Tackling Toddler Picky Eating |S4 EP103

Tackling Toddler Picky Eating |S4 EP103

The kids that we really worry about are those that continually drop foods and don’t pick up any new foods and eventually end up removing whole categories of food groups from their diets and those children are at a high risk of becoming malnourished and nutrient deficient. Well I’m quite sure the deal would be parents who that rings a lot of bells for them and that is that their little one eats a really good breakfast, has a great appetite for breakfast, eats a little less for lunch and then skips supper altogether or has no appetite. What would you be saying to them? So then you get into what I call the picky eats and vicious cycle where you have less food so you demand less.

Welcome to Sense by Megfora, the podcast that’s brought to you by ParentSense, the app that takes guesswork out of parenting. If you’re a new parent then you are in good company. Your host Megfora is a well-known OT, infant specialist and the author of eight parenting books.

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 ParentSense app and Catchmaker 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. I’m Megfora and this is Sense by Megfora and this is the podcast that helps you take the guesswork out of parenting. Each week we are joined by guests who start to uncover some of the secrets behind parenting for us.

Sometimes it’s a mum who talks about the challenges and the joys of parenting and other times it’s an expert, somebody who’s really honed their skills and got their 10,000 hours in a specific aspect of early childhood and parenting. And today we are very fortunate to be joined by Kath McGaw. Kath McGaw is a pediatric dietician.

She has worked with me on many, many of the books that I’ve worked on, the events that I’ve been part of and she’s very much part of my inner team. I consider her a partner in everything I do to do with infant feeding because she knows just so much more than, certainly than I do, but then most people do. And so Kath, we’re very grateful to have you join us here today.

Welcome. Oh, thanks for having me Meg. It’s always lovely to be here.

So Kath is the author of, Kath, how many books is it? Is it five that you’ve written or co-authored? Yeah, it’s five. Five books. And they include the books Weaning Sense and Allergy Sense, Real Food for Children.

But what were the other ones, Kath? The Low Carb Solution for Diabetics and also the Real Food, Happy, Healthy Children. Love it. Which I think is being redone, isn’t it? Yeah, yeah.

So it’ll be really awesome. Yeah. And Kath has a degree from the John Hopkins University and she keeps up to date so much so that every couple of years we have to edit our books to keep up with the latest in the literature and in the research.

And I think that’s what I love most about you, Kath, is that you really are at the forefront of what’s going on with infant feeding. And it does change a lot. I mean, 20 years ago it was introduced, started late and started with rice cereal.

And now we’re on a totally different trajectory. Absolutely. Yeah, it does.

It’s forever changing. And I think it’s exciting because we learn stuff. Sometimes we learn that what we’re doing is great.

Sometimes we learn it’s not so great. And I think we constantly have to always reassess our practice so that we always make sure we have best practice at heart. Absolutely.

And, you know, when we wrote Weaning Sense, we started to talk about weaning babies between the ages of four and six months of age. And at the time the science, well, not the science, the kind of public literature or public information was saying six months. And we started to talk about weaning babies at four months onwards.

And part of the rationale behind that was early exposure to solids to prevent picky eating later on. And so that’s actually the topic we’re going to be talking about today. We’re going to be talking about picky eating.

It’s a thorny issue. And moms of toddlers, who I’m sure are listening to this and are hanging on your every word, will definitely have experienced some sort of picky eating. I think it’s very rare for a baby never to be picky.

But today we’re going to talk about little ones who are really picky. And we’re going to talk about how to how to prevent that. So, Kath, I guess before we start talking about, you know, going through my questions that I have, how would you define a picky eater? And when is it that you think it’s within the normal range? And when is it something that parents need to worry about? So picky eating, it’s kind of, it’s got two arms.

The one would be your stage that every child will go through, and normally around in the toddler years. And they might just suddenly go off one or two foods, or they might just narrow down their categories, but they will still eat foods from every food group. And those kids we kind of know are going to just go through the phase and move on and be fine.

The kids that we really worry about are those that continually drop foods and don’t pick up any new foods, and eventually end up removing whole categories of food groups from their diets. And those children are at a high risk of becoming malnourished and nutrient deficient. And those are the ones that we flag and need to really have some treatments and assistance with.

Interesting, very interesting. So do you think, I mean, I know that you have told me before that the prevalence of picky eating is increasing, and that your practice is very full of picky eaters. Is there a way that parents, I mean, if we’re speaking now to moms who are earlier on in the journey, maybe they haven’t yet got a picky eater, but they really want to avoid having a picky eater, or their first child was a picky eater, and they don’t want their second child to be a picky eater.

Is there things that could be done early on in terms of their feeding, and particularly milk journey, and then later on their weaning journey that could work towards preventing picky eating? So we definitely know that when children are exposed to a variety of foods and flavours, and that was kind of the premise of the recipes in Wean Incense, was to kind of just get some real good flavours going and a variety going. We know that they will be more willing to accept a variety going forward. So that is the one area.

And if you are a breastfeeding mom, you do have the benefits of your child tasting the foods that you commonly eat and that you enjoy eating. If you weren’t able to breastfeed, but you were an adventurous eater, the good news is that even in your third trimester of pregnancy, your baby was getting the benefit of those tastes and flavours. So that will be something that we would definitely encourage.

The other thing is that just, I think it’s a good time, if you haven’t started weaning yet, just to reflect on your idea around food and what your relationship with food is like. Does it make you anxious? What ideas do you have? What expectations of your baby do you have when it comes to feeding? Because that also, managing our expectations when it comes to the feeding table also plays a huge role in the anxiety there and the relationship that you and your baby are going to have around the feeding experience. Because the happier that space is, the more your baby’s going to want to be in that space and the more you’re going to enjoy that space.

But if there’s this idea that every time around feeding mom is stress, mom is anxious, I don’t really like the vibes, I don’t really want to be there, the baby’s going to come across as picky, even if they normally would have eaten some of that food. So I think it is helpful just to go on a little bit of a reflection path and just ask yourself some questions around what are your expectations of your baby’s eating? What is your relationship with food? How do you enjoy food? And also just be realistic, like if you don’t ever cook veggies in your house because you don’t like veggies, the idea that now your child is going to not be like you and eat all their veggies is not very realistic. And so we do see a lot of this kind of, we call the second generation picky eaters, where they will be picky based on what they’ve observed and what they’ve seen in their home environments.

So even if a parent doesn’t eat around their child, that alone is a concern because the child needs to mimic what they see you do. And so if you’re not eating veggies ever in front of them, that why would they want to actually do that? Because there’s something common to them. Absolutely.

And you know, it’s so interesting that you say that, Kath, because I’ll never forget a few years ago in my practice in Cape Town, a mom came in and she said, look, she’s got this terribly picky eater, her baby isn’t eating, she’s got a myriad of intolerances and allergies and the family’s vegan and the mom doesn’t like having any gluten or dairy. It just was, there was this list of like, you know, this mom kind of, and I think she had studied some sort of nutritionist course and she was trying to avoid absolutely everything. And I just looked at the situation and thought, my goodness, no wonder there was this little one wasn’t eating.

There was so much anxiety around giving her food, about a hugely restrictive diet. And I could feel that terrible energy around the mealtimes for that little one. And I do think that that potentially is often, you know, as adults, we start to overthink everything we’re eating.

And particularly in years gone by where, you know, everything with gluten was the big enemy and dairy was the big enemy. And, you know, potential food groups before you even started. Correct, 100%.

And I think really not enough can be said around a happy feeding space. You know, I think it really, really is important that, you know, kids are learning to eat and it’s something new in that skill that they have to develop. And we always learn new skills when we are in a happy, kind of safe space, then we’re more open to learning.

And so that’s really how we’ve got to see feeding in the beginning in anticipation of trying to decrease the risk of a severe picky eating episode. Absolutely. So you spoke there about the psychological kind of tone that a parent sets or the happy tone that the parent may set around mealtimes.

What about introduction of flavors? You mentioned that, you know, that if you’re taking in wonderful different flavors in your third trimester of pregnancy, you know, your little one’s likely to be more recipient. What about in the early weaning journey? How quickly should we be introducing flavors, textures, and does it have a bearing on pickiness later on? So what we do know is that babies are very receptive to new flavors up until like nine months of age, and then they start to become a little bit more set in their ways. So that is why, you know, when again, when we wrote the Wean Incense book, and you and I talk a lot about this and on your app and that with the recipes, it’s always around getting in lots of flavors, lots of variety early on, not delaying exposure to them, because that really helps them to experience all the variety and different tastes that are out there.

And as that happens, so you encourage the direction of taste bud development, because taste buds, they develop, but they also increase in response to various tastes. So we do want to encourage taste to enable taste bud development at the same time, because it’s also the relationship between the different taste buds that affect the different types of foods that children eat. So for example, children that have a significant amount of bitter taste buds in their mouth will be more likely to be okay with umami flavors later on, and will be more willing to try those different flavors.

So the way to encourage those type of taste buds is the green veggies and things like that. But you can expect that when those taste buds suddenly appear in abundance, they get this like kind of insult of flavor, and they might go off certain foods for a period of time. But that is quite normal, and something that you need to just keep encouraging those foods, include the foods maybe in some hidden forms, like in sauces or smoothies, or anything like that.

And that will keep those taste buds proliferating, and your kind of taste training comes from that. So we never want to stop giving those foods, but that might be why they often pull away, and that often happens as they come into their toddler year. Yeah, and often we see them actually moving on to quite a restrictive almost white or beige diet.

So little ones who had been eating their broccoli, or had had egg, or whatever it was, and now suddenly they’re just stuck on yogurt, and all the bland colored foods. I mean is that quite common, and should a parent be worried? Because you’ve just said they need to keep exposing them to the likes of the broccolis, but if our kitties will not eat anything but beiges, how do we do that? Yeah, so it is common. So I mean we know that the stats is about 60 to 75 percent of children will go through a picky eating kind of journey at some point, and generally won’t last extremely long.

But the way to expose would be, like I mentioned, through hidden flavors. So you could even put, for example, broccoli in a baked muffin, which you can make look beige, and that is a nice way to get those oils in, at the same time training those taste buds, still exposing them, and having done away with them altogether. Because it is very common in that early stage.

I think there’s always two sides to picky eating, you know. It’s keeping them nourished, but also like allowing them space and time to go on a journey of learning to eat, of having a bit of autonomy, choosing what they want. So it’s managing that.

So it might be, you know, these are all the green foods, choose one thing from the green foods, you know. These are all the red foods, choose one thing from the red foods. So talking colors versus you must eat your broccoli or must eat your peas.

And that sometimes is a bit more exciting and engaging for a child. They’re being told to eat their broccoli. And in that way, you know that if you’re covering all the colors, you are probably covering 90 percent of your nutrients.

Absolutely. So you used a word there that I think is very important in this whole context, and that’s autonomy, you know. Because I think that what often happens when you get into a picky eating phase is that as a parent, and particularly if you’re a bit of an A type mom like I was, your hackles go up and you immediately go, well, you’ve got to eat this or you’re not going to sleep tonight and you get into a power battle.

So, you know, I think and this was a big piece that we spoke about in the Weaning Sense book was this kind of autonomy and the ability of the child to actually control certain aspects. Can you talk through, if we go back all the way to the beginning of weaning, and obviously there’s a lot of moms who are talking about baby led weaning now, in which there’s a fair amount of autonomy given to the child. Could you talk about around an ideal trajectory for autonomy? Like what autonomy can you give to a child in early weaning? What autonomy can you give to them when they are self-feeding? What autonomy can you give to them if they are a picky eater? 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.

Don’t you wish someone would just tell you everything you need to know about caring for your baby? When to feed them, how to wean them, and why they won’t sleep? ParentSense app is like having a baby expert on your phone guiding you to parent with confidence. Get a flexible routine, daily tips, and advice personalized for you and your little one. Download ParentSense app now from your app store and take the guesswork out of parenting.

So autonomy is so important and I think it’s in fairness to parents out there, autonomy doesn’t mean that you don’t do anything and they do everything. And that really, I like what you said, a trajectory. So it really is at their pace what they can cope with.

And it’s really important to remember that your baby is not capable of making wise nutritional choices, getting in volume of nutrition that they need through food in the beginning without your assistance and your help. So I think often the confusion is that baby led weaning is all up to the baby. The baby must decide on everything and you kind of just step back and go, okay, I’ll just put my hands up and list whatever goes, goes.

That’s definitely not the heart of baby led weaning and baby led kind of guided feeding. So you really want to, you want to hold your baby’s hand on that journey. So in the beginning, it will mean there will be some puree.

There will also be some handheld food and you can do those two together because your baby is still learning how to manage, to choose, to put it to their mouth. That’s a skill they need to learn. It might mean, for example, you’ve got a spoon there and it might be them taking the spoon from you and you noticing in that moment that they are able to put that spoon to their mouth or they put it to their cheek or they put it somewhere else.

So it’s just you guiding everything, you load the spoon before you give it to them. So you are assisting them with them still feeling like they’re empowered by it. And then as they get up more efficient at feeding themselves using their hand and being able to pick stuff up and direct it to their mouth very appropriately, you can allow them to have more choices in front of them and more options and more of the meal can be made up of the self feeding.

And so, and then you, so it will really be, it will move according to your baby’s skill, but you will still be ultimately the decider in when they’re going to have the feeding opportunity, what you’re going to offer at the feeding opportunity, and then how much is going to be on that space and they’re going to eat will be determined by them. Because that is you, whether you are spoon feeding or whether they’re doing self feeding, you have got no control of that. But what I do really want to highlight, which is important, self feeding takes a lot of cognitive skill, ability and energy for a baby.

So they will never take in the equivalent what they would take in if you were spoon feeding. So you have to always make allowance for that if your child is wanting to, if you are wanting to do more self feeding exclusively, you have to be aware that journey is going to take a lot longer to get to the goal where they are getting a lot of sufficient amounts of nutrition from food for milk to really take a back seat. Yeah.

And that’s always why I’ve always loved the combination feeding where mum’s got her bowl and baby’s got their bowl, because, you know, you’re ticking the box of their exploration and then, you know, kind of their autonomy and learning that kind of learning a new skill. But at the same time, you’re ticking the box of the nutrition as well. So it does work nicely.

Yeah, 100%. And then, Kath, in terms of when you do have a picky eater, so let’s say we’ve got a mum who’s got a little one who’s really not eating a lot at all. Some of it is just taking the foot off the pedal and being a little bit more relaxed about it.

But sometimes it’s not that. Sometimes our little ones could actually be at risk for a nutritional deficiency or it could impact sleep, it could impact immunity. So what I think would be the negative impacts of picky eating and how would you know if you’re in that space that you should actually be taking this seriously? So firstly, if your baby is eliminating or your toddler is eliminating a whole food group, you know, you’re going to have nutritional deficiencies because you need all the different… Give me an example of a whole food group.

A whole food group would be fruits and veggies. So they eliminate both. So sometimes a mum will come to me and say, I have a picky eater, but the child loves fruit, eats protein, eats carbs, eats fats, eats fruit, but just won’t eat any vegetables.

That child would not be at risk of a nutritional deficiency because they’re eating all their colours and a variety. But if a child comes to me and says, my child is picky, is not eating any fruits or any veggies, then definitely there’s red flags there and the micronutrients will definitely be missing in the child’s diet. If your child’s eliminating all the protein foods, and that’s something we also see with toddlers a lot because protein takes a lot of chewing work and a lot of energy.

So sometimes we can correct that with food by just giving different forms of protein in an easier to consume form. So whether it’s a nut batter, which can be mixed into porridges, whether it’s an egg, even egg white, which is the protein of the egg being mixed into a porridge, a white porridge. It’s actually pretty tasteless and it works wonders to include some good nutrition of protein.

But if you can’t make those allowances and you can’t get in those nutrients with food, then you will need to include a supplement because the risk of a deficiency from not having protein could be obviously protein deficiency, but also iron deficiency, which will have an impact on appetite. So then you get into what I call the picky eating vicious cycle, where you have less food, so you demand less. So our bodies are there to contain us and to keep us alive.

So it sends a signal to our engine of our body basically saying, shut down, go on easy. If you’re running out of petrol in your car, you’re going to free wheel as much as what you can until you get to the nearest garage. You’re trying to try and keep your gear in the lower range so that you don’t have to use up a lot of petrol.

And your kids’ bodies, they do the same. They kind of go into slow mode, which means they’re not demanding like they used to demand. And so then their appetite looks really poor.

And because the appetite’s poor, they eat less, because they eat less, the appetite gets poor. So that’s a vicious cycle. We need to break that.

And sometimes we just need to break it using a supplement, correcting the deficiencies of what they are potentially deficient in, whether it’s iron or whether it’s a multivitamin or whether it’s vitamin Bs or whether it’s protein. Protein is often one that gets missed because often multivitamins are given or iron is given, but often the protein is the issue and they need to be given protein and in a supplement form. And once you’ve done that, you start to correct that cycle and they become nourished.

And what’s so interesting is as they become nourished, they suddenly start looking for food and they start desiring food. And then as they start eating more, you can slowly cut back on the supplement. So that would be something that we would have to look at and assess based on each child.

Yeah. You know, it’s interesting what you say because I think that there would be a lot of moms who would hear that and they would go, okay, so poor appetite leads to worse appetite and you’ve got this vicious cycle that you’ve spoken about. So what I’ll do is I’ll just add in more milk bottles and my baby needs more milk at night and then I’ll cover off those bases.

And then we get into a different type of vicious cycle, which is where little ones are having maybe four or five bottles of milk in 24 hours, three at night and two in the day. That is also, I’m quite sure will contribute to picky eating as well. Yeah.

So I always say it’s not about adding more milk in because that just fills the tummy in an almost artificial superficial way. What you want to do though, is you want to maximize the milk you’re giving. So you might need to go into a different milk supplement.

So then you’re looking at a milk supplement, not in the form of just the way milk used to be in their diet. So it’s going to be a reason why you’re giving it and you’re going to give it strategically normally at the end of the day to fill the gaps for the day and to then put your mind and kind of their little bodies at rest knowing then in the night, you don’t have to give bottles in the night. So adding bottles back into the night for picky eating will not break the picky eating cycle like I’m talking about, but definitely there are times for a nutritional supplement, which can be given at the end of a day.

And sometimes at the beginning of the day, because there’s a lot of research showing that if you give a really good nutrition inputs in the beginning of the day, you’re going to elicit appetite throughout the day. And even moms can identify with that. If you skip breakfast, you can kind of skip lunch and then it doesn’t kind of matter.

But if you have breakfast by like 10 o’clock, you want your next snack because you’ve basically woken up your metabolism. So often these kitties, they hardly eat anything at breakfast. So there’s nothing waking up their metabolism.

So if you can get your kid on a bumper breakfast and that’s a good meal of the day, well, then you’re really on the right track. But if you can’t, you might need a good nutritional supplement just to start your kid’s day to get them eating throughout the rest of the day until they start getting into a better nutritional cycle. Well, I’m quite sure that there will be parents who that rings a lot of bells for them.

And that is that their little one eats a really good breakfast, has a great appetite for breakfast, eats a little bit less for lunch, and then skip supper altogether or has no appetite. What would you be saying to them? I mean, is that picky eating or is that the natural progression of appetite? I think that it’s probably a bit of both. But normally, appetite wanes as the day goes on.

The sensory system wanes as the day goes on. And technically, we would all do really well having a bumper breakfast and kind of let in as the day goes on, just less calories and intake throughout the day. Sometimes given a breakfast equivalent at our traditional Western breakfast equivalent at supper is actually quite helpful and quite comforting for a child.

It’s got a very low sensory kind of threshold. So the child is going to manage the food better, is going to just find it’s quicker to eat, easy to eat. It’s appealing to the eye because it doesn’t look full of a whole lot of colors.

And so the child will most likely get more calories in that way. And then trying to sit them through kind of a three-course meal full of colors and texture. Yeah.

Okay. Very interesting. Yeah.

So Kath, I mean, we have covered off an enormous amount on here. The one thing that I just do want to highlight is that real extreme picky eating, as you’ve discussed, where appetites are actually reducing and little ones are eating less and less. I love that illustration that you said of the car that’s using up less energy and they go into free will, maybe a little bit listless, not enough energy.

Those are not cases that parents should be self-driving. And I think it’s important in those situations, mom. I mean, I think Kath and I are very, we tend to err on the side of being more relaxed and not panicking parents.

But when your little one gets to that point that they just don’t have the energy to engage and their appetite is super low, it really is worth chatting to a pediatric dietician. Would you agree, Kath? Totally, and I think also someone to guide you with the nutritional supplements so that you don’t take overtake, you don’t take too much, you also know what’s enough, and also when to start weaning them off because that’s as important as including them. It’s like if you break your leg and you have a crutch, you know, you’re not going to stay on crutches for the rest of your life. Eventually, when your leg starts healing, you’re going to, once you actually use it so that the other muscles start working, and so you’re going to know at what point you’re going to put down one crutch and then eventually just have your one crutch, and then eventually have no crutches.

So that is the goal always when it comes to any supplementation that you’re given, whether it’s a single supplement like an iron supplement, or whether it’s a multivitamin, or whether it’s a nutritional supplement that’s got calories and protein in and things like that. You always want to do it for a season and then wean it off. Yeah, absolutely.

It does bring me around to one last point before we finish off, and that is the role of the family dinner table, and you know, I think that, you know, there’s a picture in my mind of a baby sitting in a high chair with food being shoveled into their mouth while mom is distracted, anxious around the mealtime, and there seems, when I think about that picture, it feels like there’s a lot of negative energy, and then there’s another picture I have in my head of a table where there’s noise and laughter and sharing of food and eating off each other’s plates and watching other people eat with pleasure, and that of course is the family meal or the family dinner time. At what age would you start to talk about bringing in family dinner time and what role does that have in the life of a picky eater? So I think it’s quite interesting because if you have a first-time, well, first-time mom or, you know, a baby who’s kind of the first baby of the family, they generally don’t get brought to the supper table that early on, and so you kind of have to encourage them, and I often find myself by like six months in, have you ever had your baby sat with you at the supper table and have you offered food there, and they kind of have to be encouraged to do that, whereas the second baby often just gets brought there because just logistically it’s much easier. Absolutely.

And it’s interesting because if you look at the statistics, second children are less likely to be picky eaters than your first children, so I think it has a huge role to play, and it really does, and I really encourage it from as early on, even before you start official weaning, I’m like, get your baby, because we always say one of our cues is, you know, is your baby interested in you eating, and they have to see you eat in order to be interested in you eating, and so I really do think that it’s important, and bring your child to the table, let them sit with you, by probably at every meal, but you definitely want to engage them and let them see you eating, and they love to follow, and sit on your lap, and sit on dad’s lap, sit together next to you, you know, however you want to do it, it can be very organic and fun. Yeah, and certainly, you know, I mean, there will also be parents who might be listening who’ve got much older children who are picky, you know, kind of primary school kids, and there it’s even more important, you know, and allowing them to choose off the table what they’re going to eat, and having them involved. Cath, very interesting conversation, and hugely prevalent, I mean, lots of parents battle with picky eating, if a mum wants to get hold of you because she’s in that space where she thinks her little one is really, really picky, and she’s going to need some help, how is the best way for her to get hold of you? I think the best way would be to go to my website, Nutripedes, so she can just type in Nutripedes, and there she can contact us through the website.

And that’s Nutripedes, N-U-T-R-I-P-A-E-D-E-S? Correct, yeah. Nutripedes, excellent. Well, Cath, thanks again for always being available to us, for letting the mums pick your brain, your content is always so sensible and middle of the road, but also, you know, I know that you’ve very deeply entrenched in the science as well, so thank you for that.

And mums, thank you for joining us today, you can do me a favour and go and like this podcast, share it with your friends, the more people that listen, the more it gets shown to other mums, and that’s really important for us that our work is shared. So, thank you for joining us today, and thanks again, Cath, goodbye. Thanks, Meg.

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.