A new approach to overcoming picky eating

Today, is day 15, the day little Isla will be eating her broccolini.

For the past 15 days, her mum has placed broccolini on little Isla’s plate and bribed, rewarded, threatened and begged her to at least taste the green food (a colour Isla is not fond of).

Isla’s mum hates the constant battle, but she’s made it to day 15 – the day (according to the old saying) Isla’s tastebuds will now officially love broccolini.

At dinner time, Isla refuses to even have it on her plate.

Exhausted, Isla’s mum gives up, throws the broccolini in the bin and decides her child will never ever eat anything green, so why bother.

This is a pretty common experience for parents who then may label their children picky eaters.

Parents have the right intention, trying to ensure their children are eating healthy, balanced and nutritious meals, but there may be an easier way.

Ashley Smith is a US based Paediatric Registered Dietitian Nutritionist and Owner of Veggies & Virtue LLC who has experience dealing with picky eaters – most importantly her own daughter.

“I expected to have a poster child for paediatric nutrition and often utilised the generic tips and tricks I learned throughout my education and dietitian experience to try and help my own daughter overcome picky eating,” she says.

“However, coming up with a balance between giving her the foods I knew she would eat while still exposing her to all the other foods I had hoped for her to eat continued to be a real struggle.”

Ashley’s experience led her to developing an evidenced-based framework that went beyond what was left on the plate at the end of the meal.

“Whether we sleep train, use cloth nappies, or keep our children in rear-facing car seats until four doesn’t have a huge impact on them later on,” she explains.

“While these preferences do shape our children’s upbringing, the reality is, if you sit with your adult child in thirty years, none of these will still have the same lasting impact on them that the way you fed them will. 

“Be it in obesity prevention or the prevention of eating disorders, we as parents must be mindful of how to raise children who have an innate sense of how to live healthy lifestyles.”

What do our pre-schoolers eating habits look like?

According to the Australian National Health Survey 2017-2018, 73% of children aged 2 - 17 years old ate the recommended serves of fruit.

However, only 6.3% ate the recommended amount of serves of vegetables.

The Australian Dietary Guidelines recommend toddlers aged 2 to 3 years old eat 2.5 serves of vegetables and 1 serving of fruit per day.

While children 4 to 8 years old are recommended 4.5 serves of vegetables and 1.5 serves of fruit per day.

In 2017, The Royal Children’s Hospital Melbourne found that 41% of pre-schoolers receive treat food most days of the week and 35% of children regularly consume sweetened drinks.

As for picky eating habits, research suggests that picky eating is developmentally appropriate in young children.

In a 2017 study, researchers found that Australian 14 month old infants who were perceived as picky eaters by their mothers were in their healthy growth and weight range at 2 years old (so they were getting everything they needed in terms of nutrition).

In a separate 2004 study, researchers found that parents of picky eaters only offered a new food three to five times before giving up, where the recommended is 8 to 15 times. 

In some good news for parents with picky eating pre-schoolers, a recent UK study found that while picky eating pre-schoolers grew up to be picky eating tweens and teens, the eating habits were unlikely to have adverse effects on their health and development.

The only point of concern in the study was that children, both picky eaters and non-picky eaters, ate less fruit and vegetables than is recommended.

The fundamentals of Love It, Like It, Learning It™

To understand Love It, Like It, Learning It™, it is important to first understand “The Division of Responsibility”, a term created by Ellyn Satter, an internationally recognised authority on eating and feeding.

“The Division of Responsibility in feeding acknowledges what the child and the parent are responsible for when it comes to feeding,” says Ashley.

“The parent is responsible for what, when, and where a child is fed.

“From toddlerhood through adolescence, parents are to facilitate more structured mealtimes as part of the daily routine.

“During these stages, parents need to trust their child to determine if and how much they eat.

“The child is responsible for how much and whether or not to eat what is offered by the parent.”

With this knowledge, Ashley wanted to create a framework which incorporated positive, no-pressure feeding even with the limited foods her daughter would eat.

“I began to leverage the foods I knew my daughter loved (“love it” foods) with those I wanted her to learn to like over time (“learning it” foods), offering those “learning it” foods over and over again, and demonstrating this as our normal way of offering food for the whole family.”

The Love It, Like It, Learning It™ framework categorises foods in one of three categories, says Ashley.

“Love It Foods are foods your child consistently likes and preferentially favours compared to all others. These are foods your child eats most of the time (>75% of the time).

“Like It Foods are foods your child usually likes but may or may not eat and may consume less of when offered alongside “love it” foods. These are foods your child eats some of the time they are offered (50/50).

“Learning It Foods are foods your child rarely (if ever) eats and may or may not have ever been exposed to before. These are foods your child rarely if ever eats (<25% of the time).

“With these three categories, parents are encouraged to build meals that have a variety of foods included from love it, like it, and learning it categories.

“This capitalises on the concept in feeding research that highlights how pairing preferred with non-preferred foods can help children respond more positively to new/non-preferred foods.”

Ashley explains that the Love It, Like It, Learning It™ framework is intended to be incorporated in many of the established principles for creating a healthy feeding environment, including families all eating meals together, family style meals where children are allowed to self-serve, as well as re-exposure to foods.

However, Ashley points out that instead of parents focusing on how many times new food is presented to children, “the ‘learning it’ food needs to be offered in a positive, pressure-free way indefinitely”.

Ashley also recommends limiting sneaking foods into a child’s diet.

“While foods that your child doesn’t like may be used to boost the nutritional density in say, a muffin or a smoothie, the main mechanism for getting children to ‘learn to like' these foods is not by way of hiding or sneaking.”

“Love It, Like It, Learning It™ supports the notion that parents need to trust their children will learn to like a variety of foods if/when given the chance to repeatedly ‘learn’ such foods over time.

“Conversely, children need to trust that their parents will provide a variety of foods in a predictable way, without using pressure or force in a way that erodes the feeding relationship.”

She also emphasises that it isn’t always about the actual eating of the learning-it foods.

“Parents can practise using a variety of techniques to promote their child’s interest and ultimately acceptance of such foods including (but not limited to) helping their child tolerate the new food in their space, interact with the food away from and at the table, smell the food, touch the food (whether raw or prepared), and taste the food (using a variety of novelty techniques, taste tests, and small portions).”

When to seek support

“While the majority of pickiness is age-appropriate and will be outgrown, for children who have an extremely limited range of foods (under 20-30 preferred or “love it/like it” foods), families may need to seek additional support to help their child achieve more variety,” Ashley says.

“Often, one of the first triggers that such additional support and/or intervention is needed is when a child shows they are unable to sustain proper growth and/or development with their current diet alone.

“In instances such as these, it would be wise for parents to discuss with their child’s paediatrician if and what needs to change within the child’s diet.”

Ashley highlights that nutrition is incredibly important for young children.

“In the early years, a child’s growing brain and body require a premium emphasis on nutrition in order to reach its optimal developmental and intellectual potential,” she says.

“This is particularly important before age three but extends even past the time a child’s brain is almost fully developed (around age five).

“Furthermore, this is a window in a child’s development as it relates to cultivating their own relationship with food, body image, and intrinsic ability to regulate hunger and fullness.

“Both in preventing obesity and disordered eating patterns, our children need to be able to recognise healthy, balanced eating habits that include a variety of nourishing foods from an early age.”