meal times fun. It’s easy to say, make meal times fun, but how do you do this. How do you dialogue them around food and different skills for different ages.

What do they look like, what can you expect from your one year old, versus your three year old, versus your four year old; and then we’ll have wonderful downloads, that you’ll be able to download, and to use them to actually have a thing in place that you can even get afraid together with, and you can have some fun around food and some scenes [inaudible 00:32:10] for that child that’s a bit more hesitant to maybe touch, or try something new, we always know you have to first be comfortable with the food outside of your body, before you ready to simulate it in your body. And we have a whole lot of exercises on the course that will enable your child to be able to do that.

Meg: I’m super excited for that course Kath. And as I mentioned earlier, if you use the voucher Kath podcast, all capital letters, 25, KATHPODCAST25, you’ll receive a 25% discount off either of Kath’s courses, the weaning sense course and the picky eating course. So, Kath thank you so much as usual, just so much fabulous information, so many little tit bits of practical tips that mum’s can take away. So thank you for your time as always Kath.

Kath: Thanks, Meg. Thanks everyone.

Outro

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