Month 16 Worry: What to Do about Picky Eaters
What’s the Issue?
Toddlers are creatures of habit. They crave routine and buck the system when their routines are disrupted. So how do you take a routine-driven toddler and vary his diet? It seems an inherent contradiction.
The following is an excerpt from a typical 16-month visit:
“So Mrs. Jones, how is Mikey doing with his variety of foods?”
“Well, he is very picky these days. He always picks at breakfast. So later I’ll offer him a morning snack. He won’t eat then either, so I’ll make him some macaroni and cheese, because he likes that. Then I’ll make him lunch. He won’t eat it … so I’ll make him some macaroni and cheese. At dinner, I’ll make him a well-balanced plate and he won’t eat it!”
“So what do you do?” I ask.
“Well, I usually worry that he’s not had enough to eat that day, so I’ll make him some macaroni and cheese.”
It is usually just at that moment that Mrs. Jones realizes the major flaw in her dietary plan.
Consumption of nutritious foods is a growing problem in the United States:
- 25 percent of toddlers don’t eat at least one veggie on any given day.
- 73 percent of children do not get offered a vegetable with dinner.
- In a US Department of Agriculture (USDA) survey in 1994, 83 percent of Americans ate at least one veggie per day, but French fries and potato chips counted!
- Only nine percent of Americans eat one green vegetable daily.
- 96 percent of children do not eat the minimum recommended serving of fruits and veggies per day.
What is the recommended nutritional intake for toddlers? According to the USDA’s MyPyramid nutrition guide, the average active one- to two-year-old requires, per day:
- 500 mg of calcium (found in about two cups of dairy)
- one cup of fresh fruit
- one cup of fresh veggies
- about three ounces of grains
- about two ounces of meat or protein
(Remember these calculations from when you reevaluated your child’s dietary needs at age 12 months? 1 ounce = 2 tbsp; 8 oz = 1 cup )
Another growing problem is our children’s weight. Thirty-two percent of all US children are overweight. That number is rising.
What Parents Can Do
Dietary tastes and habits start early, so what your child eats and the options he’s given in the toddler years help shape eating habits that last the rest of his life. (No pressure!) Our goal as parents should be variety and balance, but how do you force those servings of green vegetables past the nose that your toddler is now turning up?
Catch them when they are their hungriest. I’m not sure about your house, but when dinner is being prepared in our kitchen is the hungriest time of day for my kids. Waiting that extra 15 minutes for dinner to be cooked and placed on the table is the exact time when all my kids are expecting to perish of starvation. So we are ready with the vegetables! Canned peas and carrots in a bowl to pick at for infants and young toddlers, cut up veggies with a low-fat salad dressing dip, and pureed veggies in a bowl with crackers or unsalted bread sticks to dip with are all fun finger foods for most toddlers.
Cook with stealth. Those same pureed carrots, the ones you haven’t used since infancy, can be dumped into Mikey’s macaroni and cheese. You can’t pick them out and it doesn’t change the color dramatically. Veggie breads often work with toddlers: Consider spinach bread or zucchini muffins. (Rachael Ray’s recipe for them is yummo, but don’t include the pistachios. No nuts for kids until they can spell them!)
I have a Dad in my practice who is a chef. His kids love milk but hate their veggies. He has learned to steam their veggies in milk instead of water and his kids love them! (Nothing I would have thought of, certainly!)
Set a good example. Not infrequently I ask parents point blank, “Do you eat vegetables?” “Nope, can’t stand them.” Well that’s a problem! We all know that toddlers watch and emulate every move we make. This can make a slip of the tongue when you are cut off in traffic with your kids in the back seat very dangerous. But it can work in your favor, too. A child who sees Dad yumming up his green beans and happily finishing off the end of the bowl will be infinitely more likely to try them himself.
Have reasonable expectations. A serving size is small in a young toddler (the size of the palm of his hand). You should neither expect him to eat a full sandwich nor a whole banana. And one decent meal a day is pretty good for most toddlers. If you can catch that wave and maximize variety at that meal, you have done your job.
For kid-friendly recipes and a neat produce tracking device, check out the Fruits & Veggies—More Matters™ site from the Produce for Better Health Foundation. Also, the Centers for Disease Control (CDC) recipe database lets you search by any ingredient you have to make a nutritious family meal—neat!
What the Doc May Do
Your pediatrician’s job is to monitor general nutritional requirements and to follow your child’s growth curve. A dietary history should be obtained at every well visit. A child who is not eating large quantities of food yet is growing perfectly well on his curves is reassuring. On the other hand, I will often have concerned parents in my office who swear their child is eating nothing, yet their growth curves prove them to be obese. The reasons for this are perceptual and societal, and it is a growing concern of pediatricians nationally. And by all means, minimize or eliminate fruit juice. It has limited nutritional value and is taking stomach space meant for more nutritious foods.
What about vitamins? Most doctors will say that vitamins are not necessary. Although this is a controversial issue, I feel that vitamins have a few significant downsides to consider.
- First, there is little or no scientific evidence that a daily vitamin in an otherwise healthy child is medically beneficial, except in very specific situations.
- Second, multivitamins with iron are one of the top causes of poisoning in the United States. One Scooby Doo chewable a day may be okay, but the one time your toddler gets into the bottle and eats twelve … hello, Poison Control (1-800-222-1222)!
- Lastly, vitamins give parents a false sense of security. I have no study to back this up, but I believe that parents who give a multivitamin daily don’t try as hard on their child’s dietary variety as those who don’t give a vitamin.
Expanding your child’s limited diet is a full-time job, and there just are no short cuts to a balanced diet.
More 16th Month Health Help
Even the most confident parent has concerns about her child’s health and wellness from time to time. Learn more about which medical issues are most common at each age, here. (If you have any pressing concerns or questions about your child’s health, please check with her healthcare provider.)
- What was last month’s most popular health worry?
- Learn which medical question you might have next month.
- Here’s what else is happening with your child’s health and development this month.
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