Picky eaters

I was so smug when my first kid ate everything—but my second had other plans

I thought I knew it all, but feeding my picky second-born child has been humbling, to say the least.

I was so smug when it came to my first daughter.

She practically bounced out of me, raw oyster in hand. This child would eat anything and everything by the time she was a year old, from sushi to French onion soup to mussels. On her second birthday, we celebrated with a feast of sashimi, raw oysters and Russian borscht—just a few of her favorite foods.

“It’s because we introduced her early to all the food, and never ordered off the kids’ menu,” I told anyone and everyone who would listen. “In fact, she’s never even tried a chicken nugget.”

Someone should have punched me in the face, but karma came for me instead.

When it came to my second child, another daughter, I started her on solids in the same way: Homemade purées filled with beets, bananas, avocados and weird combos of all of the above, just to get her used to exotic food combinations.

But she wasn’t having any of it.

The faces she made when I tried shoving chickpea purees into her mouth were as if I was feeding her a blend of dirt and rat poison. She literally scraped her tongue to remove the butternut squash I had lovingly roasted, peeled, cooled and pureed for her. And when I offered her some fish? If she could talk, I wouldn’t want to know the obscenities that surely would have come flying out of her tiny mouth.

It’s not that she didn’t have an appetite. At six months old, she most certainly loved to eat, as evidenced by her rolls and rolls of thighs and her spirited tantrums when my breast didn’t reach her mouth the instant she demanded it. Alas, her preference was for breast milk, and eventually bread and plain cooked pasta, but nothing else. What had I done wrong?

I decided to book a visit with her paediatrician.

“Some children just need a little more time to get used to food,” the doctor told me. It seemed like he thought I wasting his time.

So I contacted Ana Sant’Anna, the chair of the CPS Nutrition and Gastroenterology Committee at the Montreal Children’s Hospital, to ask her why my toddler wouldn’t eat the delicious concoctions I dreamed up—and why years later, as a schoolaged kid, she is still ridiculously picky.

There are a few reasons, Sant’Anna says, but none have much to do with me or my cooking abilities (she thinks, though she hasn’t tried my food). As babies, some kids have issues with textures, she says, so they like pieces of food but don’t accept purées, or vice versa. Other children reject specific colours of food, so by the time they’re two, they know they want the meat and the rice but they don’t want the fruit.  “Even if they have a good appetite, they have a preference,” Sant’Anna says.

I don’t know exactly which of these issues affected and still affect my daughter, but given her interest in milk, bread, plain pasta and almost nothing else, I’m thinking it’s a combination. Regardless, Sant’Anna says my daughter is officially “picky”—but also, normal! About 20 percent of kids are picky eaters, though most do grow out of it, she says. No biggie.

But why? Is there really nothing that parents can do short of offering children a mix of foods and textures that will influence their eating habits—or is it a lost cause? If I have a third baby, what can I expect? (I am a planner, after all.)

Aimee Tyler-Smith, a registered dietitian based in London, Ont., offered me a few options. She suggested including one or two foods I know my daughter would eat with every meal and snack, in addition to providing her with the foods she *might* avoid, such as mushrooms (or just about everything edible). “It is important to not bug, coerce, reward or even comment when introducing new foods,” Tyler-Smith says. “Pressure to eat these foods will actually lead to more push-back.”

With threats and bribes off the table, however, my daughter realized that she had won. Globs and globs of spaghetti were shoved into her pie hole, with not a vegetable to be seen. Well, technically, she did see the vegetables. But they didn’t come close to her digestive system.

Meanwhile, her sister was going through her salad phase, trying to create the most inventive, delicious salad, The Chopped Leaf-style.

Jessica Corner, another dietitian, this one based in Bowmanville and Lindsay, Ont., says I’m being too hard on myself. “Being picky is a completely normal response to food,” Corner says. “A child exploring different foods will often initially reject new tastes or textures, might make a sour face or spit out food.”

The period of food exploration is part of building a positive and healthy relationship with foods. But it’s how we as parents and caregivers respond to it in an ongoing way that can make a long-term impact.

Corner recommends that we let our kids explore, touch and feel foods before accepting them. Let them get messy. If they put the food to their mouths, keep a neutral response. If they enjoy it and eat more, great. But if they spit it out, that’s fine too.

Want something a little more structured?

I’ve now learned about the Division of Responsibility model, developed by respected dietitian Ellyn Satter. In this model, Corner explains, parents are responsible for what foods are offered, where the food is served and when the child eats. The child is responsible for if they eat and how much. As long as there are no growth or medical concerns, you’re on your way to supporting your child’s journey to becoming a confident food lover, she says.

I sure wish I’d known about that a decade ago! I’ve now been on this picky eating journey with my daughter for ten full years. A decade of questioning my choices, my parenting, the curious reasons why two children with the same genetic makeup could have such different tastes. I’ve tried letting her get messy, cooking with her, offering the same foods at each meal, a dinner that looks like a cruise buffet… Alas, she still grabs the bread and calls it a meal while my other daughter chomps down on dried calamari and eggplant spread like it’s candy.

What have I learned from living through this, and consulting a variety of experts about it? Firstly, that in a lot of cases, parents have zero control over creating a great eater or a picky eater. Kids are who they are.

But also: I’ve learned that it’s a bad idea to be a smug mom until you’ve had more than one kid.

Picky eaters

How I got my picky toddler to finally eat

I knew my daughter wasn't eating enough. This is how we fixed it.

I remember the day I knew my daughter had an issue with food. I was out for a walk with a group of mom friends and we stopped for coffee. They all gave their babies a snack, and then all the babies ate their pouches and cut-up fruit and puffs. Except for mine, who ate nothing. 

“Huh,” I thought. “That’s weird.” 

It was part of a pattern of my baby just not being interested in eating much more than breastmilk, even as she neared her first birthday. And even though I kept telling myself that all babies develop at different rates, I knew she wasn’t eating enough. A few doctor appointments later, my suspicions were confirmed. In fact, her weight gain was levelling off, and blood tests showed she was becoming borderline anemic. Sometimes, “food before one” really isn’t “just for fun” (as the popular saying goes). 

My first child was a champion eater, so I had no expertise in how to make an older baby or toddler eat. My first step was meeting with a dietitian. Then, an occupational therapist (OT) came to our house for an assessment and advice on how to make my daughter eat. (This was all covered by OHIP.)

I kept logs of what she ate, changed our eating habits, and sleuthed out her sensory preferences—and some changes made a huge difference. Here’s what worked for us: 

I night weaned 

I had been breastfeeding 24/7—including nights, since we were co-sleeping and the baby nursed whenever she wanted. Because of that, my doctor suspected that she was getting too many calories at night, and that was making her disinterested in food during the day. So I night weaned (which required some sleep training) to see if that helped. And it did! She was noticeably hungrier.

I learned about “eating windows”  

One of the first things the dietitian had me do was write down when we ate on a typical day. She told me that kids generally need three meals and two snacks a day, each 2.5 to 3.5 hours apart. As a devotee of “sleep windows” and “wake windows” from all the reading I’d done on baby sleep and sleep training, “eating windows” or “feeding windows” made total sense to me. In the same way that a baby needs to be tired enough to nap well, kids need to be hungry enough to eat well. After they’ve been awake for a certain amount of time, they need a nap. If it’s been a certain number of hours between meals, they need a snack. I added a morning snack into our routine, and changed the timing of our afternoon snack and dinner. It helped get us off the “snacks all the time” habits we had fallen into, and it did seem to help her eat better. (We started this a little early because of her eating issues—many kids aren’t ready for timed meals until they’re closer to two years old.)

I served protein with every snack 

At first, I was convinced my kids couldn’t go for hours between snacks. But I learned that was because my snacks tended to be all carbs, which were quickly digested. The dietitian explained to me that adding protein to snacks was key to making them more filling. I tried thinking of snacks as mini-meals, following her rule of thumb of trying to serve at least two food groups for all snacks, and three for meals. My kids’ snacks transformed from a pack of Goldfish crackers into crackers, apple slices and cheese, and they stayed full longer. 

I improved our eating “hygiene”

Through my OT, I learned that just like there are things you can do to your bedroom to improve your sleep hygiene and make sleep more likely (like turning down the lights) there are things you can do to your environment that make kids more likely to eat. We started sitting down to eat at the table together, even for snacks. We ate without screens or toys, to help them focus on the food, and tried to socialize over meals, too—even if that meant playing peek-a-boo with the sandwiches. 

It helped that this was during COVID, so we were all at home and had nothing on the schedule. As a side benefit, I found it calming to take a break and sit and eat so often. 

I tracked her eating patterns  

For a few days, I charted how much both my kids ate. I discovered that my son woke up hungry, eating the most at breakfast—the most common pattern for little kids. My daughter actually ate the least at breakfast—but she was starving by snack and lunch. And, she was still well-rested enough to be in a good mood at that point. Lunch, I realized, was the sweet spot. 

I had been serving easy-to-make, kid-friendly convenience food for lunch, and more complicated new foods for dinner, and I was continually frustrated that she was only eating her lunch and refusing dinner. When I shifted to offering her those new and healthy foods at lunch instead—earlier in the day, before she got tired—she was way more likely to actually try them. 

I looked at textures, and sweet vs. salty foods

I looked at what she was eating and tried to look for patterns. Turns out, unlike me, my daughter didn’t delight in sweets, but she loves salty foods. And she likes sharp tastes—old cheese, mustard and garlic. 

Then I thought about texture. Lots of little kids prefer crunchy foods, and mine does, too. She wouldn’t eat cooked peas (too mushy), but when I offered frozen ones, which have a harder, more predictable texture, those were a hit. Once I figured that out, I discovered she would eat frozen pomegranates, too. I started cooking my pasta al dente, and steaming veggies just for a minute or two instead of boiling them, so they’d have more crunch. Now I know that for her, firmer textures always lead to a happier, more enthusiastic eater. 

I practiced the “division of responsibility”

The dietitian taught me about what’s called the Division of Responsibility, a research-backed method created by dietitian and family therapist Ellyn Satter. The idea is that arguing with kids and trying to get them to eat “three more peas” before leaving the table stops them from learning to tune into their own bodies to know when they’re hungry or full. 

Instead, parents are advised to control their side of things only. In the division of responsibility, grown-ups are in charge of what food is offered, where it’s offered, and when—and children are in charge of deciding what they will eat and how much they’ll eat. 

I liked the idea of having fewer power struggles at meals, but I was confused: I knew kids needed to taste foods a lot before they liked it. How were we ever going to make progress if my picky eater never tried anything new? 

Then I was introduced to something that made it all make sense for me: something called “food exposure.” Turns out, my kid didn’t have to eat food to get used to it. Just seeing the food on the table counted as a food exposure, as did her helping me wash the veggies before dinner, or seeing me eat foods and talk about them. (“Mmm, these carrots look good! Let’s hear if they make a big crunch when I bite them!”)

None of these new habits fixed her picky eating completely—but these seven changes did make a noticeable impact in how she ate. She’s three now and still the kind of kid who will eat just the icing off a piece of cake and leave the rest, but I’m OK with it, because now she also eats pepperoni sticks, pasta, carrot sticks, oatmeal and yogurt, too. I can work with this. 

When we went back for follow-up bloodwork a few months after this started, my doctor looked a little surprised at the results. “She’s back on her growth curve, and her iron levels look great!” she said. “Good job, Mom.” 

Picky eaters

What to do when your toddler won't eat anything but snacks

They want Cheerios, Goldfish and cheese. Here's how to not turn every meal into a literal food fight.

Man cannot live on bread alone…but toddlers are ready and willing to test that theory. Mine certainly is, though she’d also like to add Cheerios, Goldfish and cheese to the mix.

The really frustrating part is that I tried to do everything right, and it seemed to be working. I introduced her to a wide variety of foods from the start, and from broccoli to beans, spinach to salmon, eggs to eggplant, she gobbled it up.

Then she turned two.

Suddenly, she started rejecting her healthy favourites and demanding snacks as entrees. Every meal became a literal food fight, and I wanted to scream.

If you’ve been engaging in a similarly frustrating battle of wills, says Toronto-based dietitian Cara Rosenbloom, don’t panic. Loving a food one day and hating it the next is a normal part of a toddler’s development. “Sometimes a food is saltier, crunchier or more bitter than usual, and they will react to the difference in flavour or texture,” she explains. “And sometimes, they are just looking to assert some control and drive you bonkers.”

A young girl pouts at a plate of food on the table in front of her 5 science-backed ways to get your picky eater to try new foodsThe key is to respect a toddler’s burgeoning independence while staying the course. We wouldn’t think twice about setting rules for screen time and bedtime, and we should apply the same principles to mealtime. Otherwise, we’re teetering on the brink of a very slippery slope.

“Remember your role in the feeding relationship,” says Rosenbloom. “You should not allow your child to decide when to eat (all day!), where to eat (in front of the TV!) and what to eat (chocolate and gummi bears!). Those are your jobs. They can decide which foods to eat from what you offer them. Goldfish or Cheerios can be part of the deal…just not for every meal and snack.”

You can also try the following four tactics to get your picky eater to pick the foods you want:

Ask questions 

If a food had been a hit previously and has now landed on the no-way, no-how list, Rosenbloom suggests asking, “What can I do to make this better for you?” She says that kids will often have a simple and surprising answer such as wanting to add ketchup or have it with a side of cereal. Easy-peasy.

Offer choices—but limited, parent-approved ones

Toddlers want it all, but they can get lost in a sea of options. If you present just two or three choices, things will seem more manageable to them and you might actually get your way with at least one of the offered foods.

Let them help you shop, prepare and cook

Get them involved and invested, and there’s a higher likelihood that they’ll try what they’ve helped you to make…maybe…eventually…someday. But keep at it if it doesn’t work right away. You might hit on something or get them at a weak moment.

Sneak it in

Butternut squash blends in with macaroni and cheese. Zucchini bread actually has a vegetable in it. Yogourt smoothies can be puréed with all sorts of healthy stuff and no one will be the wiser.

So that’s what you should do. As for what you shouldn’t do, here’s the biggie: Don’t get into a fight with your toddler. It isn’t going to end well. (Trust me.) Plus, a recent study at the University of Michigan found that picky eating doesn’t generally stunt a child’s growth or cause nutrient deficiencies. What it can do, however, is make everything stressful and potentially damage the relationship you’ve built with your child.

If you’re concerned about your child’s growth, absolutely bring it up with your paediatrician, but know that everything’s probably going to be just fine. In the meantime, embrace the good foods that they do eat (admit it, there are a few) and keep offering a variety of good choices.

“Just like we teach our kids to read and to ride a bike, we need to teach our kids how to eat well—and like any skill, it takes patience and practice,” says Rosenbloom. “If you do your job, your child will learn how to eat the amount they need for their growing body, and they will learn to eat the foods you eat.”

And it may not feel like it right now, but someday this picky phase will be a distant memory—and your child will likely be eating you out of house, home and bank account in a few short years.

Picky eaters

This is how you get kids to eat vegetables

Children don't think they like vegetables. But a few smart strategies can turn young vegetable skeptics into eager eaters.

When my daughter, Jane, was 18 months old or so, our family got into the habit of “toasting” with vegetables—raising, say, a tender roasted carrot slice to the middle of the dinner table instead of our glasses. It added some fun to mealtimes, and it reassured Jane that this deeply suspicious new item on her plate was OK, since we were all eating it at the same time.

Parents know veggies—packed with important nutrients and fibre—are important. And although they can sometimes be a tough sell for toddlers, who may not like the texture, bitterness or unusual flavours, experts agree that serving them often and from a young age is best. “Parents may try two or three times and then give up,” says Jennifer House, a registered dietitian and mom of three. But studies show that your kid may need to try a new vegetable 10 to 15 times over a number of meals before she accepts it. And it’s worth noting that there’s an important window in the under-24-months age range: Researchers have found that, developmentally speaking, kids under age two are down with trying more new foods than those between two and six.

So just how many vegetables does your kid need to eat in a day? Canada’s Food Guide recommends four daily servings of fruit and vegetables for kids ages two and three—and the new food guide, due this year, is expected to emphasize more plant-based foods overall. (There aren’t existing recommendations for the 12- to 24-month age group, so it’s fine to offer smaller servings of vegetables at meals, says House, noting that you can give your toddler more if she wants it.) For example, add ¼ cup of thinly sliced raw cucumber, ¼ cup of cooked veggies like broccoli or cauliflower and ½ cup of tomato sauce, and you’ve got two full servings. And if your toddler only likes fruit, that’s fine too, says House, as long as you continue to offer vegetables regularly, even if she doesn’t eat them. Have a veggie resister on your hands? Here are some ways to get them interested in eating veggies.

Think texture and variety

There’s no need to start with “easy” vegetables like corn and work your way up to Brussels sprouts, says House. “Offer a little bit of whatever the family is eating, and keep trying different forms, too: mashed, baked, pan-fried or raw,” she says. Easy-to-handle portions are appealing. Also remember that hard, raw vegetables like carrots and celery are a choking hazard for kids under four, so grate or finely slice them. Cut cherry tomatoes into halves or quarters, and chop cooked veggies like cauliflower into half-inch pieces.

Get your tot involved

When Lynda Gellner’s son, Hunter, was two, she took him to the grocery store to see, hold and choose vegetables, and it got him interested in trying new ones. Other ideas to spark an interest: Visit a farm or farmers’ market and talk to the farmer; grow your own peas or beans; help your toddler wash vegetables or spin lettuce dry; or read a veggie-themed book, such as Eating the Alphabet by Lois Ehlert.

Jazz up veggies

There’s no need for vegetables to be naked. Butter, dips, tossed with maple syrup or an apricot glaze: Moderate amounts of these additions are all fine, says House. “I can put pretty much anything into a patty and my kids will devour it,” says Lisa Moran, mom of three. She grates vegetables like carrots and beets, mixes in a bit of beaten egg and flour, and pan-fries kid-sized patties. Bonus: Her toddler, Rosalie, takes them in her daycare lunch the next day as finger food.

Play to their strength

Little kids love any opportunity to show how strong they are, so play to that when you’re talking about food. When Debra Leitner’s son, Talon, was two, she would “remind him that veggies give him power, just like Spider-Man.” And Chelan Wilkins has also played up the strength factor since her daughters, Grace and Sophie, were toddlers. Whenever she made fruit smoothies, the girls were happy to add spinach or celery when she called them “our veggies that make us super strong.”

Give it to them straight

“I don’t like the idea of hiding vegetables, because sooner or later kids will figure it out and not trust you,” says House. “It’s fine to purée vegetables and add them to a recipe, but just be up front about it and say, ‘We’re having sweet potato pancakes.’” Like many nutrition experts, House is in favour of the “division of responsibility” approach: You are responsible for what, when and where your child eats, and your child is responsible for choosing whether he’s going to eat and how much. Yes, even when it comes to vegetables.

And as for our vegetable “toasting” strategy, we had some success: Sometimes Jane ate them and sometimes she didn’t, but we’re now a few years past the toddler stage, and she’s still a pretty good veggie eater. Cheers to that.

This article was originally published online in January 2018.

Picky eaters

Is there something more serious going on with your picky eater?

Lots of kids go through picky-eating phases. For some children, however, their food issues are more extreme, and they're actually symptoms of an eating disorder called ARFID.

Stephanie Elliot’s daughter, McKaelen, was always finicky about food. As a toddler, she subsisted on a diet of dinosaur-shaped chicken nuggets, French fries, peanut butter sandwiches, peeled apples, cake and pizza (with the cheese and sauce scraped off). McKaelen’s two brothers, one older and one younger, would eat anything, so Elliot just figured her daughter would eventually accept new foods into the mix—like most toddlers and preschoolers eventually do—after the worst of the fussy phase was over.

Instead of outgrowing it as her palate matured, however, McKaelen’s aversion to food got worse, with a strict list of only 10 acceptable items in her rotation.

“It was starting to become a real problem—she was physically repulsed by new foods,” says Elliot. Her daughter would gag at the sight of meat and vegetables, and wouldn’t eat what the rest of the family was having.

“If we ever wanted to go out to dinner, we could only pick a place that had French fries or pizza,” adds Elliot.

She remembers trying to sneak bananas into her daughter’s pancakes, but McKaelen could tell they weren’t quite “right” and refused to eat them. Another time McKaelen was curious about eggs, but she took one bite and spat it out.

“I sometimes worried that she didn’t have enough protein or vitamins, so I would try to push protein whenever I could—by offering her peanut butter or even milk,” says Elliot. “But I was pretty good about not forcing her to eat things, because I knew how stressful it was for her.”

Elliot sought help for her daughter for years, visiting their family doctor, psychologists and nutritionists repeatedly.

“They would always say, ‘She’s just a picky eater,’” says Elliot. But she suspected it was more than that. “I worried about the physical aspects of her food avoidance to a small degree, but not as much as I worried about the mental, social and emotional ways it affected her.”

By grade six, McKaelen was beginning to isolate herself from friends and avoid situations like sleepovers, where she might be expected to eat foods that weren’t on her safe list.

When McKaelen was 15, they finally took her to Healthy Futures, an eating disorders clinic in their hometown of Scottsdale, Arizona. McKaelen, it turned out, had been struggling her whole life with an eating disorder called ARFID.

What is ARFID?                                     

ARFID stands for avoidant/restrictive food intake disorder. It was first classified as an eating disorder in the American Psychiatric Association Diagnostic and Statistical Manual (DSM-5) in 2013. Essentially, it’s picky eating to the point where a child will fail to meet growth milestones; start losing weight; develop a nutritional deficiency such as anemia; require supplements or enteral feeding (tube feeding) to maintain health; or whose food avoidance interferes with other aspects of everyday life, says Mark Norris, an adolescent health physician and a member of the eating disorders team at the Children’s Hospital of Eastern Ontario in Ottawa. (For an ARFID diagnosis, a child would need to exhibit at least one of these symptoms, not necessarily all of them.)

Unlike the eating disorder anorexia nervosa, ARFID has nothing to do with body image or fear of gaining weight. ARFID kids avoid food due to sensory issues or an “averse experience,” such as choking.

What does ARFID look like?

No two cases of ARFID are exactly the same, but there are enough similarities when it comes to the typical ARFID diet that should act as red flags for parents or caregivers, says Gillian Harris, the U.K.-based co-author of Food Refusal and Avoidant Eating in Children, including those with Autism Spectrum Conditions.

“With the ARFID child, the real key point is what we call the ‘beige brown carbohydrate diet.’ Everything has that dry, easy texture,” she says.

Kids with ARFID prefer white or beige foods that are soft or crumbly and easy to chew—bread, rice, plain pasta, cake, cookies, cereal or processed meats such as chicken nuggets or fish sticks. This list also describes what parents of kids with autism spectrum disorder (ASD) call the “autism diet.” Coincidentally, it’s also a pretty comprehensive tally of what many toddlers will willingly eat, which can be quite alarming for new parents.

Many children go through a picky-eating stage at age two or three when they gain language and begin to categorize foods into “likes” and “dislikes,” or  “safe” and “not safe,” says Harris, who is also a consultant clinical psychologist at the Birmingham Food Refusal Service in the U.K. For example, a toddler might eyeball a cookie and think, “Yum!” But she will look at an asparagus spear and think, “That’s not food.” Most kids get past this when asparagus keeps making an appearance at dinnertime, or when they’re introduced to new foods at daycare or preschool and see peers gobbling up their veggies.

Kids with ARFID, however, don’t outgrow the picky eating, and over time it may begin to impact their growth or health. They may fail to meet height and weight milestones, or begin to lose weight. They may also develop nutritional deficiencies, such as anemia or a lack of vitamin A, B, C or D. However, since several foods that typically appeal to ARFID kids (and picky eaters) are fortified—such as bread, cereal and milk—even children with limited diets grow on track and are surprisingly healthy.

ARFID almost always negatively interferes with other aspects of life, like mealtime, friendships (avoiding playdates for fear of having to eat something new) or the ability to travel because of the rigid diet. Parents will also want to watch for signs of co-occurring conditions, such as anxiety and autism. (More on that later.)

But food is good. Why do ARFID kids avoid it?

It seems to go against human nature to dislike eating, or to limit your range of foods to only a few boring carbs. Parents of good eaters, and even doctors, will say reassuringly to the mom or dad of an extremely picky eater, “Don’t worry, kids will eat when they’re hungry.” But that’s not necessarily true for a child with ARFID.

They actually might not feel hunger in the same way, or they might have other motivations for skipping mealtime. In fact, experts have pinpointed three primary reasons for food avoidance in children with ARFID, says Norris.

One reason a child might start refusing or restricting food is because something bad happened that involved food (the “averse experience”). Perhaps she choked on a hot dog, or saw her sibling vomit all night long and has developed a revulsion to food out of fear she will choke again or vomit like her brother did.

Another reason a child might avoid eating or restrict what food he eats has to do with sensory hypersensitivity.

“These are your children [who] have extremely picky eating behaviours—they’ll often be quite rigid and set in terms of foods they will accept or won’t accept, and those choices may be based on factors such as texture, colour, taste,” says Norris.

For example, a child might eat chicken nuggets but refuse harder-to-chew chicken breast because of the texture, or he might prefer a certain brand of fish sticks or potato chips and renounce any alternatives based on taste, or solely on the packaging. ARFID kids who also have autism typically fall into this category.

The final reason a child won’t eat has to do with appetite signalling or food indifference. These are kids who say they just aren’t hungry, ever—they don’t recognize that they’re hungry or feel their stomachs grumbling, or they’ve gotten used to smaller meals. They might pick at their plate or get away with just grazing during mealtimes, but they start falling off the growth charts when puberty hits. This is when their food intake will be a lot lower than their energy requirement, says Norris.

Getting an ARFID diagnosis

If you’re worried about your child’s eating, raise those concerns with a doctor. Because picky eating has been normalized as a rite of childhood, sometimes parents’ concerns might be brushed off, especially if the child looks healthy and is gaining weight, says Harris. But be persistent. Norris says there’s been a big push around ARFID awareness in Canada, and your family physician should know what resources are available in the community.

chicken nuggets on a plate 8 recipes your picky eater might actually eatIt took Elliot nearly 15 years to get a diagnosis for her daughter, in part because ARFID didn’t yet exist as an eating disorder when McKaelen was little, and also because she was still growing normally. But Elliot persevered.

“When anxiety and depression are present, and kids are avoiding situations where there’s food—then it’s something to worry about,” says Elliot, who later wrote a young-adult novel called Sad Perfect, based on her family’s experience with disordered eating. “It got so bad we had to figure something out.”

How common is ARFID?

Because ARFID has only recently been classified as an eating disorder, experts aren’t sure yet how many kids in Canada have it. A community-based surveillance study on ARFID was recently completed; doctors hope it will soon give a better sense of ARFID rates in Canada, as well as highlight the similarities and differences across a range of cases. A community-based study in Switzerland found that 3.2 per cent of Swiss children aged eight to 13 met criteria for having ARFID. In the U.K., says Harris, it’s about one in 600 kids. She estimates that there will be at least one child with ARFID in every primary school.

Experts stress that picky eating does not equal ARFID, which is actually quite rare among neurotypical children, Harris says. It is much more common in children on the autism spectrum, however. In her experience, 50 to 60 percent of kids with ASD also have ARFID. Children who had reflux as babies are also at greater risk of developing ARFID, she says, because the vomiting and regurgitation causes “hyper-responsiveness in the throat and mouth.” This means that children will find any stimuli in the mouth—including food—unpleasant.

Finally, there’s a connection between ARFID and mental health disorders, such as anxiety, which is commonly noticed in kids diagnosed with the eating disorder, says Norris.

Treatment for ARFID

Because ARFID is a relatively new diagnosis and it presents differently from one child to the next, there isn’t one standard way to treat the eating disorder. Doctors look at why the child is avoiding food, and consider their stage of emotional development.

Harris says treatment often focuses on reducing anxiety around food, and on desensitizing, if it’s a sensory issue. For young children, this might involve getting comfortable around food without any pressure to try something: talking about it, going to the grocery store to look at it or venturing into a garden to touch different vegetables. Desensitizing can include massaging a child’s face, counting their teeth or—for younger kids—providing chew toys, all in an effort to get them used to different textures inside their mouth.

Treatment can be more successful after age eight, when a child is able to generalize about food, says Harris. For example, kids this age can understand that bread is bread, no matter the brand or packaging, or rationalize that an apple might be OK to eat, since they already like carrots, which are also crunchy. Children this age and older are more motivated to change and may have luck with cognitive behaviour therapy or relaxation therapy followed by tiny tastes of new foods, says Harris.

McKaelen underwent somatic experience therapy (also called touch therapy) during her treatment for ARFID. Over a number of sessions, a trained therapist touched where her adrenal and pituitary glands are located. This helped her relax, lowered the “fight or flight” response from the adrenal glands and gradually helped her overcome her revulsion to new and non-preferred foods. The therapy was part of a 20-week outpatient program that also included consultations with nutritionists, peer group discussions, twice-weekly peer dinners with other kids with eating disorders and group therapy for the parents.

The most important thing for kids with an ARFID diagnosis, say parents and experts, is to keep the child eating.

“Always give the child the food he or she wants, because growth is more important than anything else,” says Harris. And refrain from bribing them or begging them to eat—change will happen gradually, on the child’s own terms.

Now 19, McKaelen is living in a university apartment and cooking for herself. After two or three years of touch therapy, she gradually reduced her sessions. She now goes out to eat at restaurants and will order a hamburger, or even chicken parmesan. She’s still not what you’d call an adventurous eater, says Elliot, but it’s a long way from ARFID.

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Picky eaters

8 healthy snacks toddlers will love

Skip the packaged treats and give your picky toddler fresh, whole-food snacks that will keep them nourished between meals.

Toddlers have small tummies and get hungry between meals, so they often need snacks to keep them energized all day long. But not just any snack will do. It’s easy to reach for packaged treats at snack time—like cookies, cereal bars, muffins and chips—but these options don’t provide the nutrients that kids need for optimal growth and development. Instead, they often have too much salt and sugar. A snack should be made up of the same foods found in their daily meals, and should include both protein (such as eggs, beans, yogurt and nuts) and fibre-rich carbs (think vegetables, fruits and whole grains). Here are eight snacks that toddlers love and are easy for parents to make.

1. Parfait party
If you have yogurt and fruit on hand, you’ve got everything you need to make a parfait. Use a transparent glass or bowl so your child can marvel at the layers, and add some granola on top. Choose calcium-rich plain Greek yogurt, which has more protein and less sugar than regular yogurt. Kids will love these kiwi yogurt cups.

2. Tuna and crackers
Mash tuna with mayo and serve with toast or whole grain crackers. Use light skipjack or yellowfin tuna instead of white albacore tuna, because it’s lower in mercury. Tuna is full of healthy omega-3 fats, which are important for your toddler’s brain health.

3. Veggies and dip
Having trouble getting kids to eat veggies at meals? Try introducing them at snacks, when kids are super hungry. Pair them with a dip like hummus or tzatziki to ensure that there’s some muscle-fuelling protein. The dip may be the key to getting your kids to eat more veggies.

4. Edamame
These green soybean pods take time to pop and eat, so they are a fun activity and a nutritious snack rolled into one! Edamame also contain fibre (four grams per ½ cup), which is important for preventing constipation and is lacking in many toddlers’ diets.

5. Ants on a log
Julie Daniluk: Healthy, on-the-go meals kids love This snack is old-school, but toddlers still love celery filled with peanut butter and topped with raisins. Of course, you could also try a modern remake: hollowed-out cucumbers filled with sunflower butter and dried cherries. With either version, kids will get some vegetables, plus a winning combination of protein, fibre and healthy fat.

6. Fruit with nutty dip
Watermelon, strawberries, cantaloupe and cut grapes are fun to dip. Fruit is filled with vitamins A and C, which help ensure normal immune functioning. For a protein boost, make a dip out of Greek yogurt, nut butter, cinnamon and a small ribbon of honey.

7. Trail mix
Toddlers can help you mix dried fruit, nuts, seeds and crunchy roasted chickpeas. Trail mix offers a great combination of energy from carbs, plus fat and protein to provide long-lasting fullness. Just be sure to brush kids’ teeth afterwards so sticky dried fruit doesn’t lead to cavities.

8. Vegetable chips
Does your toddler love crunchy snacks? Substitute regular potato chips or pretzels with homemade baked zucchini chips and kale chips, which are lower in salt, and provide fibre, vitamins A and C, and folate.

Read more:
7 healthy packaged snacks for school
Why you should let your kids play with their food

An age-by-age guide to your baby's eating habits

Your kid's eating habits will change a lot within the first three years. Here's what you need to know.

Birth to three months: Frequent feedings

Everyone knows newborns need feedings day and night. But what may surprise new parents is how often the baby gets hungry. Lactation consultant Karyn-grace Clarke says: “Many newborns will have a day or two of nursing around the clock, and then they tend to fall into a pattern of nursing every two to three hours. But there are huge variations among babies.”

Remember that your baby will likely double his birthweight by about five months — how often would you need to eat to double your weight in that period of time?

Clarke says it’s important to feed your baby on demand (also known as cue feeding) because it helps the baby be in control of intake. “Sometimes an infant is hungry for a meal, other times he just wants a little snack, and later he might be thirsty and just need a few sips of milk,” she points out.

But what about your neighbour’s baby, who only nurses every four hours and is gaining weight beautifully? Clarke explains that every mother has a milk “factory” and a milk “warehouse,” and both are unique to her. The factory is where the milk is made, and the warehouse is where it’s stored between feedings. When a baby begins to nurse, he first empties the warehouse and then signals the factory to start making more milk. Some women have a large warehouse and some have a small one, so the amount of milk their babies get varies. “Naturally, those babies who get a smaller serving size when they nurse will want and need to breastfeed more often,” says Clarke. Your baby’s rate of growth, stomach size and energy level affect feeding frequency as well.

Three to six months: Eating more regularly

Just as you get used to your baby’s nursing patterns, everything changes again. While in general older babies eat less often than younger ones, there are a lot of variations. Michelle Raghubar of Brampton, Ont., says her five-month-old daughter, Ava-Riley, breastfeeds more often now than she did a couple of weeks ago. “Right now, she nurses about every hour and a half or two hours during the day, and usually twice during the night as well. A few weeks ago, she was usually at least two hours between feedings, and only once at night.”

Is she concerned? “No, I’m not worried,” says Raghubar. “I figure she’s going through a growth spurt again, and this is her way of getting more milk when she needs it.” And Ava-Riley’s regulation of her mother’s milk production seems to be working just fine so far. Born weighing six pounds, nine ounces, she’s now over 16 pounds.

The biggest problem Raghubar’s facing: Ava-Riley has become very easily distracted. While once she was so focused on nursing that she’d keep going no matter what else happened, now she’s likely to stop nursing to look around at the slightest noise or movement in the room. “It makes feedings take longer than they used to,” says Raghubar. “I’ll spend 20 or 30 minutes nursing her, but with all the stopping and starting, she actually nurses for only 10 minutes out of that time.”

With these changing feeding patterns and seeming disinterest in nursing, parents sometimes think that it’s time to start solids. Susan Evers, a professor of family relations and applied nutrition at the University of Guelph in Ontario, explains that research shows it’s better to wait until the recommended six months. Starting solids earlier won’t make the baby sleep longer at night, as many parents hope it will. Studies have shown that adding solids earlier than six months increases the baby’s risk of respiratory and gastrointestinal infections—so it’s worth holding off.

Six to 12 months: Starting solid foods

Six-month-old Rune, son of Alison Stalker in Guelph, Ont., was showing all the signs of being ready for solid foods. He could sit up in his high chair, was eager to put things in his mouth, and was watching his family eat with deep interest.

“One day Mario and I were eating some lovely organic squash,” says Stalker. “Rune was watching, watching, watching as I was eating, as he always did, so I put a little of the mashed squash on my finger and offered it to him. He loved it!”

That was Rune’s first solid food. Now at nine months, he usually eats two meals of solid foods each day, and breastfeeds frequently both day and night. He’s not too keen on green peas, Stalker says, but likes most of the foods he’s tried. “I purée foods and freeze them in ice cube trays for him,” she says. “Sometimes I’ll mix in a little of what the rest of us are eating, if it’s something he can have.”

“Squash, sweet potatoes, carrots and beans are often appealing to babies starting solids,” says Evers. “But even at this age, babies have different preferences. One likes rice cereal; another hates it.” This, adds Evers, can mean some trial and error for parents.

She suggests starting out with small amounts, as Stalker did, and gradually increasing them. Evers adds that the texture of food is a big deal for many babies. Some want their food puréed; others prefer it chunkier. Parents sometimes need to get a little creative to make a food more acceptable to the baby. “For example, many babies gag on the texture of prepared baby-food meats,” she says. “But mix it in with a little mashed sweet potato, and they might like it.”

While Rune was right on schedule by showing interest in solids at six months, Evers reminds parents that “six months is only a guideline and some babies are not quite ready at that age.” If you offer your baby a tasty spoonful of oatmeal and he spits it right back at you, Evers says it’s nothing to worry about: “Just wait a week or so, and try again.”

Whether your baby is enthusiastic about adding solids to his diet, or takes only a spoonful or two each day, it’s important to keep mealtimes relaxed and pleasant, Evers says. Don’t try to force your baby to eat more than he wants, even if it doesn’t seem like much. Your baby is the best judge of how much he needs.

One to three years: Prepare for picky eating

Three-year-old Libby Dufton has some quirks when it comes to food, says her mother, Sarah, also of Guelph. “She will go for days when all she wants is meat and cheese,” Dufton says. Libby’s not always so inflexible — sometimes she’s quite open to trying new things — but when she’s going through a meat-and-cheese jag, she gets pretty determined.

She’s also gone through stages when she eats very little. “She’s a tiny girl anyway,” says Dufton, “so I’ve always tried not to compare her appetite to her brother’s. My doctor said that many kids go through periods of not eating very much, and not to worry if she stays healthy.”

Dufton handles these stages by offering Libby breads, fruits and vegetables at mealtimes, but not commenting if they don’t get touched. She does use a little creativity to make things more appealing: melting the cheese Libby loves on bread, cutting fruit and veggies into bite-sized pieces and serving them with a dip, and giving her some pure fruit juices to drink. “I also let her snack frequently, by just setting food out where she can access it,” Dufton adds.

“This age can be quite frustrating for parents when it comes to eating,” says Evers. “Toddlers often go on these food jags when they’ll only eat certain things and reject others.” She agrees with Dufton’s relaxed approach, adding: “If a child pushes away or ignores the food you’ve offered, don’t make a fuss or plead or bargain to get her to eat it. Just offer it again another day, maybe prepared in a different way.”

While infants are trying to eat enough to triple their birthweight in a year, it’s natural for a toddler — who may gain only a few pounds between her first and second birthday—to have a smaller appetite. “Clean your plate isn’t a good mantra,” cautions Evers.

“Probably one of the most important lessons your child learns during these early years is to listen to her body about how much or how little she needs to eat,” says Evers. “Parents tend to panic when their children’s appetites decrease or they go on food jags, but all these fluctuations and changes are normal. Just keep offering healthy foods and set a good example yourself by eating well, and your children will do just fine.”

Appetizing tips

1. Let the baby tell you how often he needs to nurse and for how long. Responding to his cues will help to build and maintain your milk production to match your baby’s needs.

2. If you’re bottle-feeding, watching your baby’s signals is also important. For example, don’t try to get the baby to finish the last ounce or so in the bottle if she’s not interested.

3. Try not to compare your baby with other babies. All babies have their own individual feeding patterns suited to their rates of growth.

4. If your baby is asking to nurse more frequently than in the past, she may be going through a growth spurt or fighting off an illness. While you may feel as if you don’t have enough milk to meet her needs at first, don’t worry — after a day or two, your milk production will catch up.

5. If your baby is easily distracted (like most babies this age!), look for a quiet spot to minimize interruptions. A fan (facing away from the baby) can blot out other noises. Or try nursing the baby in a sling, with the fabric pulled up behind her head so she doesn’t hear and see everything going on around her.

6. Even if your baby is happy to be fed from a spoon at first, most babies will soon be interested in finger foods, and some prefer them right from the start. Prepare small pieces of soft food (banana, for example) that the baby can pick up to feed himself.

7. Expect mealtimes to be messy. Don’t be surprised if more food seems to be spread over baby’s face and the high-chair tray than actually goes into baby’s mouth. That’s part of the learning experience!

8. Keep sugary, high-fat treats like candy, ice cream and cookies to a minimum, especially if your child has a small appetite. You want to be sure she’s getting the maximum nutritional value from the foods she does eat.

9. Since toddlers still have small tummies, they usually do better eating five or six times a day (three meals and two or three snacks) rather than three larger meals. Just make sure the snack foods are healthy ones too.

10. Presentation counts! Toast cut in triangles may be acceptable when toast cut in squares is soundly rejected. Mashed potatoes touching the peas might cause a serious meltdown, and fruit salad arranged to look like a rabbit with raisin eyes might be gobbled right up. You will soon learn your child’s individual food quirks.

11. Worried that your child is eating too much? Don’t put her on a diet, but do focus on offering nutritious foods like fruits, vegetables, whole grains and lower-fat protein sources. (Remember, though, that children under two should have whole milk, not skim or low-fat.)

Toddler-sized portions (from Canada’s Food Guide)

There’s a lot of variation among children, but typical portion sizes for toddlers are:

½ slice bread
1/3 cup (75 mL) cereal
¼ cup (50 mL) fruit or vegetables
¼ cup (50 mL) fruit juice
4 crackers
25 g (1 oz) meat
¼ cup (50 mL) cooked beans

Want to know what a serving size of poultry or fish for a toddler looks like? Picture a nine-volt battery.

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Toddler health

How to deal with a toddler who just won’t eat

Have a picky eater? Or a kid who just seems disinterested in food? A paediatrician weighs in on what to do when your toddler refuses to eat.

My toddler just won’t eat. I sneak in snacks now and then, but she generally seems uninterested in food. How can she possibly be getting the nutrients she needs to grow?

A kid hand grabbing an egg from a plate How to get your toddler to eat more proteinMy kids and my patients know I’m very “tough love” about eating at mealtimes. Children learn to manipulate parents to get what they want, and sometimes not eating meals can be a tactic for getting a food they love. My family and I eat together every day. We all have the same plate of food, with a balanced, nutritious meal. My kids have to try everything on their plates. Usually they eat everything. If they do eat well, they get fruit, and if they eat that, they can have what they’re craving, within reason. This might be yogurt (a common favourite food for kids) or a treat, like a cookie. They will not get this option, though, if they don’t eat the food we prepared—even if it means going to bed hungry. 

Avoid offering snacks all day out of fear that they’ll starve. Many kids snack all day and then don’t have appetites for real meals. This can pose problems because snacks tend to be carb-heavy and low in protein, fibre and healthy fats. Sometimes kids must be left to get hungry so they’ll eat proper meals. Similarly, watch how much milk your child drinks. Kids older than one should have no more than 2¼ cups of milk a day. Too much and they won’t have an appetite for solids, and they’ll risk iron deficiency as well.

It’s unlikely your child will become malnourished—though iron deficiency is relatively common in picky eaters, other nutritional deficiencies are very uncommon if your child is willing to eat at least some variety. After all, so many foods in Canada, like breads and cereals, are enriched with vitamins and minerals. 

Read more:
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7 signs you should seek help for your picky eater

Picky eaters

6 tips to encourage your picky eater to actually eat


Picky eaters

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