Nutrition Tips for the Selective Eater
As much as we want our children to eat a nutritionally balanced diet, it often is not possible until some developmental behavioural, and/or medical issues are resolved. As a consequence of these issues, children often become “selective eaters”.
If constipation and gastroesophageal reflux are present, these issues need to be managed before you can expect your child to change their eating behaviour and accept new foods and beverages.
To help meet nutrient requirements, your child might benefit from a pediatric vitamin and mineral supplement which provides some iron (4-5 mg) and vitamin D (400IU). Also blood work can be done to assess serum levels of ferritin, hemoglobin, vitamin D (25- OH), vitamin A, folate, and vitamin B12. Discuss with a dietitian or pediatrician to assess needs for a supplement and/or blood work.
Short term strategies to increase amount and variety of foods eaten:
It is important that changes to be made gradually and to make only 1 change at a time.
- Eat meals at a table as a family, in the kitchen or dining room if possible. Avoid distractions to encourage your child to use all of his/her senses to experiment with new food.
- Everyone should eat together as much as possible. Keep mealtimes positive by reinforcing good behaviours, and ensuring successful and pleasurable meals.
- Place a non-preferred food next to the child’s preferred food to change the appearance of their meal. Having a favorite food on her plate will help attract his/her attention to her plate. Remember it can take up to 20 positive exposures to a food before a child accepts to eat it.
- Children will eat and drink the same as what parents and siblings are eating /drinking. Learning by imitation is a powerful tool. Be a good role model for them by serving and eating healthy foods.
- Offer 3 meals and 2-3 snacks per day. There should be two hours between each meals and snacks with nothing in between (except water) to ensure that your child is hungry.
- Gently remove unfinished food within 20 to 30 minutes of serving and do not allow other food until the next planned meal or snack.
- Push water intake. We would ideally recommend 2 cups of milk, ½ cup of juice (may be diluted with water), and 2 to 3 cups of water per day. If milk is not a favorite beverage, milk may be added to fruit smoothies. Be persistent and keep offering milk every few days.
- Respect tiny tummies. Portion size for children is ¼ to ½ of an adult portion.
Long term strategies to increase variety of foods eaten:
Food play activities can lead to increased acceptance of food. Give your child opportunities to see, touch and smell a variety of foods.
**There should be no expectation of eating during the times set aside for food play. It can take up to 15 or more positive food experiences for a child to accept a new food.
Some examples you can try to stimulate the various senses:
- help unpack vegetables/fruits and place them in a bowl or sort them by color, etc
- bring your child grocery shopping and encourage them to feel the fresh produce
- have your child help serve the food; build a rainbow of colours on the dinner plates
- find books and games with pictures of food and introduce them to your child
- describe the color, taste and shape of a food
- encourage your child to participate in meal preparation, children love to stir!
- have your child help arrange cut vegetables or fruits on a plate
- have your child wash fruits and vegetables in the sink
- ask your child to add fruit to a fruit smoothie
- use raw or cooked foods during craft activities:
- Spaghetti can become a road for cars, or hair for a happy face
- Cucumber slices can become wheels for a car or eyes for a happy face
- Bread or carrot sticks can be used to make a fence
- An orange slice can become a sun
- Finger paint with pudding or pureed food, and make Jell-O gigglers
- use peas, cherry tomatoes, orange slices, crackers or other food for a counting or stacking activities
- a potato or other firm fruit can be used to make a stencil
- dried fruits can be used to make a walking path
- a cucumber can be used as a rolling pin
- rub foods on hands, arms and progress to cheeks and mouth area. As child builds acceptance to touch, you can rub tastes along the lips and encourage your child to lick the food.
- Expose your child to a variety of scents (vanilla, lemon, spices) and discuss whether they like/do not like that smell. Make a graph with pictures of “Nice Smells” vs. “Not-so-Nice Smells”.
- Game: What noise does this food make?
- Exaggerate the sounds of biting, chewing, and swallowing.
An assessment of oral motor and/or sensory integration difficulties by the Occupational Therapist and /or Speech Language Therapist is strongly recommended for children who have difficulty swallowing/chewing, pouching food in their cheeks, for children who have strong aversions to textures/tastes or being touched in the head/face area. Behavioural issues also need to be addressed to make changes in food acceptance.
There are some very good books which you can read to help you work with your selective eater.
1) Food Chaining: The Proven 6-Step Plan to Stop Picky Eating, Solve Feeding Problems, and Expand Your Child’s Diet. Fraker, C., Fishbein, M., Cox, S., Walbert, L. (2007).Da CapoPress
2) Just Take a Bite: Easy, Effective Answers to Feeding, Ernsperger, L., Stegen-Hanson, T. (2004).USA: Future Horizons.
3) Eat Right Ontario