“Help! My Child Isn’t Eating at School!” 8 Fuel-at-School Tips for Picky Eaters

School has started for some of us, and will start for the rest of the country soon! A big worry for parents of picky eaters, especially those with more extreme picky eating and anxiety, is what happens at school around food. We get emails with a variation on this theme all the time: “My son is six, we’ve struggled to get him to eat enough his whole life. It’s all worse at school where he is already anxious. He has twenty minutes, and lunch staff try to make him eat which makes him upset. They threaten to take away recess time. He comes home with his lunch untouched most days and is understandably crabby when I pick him up.” Government programs address child hunger, often through schools: from breakfast in the classroom to free and reduced lunches, millions of children are getting fuel for their day. But what about the “hidden hungry”? The kids these programs can’t help? There are hundreds of thousands of kids heading to school every day from homes with enough food and resources. But they are too distracted, anxious or scared to eat.     Helping Your Child with Fuel at School Gather information How much time does your child have to eat? Can he open containers on his own? Is temperature an issue? Does he prefer foods hot, warm or very cold? Is lunch right before recess, so he’s eager to get outside to maximize playtime? Is he eating in his snowsuit or carrying gloves, or has a hat that gets in his way? Are adults or other children pressuring him to eat? Ask him...

Musings on Anxiety, Sensitivities, and Extreme Picky Eating

Earlier this week, a study came out linking moderate and extreme picky eating with anxiety and depression in children. It has caused quite a stir in the media, with headlines like, “Is picky eating causing depression?” That grabs attention! With one in three parents describing their child as “picky” at some point, the reporting on this study has probably caused more anxiety.  Quick answer, no, typical picky eating, which impacts one in three kids at some point, does not lead to depression, anxiety or ADHD, nor was it associated. A small percentage of children have severe or moderate selective eating which were the two groups associated with anxiety and other concerns. Of note, this study, like all studies had some limitations. Among them, it was voluntary (meaning some parents opted not to partake which could alter findings), and the study followed a portion of the children for a few years, not to adulthood, and didn’t take into account how the challenges were addressed among other factors. The study itself doesn’t claim that picky eating causes depression, another example of how the media distorts science. Here is a nice summary of the study, and below are some more thoughts that we (Jenny and Katja) had on the issue to help parents unpack these scary headlines.   IS picky eating causing anxiety and depression? Do you see anxiety in children with more severe picky eating? This study found a correlation, not causation, between moderate to severe picky eating and other conditions like anxiety and ADHD, which has been suggested in other research. It does not mean that picky eating causes depression or anxiety...

Doctors: Support Parents of Children with Picky Eating (from Typical to Extreme)

We were so excited to see this recent article, A Practical Approach to Classifying and Managing Feeding Difficulties (Kerzner et al. 2015) from the Journal of Pediatrics. It does a great job of providing an overview of feeding challenges: underlying factors, screening, red-flags, and a user-friendly format for primary care providers who are the front lines on this issue— most of whom receive little to no training in feeding challenges. This paper provides an excellent overview. Here are our summary points for clinicians: 1) Take every worry and complaint about picky eating seriously before jumping to reassurance. “…pediatricians must take all parental concerns seriously and offer appropriate guidance.” Parents may do well with reassurance and a handout, or they may need a referral to specialist care. You can’t reassure parents without listening to and addressing their concerns. 2) History, physical exam, potential lab tests, and red flags are discussed and help determine severity and what general category challenges fall under: misperceptions of typical variants, low appetite, medical/organic, selective, sensory, fear of feeding, and feeding style. This helps guide referral and treatment. Some sample red flags: using distraction to increase amount eaten, prolonged time at the table, gagging or coughing/choking, significant conflict, history of choking, or forceful feeding. “When it is apparent that a potential feeding difficulty exists, a complete history and physical examination, including carefully done anthropometrics and a brief dietary assessment, are necessary with special attention to serious red flags…” 3) Assess parents’ feeding style by asking parents how feeding is going, what they worry about, what they do if they think a child needs to eat more...

Milk is Food: Improving Appetite for Toddlers with Picky Eating

Lately, we’ve been getting questions from parents whose toddlers are struggling with poor appetite for solid foods but eagerly take a bottle or want to nurse around the clock. Cow’s milk (or a milk alternative) is a recommended part of a toddler’s overall diet, and many toddlers continue taking formula or breast milk into the second year of life. Some children may need a more fortified liquid supplement like Pediasure if growth has been poor. The American Academy of Pediatrics recommends that low-fat/reduced-fat milk not be started before 2 years of age, and at age two, toddlers need approximately two cups of dairy per day. (And if your child prefers whole fat dairy, serve what he likes. There is no compelling evidence that low fat dairy reduces the risk of being overweight down the road.) A common problem with milk occurs when the amount he consumes or the timing of consumption interferes with appetite for other foods. Not only can nutritional variety suffer, but crucial early experiences eating a variety of foods can be missed. Whatever type of milk we are talking about, it is digested in the same way as food, and contains filling fat and protein. There’s only so much room in that toddler tummy! Let’s be honest. We all prefer the path of least resistance, and children are no different. Drinking most of their calories is just easier for some children. The comfort of being in mom’s arms, the soothing nature of sucking, and the ease of just swallowing- and not having to chew- are all reasons why some toddlers can have trouble transitioning to a more...

“But It’s Healthy!” The Lure of Nutrition Talk and How it Fails with Extreme Picky Eating

We had a little boy over for lunch recently. His mom asked what I do for work and when I told her, her eyes lit up. “He’s so picky! Maybe you can get him to eat something!” From the spread at lunch, he happily stuck with bread and butter, and we had a lovely time. (I won’t make your child eat vegetables, that’s not how it works.)  During the meal, this six year-old shared that he LOVED his grandmother’s “homemade chicken soup” that was “organic, from scratch and has no chemicals in it!” When I delivered him back to his RV (we are living/traveling/working in an RV across the US this year) I shared his story about how much he loves Grandma’s homemade soup. His mom rolled her eyes. “Campbell’s” she said, “…from a can.” Small Children Can’t Understand Complex Nutrition Messages We chuckled and it reminded me of a conversation I had with my then almost four year-old. “Mom, is lettuce protein?” When I asked why she wanted to know, she explained that every day at school, the children had to all share what “protein” they had in their lunch. The following year in kindergarten she was teased by two classmates for choosing 1% milk, “You’ll get fat! It has fat in it!” What do these stories have in common? They illustrate how small children pick up on nutrition messages and words, and while they may seem to understand, in general they don’t. It doesn’t help their eating to try to use nutrition messaging as a way to get them to eat more or different foods. It’s another form of...

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