Recently I've become fascinated with the concept of picky eating. I can't really pinpoint what sparked this interest. Maybe it was the birth of my son 14 weeks ago and preparing for him to try his first solid foods in 3 short months. Maybe it was the fact that my husband sticks his nose up at the thought of trying a new and unfamiliar vegetable or the fact that "gross" and "disgusting" are a part of his normal food vocabulary as a full grown man. Or maybe it's related to the opportunity I've had in being able to watch my curious 2.5 yr old nephew develop his own little personality and begin to explore with new foods, tastes, textures and smells at the dinner table, sometimes approving of my sister's cooking and scarfing the meal down and other times pushing his plate away and announcing that he's all done when he hasn't even taken much more than a bite.
I don't know if I found picky eating or if picky eating found me, but I've started seeing more adolescents in my private practice for parental concerns of picky eating and diagnosis of ARFID* (Avoidant Restrictive Food Intake Disorder).
I've met with parents who are overwhelmed, anxious and flat-out exhausted. Parents who don't find any joy in sitting down to a family meal due to the stressfulness of their child's picky eating and the fear of another fight at the dinner table. I've met with moms worried that their child is dropping on the growth curve and experiencing nutrient deficiencies due to their lack of variety and balance in their eating. I've talked with parents in my office who are concerned that their child's concentration issues and lack of energy at school are due to an inadequate diet.
With my growing case load in this area, along with my growing interest, I've jumped into books like, "Born to Eat" by Leslie Schilling, MA, RDN and Wendy Jo Peterson, MS, RDN and "Child of Mine" by Ellyn Satter, MS, RD, CICSW, BCD. I've also consulted colleagues in the field who are more experienced than me in this area in order to gain insight, discuss difficult cases and gather resources for seeing this patient population in my office.
In addition to my new fascination regarding picky eating, I've become more and more intrigued with the concept of family meals.
In their book, "Born to Eat" authors Leslie Schilling, MA, RDN and Wendy Jo Peterson, MS, RDN say, "Consistently sitting down to family meals may reduce the likelihood of a child engaging in disordered eating behaviors and has been linked to less depressive symptoms. This time spent together as a family may also make a child more likely to eat healthier foods and less likely to experience weight concerns."
I've wondered what contributing factors play a role in the child who grows up sitting with their family at the dinner table, eating the foods of the family and having a pleasant meal experience. On the flip side, what contributing factors play a role in the child who refuses to sit at the table, doesn't participate in family dinners and whose parents bend and become short-order cooks resulting in stressful mealtimes and further perpetuating the problem of picky eating?
How come some kids are more than willing to try a little taste of everything at the family reunion pot luck while other kids refuse to place anything that doesn't resemble a roll or Mac and cheese onto their plates?
How do we raise kids to become healthy, competent eaters who trust their internal hunger and fullness cues and who feel empowered in their bodies?
The Ellyn Satter Institute has a solution that's rapidly gaining attention with families of picky eaters and is being used by many healthcare professionals working with pediatric patients in the field of nutrition. The Division of Responsibility in Feeding** was developed by Ellyn Matter, MS, RD, CICSW, BCD and states that parents and children have two distinct roles to play in the feeding relationship. According to Satter's model, parents are in charge of what, when and where meals will be eaten. Kids are in charge of whether or not they are going to eat as well as how much. It is the parents' job to decide what foods will be in the home, what recipes will be used in preparing meals, when and where they family will eat. For example, a parent might decide to make spaghetti and meatballs, garlic bread and a Cesar salad for dinner at 6pm seated at the family dinner table. The child can then decided whether or not they are going to eat and how much. Sometimes they may choose to only take one bite or not eat at all and, other times, they may want seconds, even third helpings. If a child chooses not to eat the meal, then they must wait for the next desiganted snack or meal time. Parents do not act as a short-order cook to meet the child's demands. However, they do provide a variety of foods for the child to try. They always present a familiar and comfortable food item on the plate that they know the child enjoys eating. They are not afraid to place new items onto the plate allowing the child to experiment with unfamiliar tastes, smells and textures. New food items are presented over and over again, in different forms and sometimes prepared the same way. The child is never pressured to try it or take another bite. They are simply exposed to the new food. Again, this is a non-pressured approach. Words like "yucky" and "gross" are not allowed at the table. Parents model a healthy relationship with food and practice self-care through balanced eating.
This approach to childhood feeding empowers kids to trust their bodies, listen to their internal hunger and fullness cues and be curious about new and unfamiliar foods. This process decreases the likelihood of kids developing disordered eating patterns and increases the probability of kids enjoying a larger variety of food items and being more willing to try new dishes.
I've found The Division of Responsibility in Feeding model to be a helpful approach to helping families who are concerned about picky eating in their child. Parents who were so frustrated each evening when dinnertime rolled around are now excited to share a meal with their family after a long day. Kids are participating in menu planning and meal preparation and are excited to try new foods. It is so rewarding to see joy being brought back to the family dinner table one meal at a time. I have Ellyn Satter to thank for that.
*According to the DSM-5, ARFID is diagnosed when:
- An eating or feeding disturbance (e.g., apparent lack of interest in eating or food; avoidance based on the sensory characteristics of food; concern about aversive consequences of eating) as manifested by persistent failure to meet appropriate nutritional and/or energy needs associated with one (or more) of the following:
- Significant weight loss (or failure to achieve expected weight gain or faltering growth in children).
- Significant nutritional deficiency.
- Dependence on enteral feeding or oral nutritional supplements.
- Marked interference with psychosocial functioning.
- The disturbance is not better explained by lack of available food or by an associated culturally sanctioned practice.
- The eating disturbance does not occur exclusively during the course of anorexia nervosa or bulimia nervosa, and there is no evidence of a disturbance in the way in which one’s body weight or shape is experienced.
- The eating disturbance is not attributable to a concurrent medical condition or not better explained by another mental disorder. When the eating disturbance occurs in the context of another condition or disorder, the severity of the eating disturbance exceeds that routinely associated with the condition or disorder and warrants additional clinical attention.