Posted on May 9, 2022

Managing Picky Eating children: Its about Team work

Healthy, balanced eating is important for survival and health. Try telling this to a 3-year-old!

I truly believe that every parent has/will grapple with this question at some point of their lives. I remember an incident 10 years ago when I went to a restaurant with my 3-year-old twins. The restaurant out of courtesy served delicious kids starter menu which had a “tinge of green” in it, to which my ever-polite son responded, “No, Thank-You”. We as dutiful parents tried to force the issue, to which he replied confusingly,” But, I said No thanks!” It was a double whammy, as we were teaching him table manners too!!

10 years down the line, sitting in Pediatric Neurology office, nothing much has changed and I get the “evergreen” question often: Our child is a picky eater, What should we do?!

Let me start by saying that being Picky/Fussy eating as a child is absolutely normal! Picky eating or food refusal can be seen in up to 50% of children and usually starts around or after 2 years of age when the children start exploring food themselves. Therefore when a parent comes to me with this perennial question, I try to untangle it by first establishing whether it is just a kid, well, just trying to be a kid or am I actually dealing with a more serious Eating Behavior Disorder of Early Childhood, or in simple terms Extreme Picky Eating.

The approach to both these mostly overlap but have slight differences as the former needs more of a “Developing a healthy relationship with food” approach and latter needing an urgent Multi-disciplinary approach involving various Health Care Professionals to diagnose any underlying causes, dietary management, behavioural education and therapy for both the parents and the child. Many eating behaviours are “short-term” eating disorders but can have long-term implications on child’s health if not dealt appropriately. Roughly speaking, the three prominent features of extreme picky eating are:

1. Loss of interest in the food.

2. Strong food preferences limiting the variety and quantity of intake.

3. A strong aversion to trying new or certain foods.


Extreme picky eating can be challenging for both parents and doctors and needs Multi-Team approach. A Pediatrician will undertake a thorough history and careful clinical examination to unpick any underlying disorders e.g. Cow’s milk protein intolerance, lactose intolerance, and faltering growth etc. causing eating behavioral disorder. This is important because if left untreated, in some cases, it can lead to long term consequences e.g. growth disturbances, development delays, anorexia, nutrient and vitamin deficiencies etc. A detailed history on food consumption, bowel habits, development milestones, activity level, sleep pattern etc along with an anthropometric measurement (weight, height, head circumference, BMI) is carried out by your doctor. The Pediatrician may also request blood tests to ensure there is no deficiency of iron, minerals and vitamins.

A Pediatric Dietician’s role is critical in managing these children who analyses the composition of the diet including its quality, quantity, and its nutritional value. They will make a detailed caloric assessment and ask the parents to maintain a 24-hour diary/food log of food intake and set well-defined meal times and avoiding food fillers. Dieticians will also advise you on encouraging/introducing new food items to your child along with nutritional supplementation if needed.

Now let’s look at 5 “Useful Tips” parents can use for picky eating children.

  1. Set Realistic Goals:You might want the kid to eat whole serving, but he/she may have different ideas! Therefore as a parent you may have to bring down your expectations in terms of volume of food you would like your child to eat.
  2. Meal Time Equals Happy Family Time. :Try to eat as a family from the earliest possible age of the child. Ensure that the child’s seating position is comfortable, and the food and you are in his eye line. They will learn by example when they see their parents eating veggies, that is if you like them too !!
  3. Nutritionally Balanced Week, Not Just a Day. :Toddlers like to binge on one food at a time, so they may eat high caloric food one day and not the next. Therefore it is important to plan for the whole week ahead.
  4. Encourage Variety:Serve variety in the meals so that kids become familiar with taste of different types of food. Serve “new foods” frequently to counteract Neophobia. You may want to offer nibble tray with small amounts of food as a mixture of new and experienced food items.
  5. Dip it, Spread it, Top it, Cut it and Share it! :It is okay to be delightfully messy for toddlers and young ones. They like to smear, so take the opportunity to show them how to use a table knife. Top up the food with nutritious toppings, cut the food items in shapes they like and then share with older siblings or family members. Small children learn from their older siblings.

Lastly, as parents, we must all learn to relax when it comes to eating habits in children. When the children are truly hungry, they will eat. Your child’s eating habits will not change in a day, and neither was Rome built in a day!