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Picky Eaters

Brought to you by: Childcare Network

What we will cover

Eating issues

Jags

Picky eaters

Problem eaters

Factors

Temperament

Genetics

Parenting style

Stage of development

Goals based on the childs needs and our capabilities

Quality of diet

Quality of mealtime

Aiding proper development

Carrying out an action plan

Methods

What is a picky eater?

picky eater:

child who has begun to eat limited number of food choices for several weeks
to months

made distinct by the length of time

food demanded to be prepared one way i.e. must be fried, a certain color,
accompanied by a certain condiment etc.

Becomes upset and or does not eat if meal contains other foods alongside preferred
food

Eats the desired food when available then refuse to eat when other meals are
served.

Food Jag

will usually last about 3 weeks at most

Category

Picky Eater

Types of food child eats

30 or more

Food Jags

Foods not eaten for a


period of time are usually
re-adopted

Acceptance to new foods

Will touch or taste it.


Allows it on their plate

Categories of food texture

Eats at least 1 food from


different texture category

Family/group Meals

Eats different food but


alongside family food

Steps to new food

15-25 steps to eat new


food

Parent report

Sometimes reported as
picky eater

Combination of Factors
Genetics
of taste

1. Genetics of Taste
Sensitivity to certain flavors that each
person is born with
These taste sensitivities change very
slowly through training

Genetics of taste

Overall, humans prefer sweet & slightly salty


reject sour & bitter foods, especially children.
Genetic taste preference vs learned preference

Genetic sensitivity can be overridden through

Alteration of food to neutralize or mask disliked flavors

Aside from these points, there is no evidence that a child cannot learn to like
a new food

they are not inborn with preference

shaped by the environment in which they learn about new food

2. Temperament
The behavioral style of
the child to given
circumstances

Temperament

You will already be familiar with most of your childrens temperaments and actions

Easy - 40%

adapts to regular schedules & accepts new foods

Difficult - 10%

slow to adapt and definitely negative to new foods

Slow to warm up - 15%

slow adaptability, negative to new foods but can learn to accept new foods

Intermediate low or high (mixed behaviors) 35%

Slow to Warm Up and Difficult children may need 810 exposures to new foods before
acceptance

If the food is not offered they will never learn to accept a new food

3. Parenting style
Methods and attitudes
towards the child that
influence their behavior

Parenting style

Parents and caretakers have tremendous influence on childrens development of


appropriate eating, physical activity, and other health behaviors and habits formed
during the toddler and preschool years.

Lessons transferred by example and attitude conveyed from parent or caretaker

Both positive and negative aspect

Food intake related to parents or caretakers preferences

Feeding and growth concerns for infants and toddlers

are common in all cultures


families will respond to this in various ways (parents telling childcare providers which way
to feed)

Style should be the same for all children

High

Respons
ive

ness

Behavioral control,

Low

warmth
, suppor
tiveness

Demandingness

High

Low

Qualities valued and methods used

Authoritarian

Qualities Obedience, Structure, Rules

Methods Punishment, Demands, All or nothing Expectations

Authoritative

Qualities Standards, Self-regulation, Flexible but Assertive

Methods Guidance, Support, Enable

Uninvolved

Qualities Distance, Disinterest,

Methods passive neglect, absence, Unaware

Permissive

Qualities Lack of structure, guidelines, roles, or goals

Methods Appeasement, over-involved, avoids direction, indulges

4. Stage of Development
Physical, mental, and emotional
development of the child that varies
for each child

Toddlers and Preschoolers

Picky eating begins in these age ranges but does not cease once the child grows

Toddlers (1-3 years old)

Remember that with toddlers, growth may plateau while eating patterns are changing

As a toddlers growth rate slows, their appetite decreases. Usually after 2 years old, they will gain ~5 lb and 2 inches
per year

Around 2-3 years old the child needs to develop a sense of personal control

Preschoolers ( 3 or 4-5 years old)

Child begins to assert control over their environment

Toddlers

Feeding skills:

Gross & fine motor development improved

12 - 24 monthsweaning from breast/bottle to cup

12 monthsrefined pincer

18-24 monthsable to use tongue to clean lips & has developed rotary chewing

2-3 years- feeds self using fingers, spoon, and cup. Spills a lot. Have a favorite food

Adult supervision vital to prevent choking

Feeding rituals of toddlers

Rituals in feeding are common

Likes the food in a certain bowl and or during a tv show

May have strong preferences & dislikes

Food jags common - can occur when growth is not occurring due to decreased
caloric needs

How to provide:

Serve new foods with familiar foods & when child is hungry

Have the child watch you eating the food or others

Appetite and Food Intake of Toddlers

Nutrient-dense snacks needed (animal crackers, salted crackers will not fill
up)

Provide new snacks, kids will become bored

To ensure hunger for meals:

Avoid grazing including with juices, not allowing kids to eat alone, provide water

Having snacks too close to meal time (within 2 hours)

Toddler Portions:~ 1Tablespoonfor


each year of age from each food group.

Ex., 2 y.o. is offered

2 Tbsp of starch
2 Tbsp of protein
2 Tbsp of vegetable

Minimum amount for each type of food

(rice)
(beans)
(Tomatoes)

Preschoolers
Growth increases to 4-6 lb per year and 2-3 inches
Feeding Skills

Able to feed self and drink from cups neatly

Eventually moves to knife and fork by grade school age

Feeding Rituals include:

Hunger related to growth

Hunger increases prior to the spurts of growth

Some kids will go through growth earlier or later than other children

How to provide:

Can include child in meal selection & meal preparation; at home and at day care

help add and stir ingredients

give 2 appropriate choices (i.e., what vegetable to add to salad or what cereal
for breakfast)

Growth - continued

Five to six years

same rate of growth

Six-year permanent molars appear

Begin to lose front baby teeth

Prefer plain, bland, unmixed foods

Six to Nine Years

Further teeth development

Nine to Twelve Years

Appetite is increased

Girls growth spurt begins

Irritable when hungry

How does picky eating affect the child?


Emotional, Behavioral, and Physical
Self expression the need to develop a sense of self
Sense of control and independence leads to feelings of autonomy
They need support in transitioning from toddlerhood to pre-schooler
Avoid power struggles will make meal time a negative experience

Why picky eating is an important issue to overcome


Learning to enjoy new foods and developing feeding skills are important components of this period of
increasing independence and exploration.
It is one of the main concerns parents bring to their pediatricians
During toddler and preschool years, adequate nutrition is required to support cognitive and physical
development
Prevention and treatment of overweight and obesity

Of

children ages 2-5:

10.4% are overweight (BMI/age >95%)

20.6% are at risk for overweight (BMI/age 85%-95%)

BMI

is lowest from ages 4-6 years

Adiposity

declines

reboundnormal increase in BMI that occurs after BMI

When is picky eating


confused with or
evolved into Problem
eating?

Goodness of
fit

Sensory
based
eating issue

Genetics of
taste

Picky eaters vs Problem eaters


Behavioral
Category

Picky Eater

Problem Eater

Range of food

30 or more

20 or less

Food Jags

Foods not eaten for a period of


time are usually regained

Food lost is not regained

Acceptance to new foods

Can touch or taste. Allows it on


their plate

falls apart with new food

Categories of food texture

Eats at least 1 food from different


texture category

Refuses entire categories

Family/group Meals

Eats different food but alongside


family food

Always different food than family

Steps to new food

15-25 steps to eat new food

More than 25 steps

Parent report

Sometimes reported as picky


eater

Always reported

Identifying Problem eaters

As we saw from the chart

Have similar issues with picky eaters

Aversion or avoidance of all foods in a specific texture or nutrition group

Delay in transition from soft to solids by 1 year

Less than 20 foods, losing foods, not picking up new ones

Cries during meal

Problem eating be a difficult issue to overcome and can continue into later
life leading to health issues or poor quality of life for the person and those
who care for them

Causes of eating problems Being aware of


issues a child may have, communicate with
parents

Oral motor feeding problems

Difficulty with mixed textured foods, preferring only crunchy or soft

Oral motor weaknesses with chewing, sucking, tongue movements

Choking/gagging with trying non-preferred textures

Tongue thrust

Other medical issue causing stomach discomfort

GERD (gastro-esophageal reflux disorder), delayed stomach emptying, chronic


constipation

Sensory-Based Feeding disorders

Dental Issues

Swallowing issues

food sensitivity -such as dairy or gluten

Being aware of physical symptoms that


may be displayed

You may see these traits that help you identify problem eating that now has
caused issues with the child

Some issues will not be obvious, like deficiency, until they are advanced

When the child is underweight/not following growth curve

Concerns about micronutrient deficiency (Fe, Ca, vitamin D)

When extreme or prolonged

Overweight obesity

Iron-deficiency

anemia

May cause delays in cognitive development and behavioral disturbances

Child seems tired

Being aware of physical symptoms that


may be displayed - continued
Constipation

Causes of constipation: Stool holding, inadequate fiber and fluid in diet and inadequate activity

Adequate fiber

1 and older

Use the childs age then add 5 grams of fiber OR 14g/1000kcal

Ex. Age=5; 5 years old+5 gram of fiber = 10 grams/day

Ex. 1300kcal needs = 14 +~5 grams = 19gms/day

Dental Carries

Children who do not want to drink water during the day, only juices or milk

Prevalence:

1 in 5 children ages 2 to 4

Causes:

Drinking juice from a bottle

Bedtime bottle with juice or milk

Carbohydrate foods in mouth for >30 minutes

How does picky eating affect you


as a childcare provider?
Increases your work by:

Cooking personalized meals for a child (Short-order-cook)

Puts you off schedule for meals

Requires you to chase after/entertain picky eating children

Wastes food if the child is not eating

TIP:
Cater to the childs
imagination.
Giving a name creates
ownership and pride
Introduce new items one at
a time
i.e.
1. Broccoli
2. Broccoli w/ butter
3. Broccoli w/ cheese
4. Broccoli w/ cheese and
chicken
5. Broccoli w/ cheese and
chicken and rice

Show the child that the


source of these flavors can
be just as delicious.
1. Strawberry Ice cream
with small bites of
strawberry mixed in
2. Strawberry Yogurt with
strawberries mixed in
3. Plain yogurt with
strawberries mixed in
4. Strawberries

Make kids more aware of


the variety of good tasting
vegetables available.
Use what they like to
expand what they eat.
What can salsa be paired
with that this child might
not like if it was not
seasoned?

Be aware of strong
dislikes.
These foods can be
introduced later on or in a
different form rather than
throwing them into the
meal hoping the child will
not notice.

Methods

Psychological stages 8 to 14 months

CHILDS TASK = learn to explore their world and manage separation anxiety at
the same time. The child controls HOW MUCH and WHETHER to eat.

However, children are not born with the knowledge of what they should eat

PROVIDERS TASK = encourage new initiative in self feeding and allow


exploration of foods WHILE providing structure, routines and safe boundaries.
The care giver controls WHAT and WHERE to eat.

Division of Responsibility

Ellyn Satters DOR (Division of Responsibility in Eating)


Provider is responsible for WHAT, WHEN and WHERE
Child is responsible for WHETHER and HOW MUCH
Children have an innate ability to self-regulate food
intake.
BUT
Children are egocentric
Cannot understand that something is good for
them if it tastes bad or does not appeal to their
senses (texture, sight, sound, smell).

Psychological stages 18 to 30 months

CHILDS TASK = to undertake body management more


independently.
May express dislike for foods
Assertion of self by doing things differently and by self

Provider's TASK = maintaining a positive relationship and


teaching the concrete components of learning to eat and
social interaction at meal time VERSUS on how much food
gets into the child.

Mealtime

Mealtime structure maintaining the mealtimes that you set for children

Even though a child may not be hungry, keep them seated with the rest of the
children during the meal keep them involved with the meal

They may not want to listen/become confrontational

Allow the child to self feed if able provide proper utensils

Dont worry about the mess

Be a model for the child

Sit with the children

Eat the same food

Avoid distractions - no TV/phones/toys/books

Avoid Distractions for yourself too!

Ask parents not interrupt mealtime

Foods to provide

Foods that are easily chewed for those under 4

Steamed carrots vs raw

Tough foods can present a choking hazard

Provide new foods with known foods (foods they will eat)

Continue to expose the child to new foods several times, through each meal
of the day once, and in different forms

Be aware of the childrens culture- try culturally diverse food

Vegetables on the plate vs vegetables in a stew vs vegetables in rice

(Examples)

Variety

Offer new foods with a different


dressings/condiments/toppings/colors/texture/temperature/utensils

It is more likely they will find a pairing they like

Avoid these choking hazards

Raw carrots

Large sections of hot dogs

Raw celery

Raw cherries with pits

Whole grapes

Round, hard candy

Peanuts and other nuts

Amount

Appropriate portion sizes are important, but when it comes to new foods,
having the child try even a bite is a success

Serve sampler platters different fruits and vegetables

just like at a normal party or family style


This practices self-service

Avoid encouraging child to clean your plate

Children adjust caloric intake to meet caloric needs naturally

Time
As

we said before, offer new foods when the


child is hungriest, at the beginning of the meal.

Offer

food at intervals not less than 2 hours &


no more 3 hours, However, DO NOT BE AFRAID
IF THE CHILD DOES NOT EAT

hungry child will eventually eat

Continue

to offer the foods over time, dont


become discouraged after a few failed
attempts

Dont

force the child to sit and eat everything


or beyond the time when everyone else has
finished the meal

Teaching
Healthful
WHAT

eating habits must be learned

IS THIS STUFF? Proper table manners

Gradual

desensitization what is it?

introducing

new foods to the senses

Visual

Smell

Touch (temperatures, textures)

Lips, teeth, tongue, bite

Dont write off a child as someone who doesnt eat i.e. Broccoli

My Pyramid for Kids


Teaching the children about my plate will help them visualize their meal in a different
way
Teaching yourself about the needs of the child
- Malnutrition can occur at low levels for long periods of time (reference the copies you
made)
Most toddlers and preschool-age children have adequate vitamin & mineral
consumption except for

iron

calcium

zinc

http://www.cnpp.usda.gov/FGP4Children

Development of the child

Working with the child on meeting the expectations of growth

Being able to use utensils and cups

Sitting for the meal

Not playing with food

Reference the sheet

Working with Parents

Making parents aware of your efforts and childs progress

Alert the parents of any concerns you have, perhaps it is something they knew
about but did not mention

Encouraging the parents to work with the child at home

Creating a nutrition Board

Create a bulletin board for the kids to see when they come into the day care

Post menu items you will be providing and include pictures so that they can

see what to expect

Post the food art that the children have colored

Create activities for children to decorate the board

For example: if you are serving broccoli for dinner, make the afternoon activity to cut out
little broccoli men to post on the board

Have the kids try to wear the color of the food that will be introduced to

For example: if they are eating carrots, wear orange

Being creative with food


Exposing a child to a new food in a different way just a few times can
condition them to request these items instead of dreading them.

Begin by introducing
the food in a playful
way

And then work your


way up to simpler
presentations

Showing Kids How They Are


Growing

Posting the growth chart can teach kids the importance of

eating healthily in order to grow big & strong to motive them

Creates a positive connection between their nutrition and


growth

Visual progress is easiest for them to understand

Have the kids see you mark their growth on a piece of paper
for them to take home

Skills the children can and want to use

SEE KITCHEN ACTIVITIES SHEET

2 years old

4 years old

Peel eggs and some fruits

Set table

Wipe tables

Measure dry ingredients

Throw things into the trash

Assemble sandwich

Tear lettuce

3 years old

5 years old

Measure liquids

Add ingredients

Cut soft fruits with a knife (dull)

Scoop, stir, squeeze, knead

Name and count food

Use egg beater (with assistance and


monitoring)

Expecting Results

Sample Meal/ Practice

11:45am

Tell the children it is time to eat

Child stop playing and wash hands in preparation for the meal

11:50am

Table is set

Everyone is seated

11:55am

Food is served

12:00 pm

Meal Begins

Behaviors and Responses

The child may display a range of temperaments from easy to difficult

Different children will take up new foods more easily than others

When a child is refusing to eat, it may seem impossible to coerce, force, or


charm them into consuming what you are putting on the table especially
when the child or children behave by:

Crying

Hiding

Wasting time playing

Recruiting other children

What are some of the behaviors you have seen?

HOW DO WE DEAL WITH THESE ISSUES

Review and Summary

Review and Summary


So

what is a picky eater?

What

are causes of picky eating?

How

do we know a food jag from a picky eater


from a problem eater?

What

are the problems we can see arise from


picky eating?

What

can I do about picky eating?

Toddlers

Serve new foods with familiar foods & when child is hungry

Toddlers imitate parents & older siblings

Preschoolers

Creating new ideas

The double-edged sword of milk

Limit milk consumption to 24 oz./d (3 cups) since milk is a


poor source of iron

Why?

Child fills up on milk, no long has an appetite for other


foods

May be being provided too much too soon child is not ready
for so much food which doesnt leave space to create a
balanced diet

Offer heme iron food sources (beef, chicken, fish) and nonheme iron containing food sources (grains, legumes)

References

Nutrition Now Judith E. Brown Nutrition for the Growing Years: Childhood through
adolescence

Nutrition for the Toddler and Preschooler (2014) -Patricia Miner PhD. RD.

The Science and Culture of Picky Eating When to Worry and What to Do (2012) Dr. Ruby Roy

Addressing Picky Eating: Strategies for Success (2013) Molly Holland, RD, MPH, CD American Dairy Association and Dairy Council, Inc. & New York State Dietetics Association

My pyramid posters http://


www.cnpp.usda.gov/food-guide-pyramid-young-children-graphic-resources

My Plate Coloring - http://www.foodpyramid.com/myplate/for-kids/

Maze Sheet - http://www.choosemyplate.gov/kids-activity-sheets

Behavioral Milestones sheet - http://


www.choosemyplate.gov/health-and-nutrition-information

Picky Eaters Sheet, Picky Eaters Tips, Kitchen Activities. http://www.choosemyplate.gov/preschoolers-picky-eating

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