Monday, November 14, 2011

The Picky Eater

My parents are preparing a traditional Thanksgiving dinner for the extended family this year.  They're excited to have all their grandkids at the table, but also a bit nervous, as they're venturing far outside their Chinese food comfort zone.  I've warned them, though, not to feel hurt if my 6-year-old daughter eats nothing but mashed potatoes.

That's right, despite our vibrant heritage of Chinese-American gluttony dating back to the Ching dynasty, my family has been cursed with a picky eater.  

In-n-Out started her down the road to perdition.

There is no universally accepted definition of what makes a fussy eater, but most parents say they know it when they see it.  Nutritionists and psychologists distinguish between two related conditions.  Food neophobia is defined as the fear of trying new foods.  It's thought to be an evolutionary vestige from our Neanderthal days, when eating something new, particularly a plant, carried a risk of poisoning or illness. Food neophobes will often reject a new food based on sight or odor alone, refusing to even taste it.  Neophobia starts at age 2, when the child becomes more mobile and hence, less supervised, and usually ends at around 6 years of age.  Picky eating, on the other hand, is the refusal to eat even familiar foods.  Picky eaters may be more willing to taste new foods, but will regularly eat only a narrow range of items.  Picky eaters gravitate towards carbohydrates and away from vegetables and protein sources.  Unlike food neophobia, many picky eaters do not outgrow this tendency.  In reality, there is a great deal of overlap between food neophobia and picky eating, and many kids have both.

Up to half of parents claim to have a picky eater in their family.  The health consequences of picky eating aren't clear.  Some studies have shown a lower body mass index in picky eaters, while others have found the opposite.  Picky eaters tend to take in fewer nutrients and vitamins, though frank deficiency is rare.  And one study, which followed children over an average of 11 years, found that picky eaters have more symptoms of anorexia in later adolescence. 

Scientists aren't even sure of what causes some kids to be picky eaters.  Twin studies suggest that about two-thirds of picky eating is genetic, rather than environmental.  Part of this may be due to a known inherited variation in the ability to taste bitterness in vegetables; those with higher sensitivity may be more likely to avoid veggies.  Picky eating may also associated with higher rates of anxiety.  Regardless of the underlying cause, meal times can often deteriorate into a battle for control, further exacerbating the pickiness.

My daughter Sarah's all-time record was being forced to sit two hours at the dinner table with an unwanted pork chop in her mouth.  I finally gave up when she started nodding off.  If she was going to choke on something in her sleep, I wanted it to at least be a vegetable.  Otherwise, what would the neighbors say?
There are studies examining ways to diversify the picky eater's diet.  The French, naturally, are on the cutting edge of gastronomical research.*  In schools in Dijon, half of 9-year-olds were assigned to a weekly 90-minute program to train their tender young palates.  The sessions included lectures, cooking workshops, and a field trip to a restaurant (though contrary to stereotype, no wine tastings).  The children were surveyed before and after the program, and presented with unusual items, such as leek sprouts and dried anchovies, to taste.  Kids enrolled in the program were slightly more likely to sample the offerings.  Tant pis, ten months after the program ended, the reduction in food neophobia disappeared and returned to baseline.

Of course, this study is unlikely to be of much help to those of us in the States, where schools are dealing with budget crunches by dropping frivolous subjects, like long division.  So what's a beleaguered parent to do?  Here are some tips:

Munch on a carrot while breastfeeding your baby.  (Or better yet, drink a Bloody Mary -- read my post on drinking while nursing.)  Breastfeeding is associated with lower rates of picky eating.  It's been well-established that many flavors from a mother's diet are transferred to her breast milk -- which may explain, for instance, why Indian babies have no problems tolerating curry.  There's weak evidence that consuming carrot juice while nursing increases an infant's acceptance of carrot puree.**  Although there are few studies on this topic, there are plenty of other good reasons to nurse.

Don't reward your children for eating healthy food.  Multiple studies have found that if you reward a child for eating something, she will eat more of it in the short term, but she'll end up disliking and eating less of it in the future -- the thought being, "If Mom has to give me a prize to eat this green bean, it must taste terrible."  Even verbal praise for consuming a particular food reduces a child's liking for it.  

Present healthy food as a reward.  Rewarding behavior with food increases the desirability of that food.  Note that this trick works best with the very young.  One researcher who tried the old "eat your dessert, then you may eat your vegetables" ruse was unable to fool a single 4-year-old.

Expose your child to the food you want him to eat.  Then do it again.  And again.  And again.  In fact, studies show you must present new food to a child a minimum of 10 times for him to finally accept it.  One randomized trial had parents in the experimental arm present an unpopular vegetable (most often a bell pepper) to their child every day for 14 days.  The parents were to encourage their child to taste it, but not to offer any reward for eating it.  At the end of the two weeks, kids in the exposure group increased their liking and consumption of the vegetable, compared to no change in the control group.  The problem?  Many of the parents weren't able to stick it out for the full 14 days, and when they included these kids in the analysis, there was no benefit.

Set a good example for your kids, and eat your veggies.  This won't be a surprise to anyone, but several studies have found that vegetable consumption in kids closely mirrors that of their parents.  Hard to know if this is genetic or environmental, or if there's a cause and effect relationship, but it can't hurt.

If all else fails, talk to your pediatrician -- preferably someone as non-judgmental as my kids' doctor.  I became really concerned when Sarah weighed one pound less at her 4-year-old visit than she did at her 3-year-old one.  I bemoaned her tuber-based diet, and asked for suggestions on how I could get her to eat her veggies.  Her pediatrician's answer?  "Does she eat ketchup with her French fries?  Ketchup counts."

Ketchup counts?  I've got Thanksgiving covered.

*Public schools in France serve a five-course meal to their students, and no, it's not like in America, where the hors d'oeurves consist primarily of pomme frites.

**OK, I realize that you could use the same logic to argue that drinking while nursing could give your baby a taste for Jack Daniels.  If you're a breastfeeding mom, just pretend that you never read this footnote.


  1. i really like your blog, thanks for the insightful, evident based and funny opinion!!
    happy holidays!!

  2. Our method was to (1) pretend to ignore picky eating and (2) praise a kid that eats veggies and other health foods. The method for pretending to ignore is to act facinated with someone else (typically a sibling or your spouse) who is eating the veggies or whatever it is that the the picky eater is not eating. If the picky eater says "I don't like X!" act like you don't hear them, give them no face time.

    It's an proven evidence-based parenting method from scientific research. See these books: "Kazdin Method"

    and "Incredible Years"

  3. Great ideas! Picky eating wasn't something I ever heard about (though surrounded by a lot of kids) in Kenya. Their diet is almost identical, day after day. I realized that something I had taken for granted, dietary novelty, was not universal. "But we ate that yesterday" isn't the sort of thought that goes through the minds of the rural poor. I wonder if it is the perpetual novelty of the American diet that causes some kids to be "picky". These data would be consistent with the bell pepper experiment.

    The connection between picky eating and psychiatric illness is intriguing. Perhaps the ability to do distasteful things (literally, in this case) is a proxy for the Will (or in others' words, for mindfulness). Lacking the skill of sitting with uncomfortable feelings may indeed predict anxiety disorders if the skill is not later obtained.

  4. "about two-thirds of picky eating is genetic, rather than environmental."

    Note that this is a function of amount of environmental variation. If all the environments are the same in effectiveness, the it would be 100% genetic. If they varied a great deal in effectiveness, then the genetic proportion would be lower.