February 05th, 2012

Children instinctively know how much to eat. However, many children’s eating patterns may derail over time. Given the right temperament, environment and genetics these patterns may escalate into eating disorders. The following are 3 common scenarios that are important to watch for.

The Picky Eater: Jacob is an 8 year boy whose mother describes him as picky since age 2, but over the past year, has become increasingly difficult to fee. Jacob is sensitive to texture and smells. He will eat kid foods such as fries, chicken nuggets and pizza but he won’t touch fruits, veggies, and most animal protein. In addition Jacob eats excruciatingly slow, taking 8-9 bites before finishing a chicken nugget. Dinner lasts 45 minutes and mom prompts him to finish. Jacob has always had a slight build but has fallen from the 5th percentile for weight to less than the 3rd percentile.
  
What to Do:
Family meals are a priority for picky eaters. Family meals foster warmth, security, love and offer opportunities to model healthy attitudes towards food. Keep the mood light and relaxed. Avoid nagging or using meal time to discuss subjects that may cause tension.
Serve new foods in a kid-friendly way. This means cook the broccoli with cheese sauce or serve carrots with ranch. Put butter on vegetables or peanut butter on apples. Sure, its added fat however your child will certainly have more success with tastier vegetables and with time, will begin to accept “naked” vegetables. Be patient with food acceptance. It takes at least 10 exposures to new foods to be accepted and a picky child will require more exposures.  Even if the food is not accepted for months, continue to place a bite on the child’s plate. Resist encouraging your child to take a bite.  Studies support that the more a child feels forced to eat the more likely food will become a control issue. Also be careful to not applaud your child for trying a new food.  The less attention that a picky eater receives about eating the less likely the child will spiral into disordered eating.
So what if your child will not eat the main course. Should you make him a peanut butter sandwich or bowl of cereal. NO! Unless you want to be a short order cook until your child moves out of the house refrain from offering alternatives. Instead offer milk and have sides that your child will eat, even if its fruit or bread. 


The Vegetarian:  Sarah is 13 and wanting to be vegetarian after watching an animal rights documentary.  She has begun avoiding red meat but will still eat grilled chicken. She is continuing to eat dairy products, eggs and fish.  

What to Do:
Imagine Sarah’s mom telling Sarah “you can’t eliminate meat, how would you get protein? You don’t even like beans or nuts and those are the main protein sources that vegetarians eat. I do not support you eliminating meat!”  How do you think Sarah would react?  Most likely Sarah will become even more convinced to be vegetarian.  Now picture Sarah’s mom saying “ok, you can give it a try if you like.” If the elimination is not made into an ordeal and Sarah’s mom continues to cook foods she knows Sarah will eat (ie, grilled chicken) than the novelty of being vegetarian may disappear. Only 2% of teens are vegetarian so chances are good that this phase will be short.  Equally important is to monitor that your child does not begin to restrict other foods, for example progressing to vegan, gluten free or eliminating starchy carbohydrates.


The Dieter:  Alley is a 15 year old teen who wants to lose a few pounds because she feels her stomach, legs and face are big. She weighs herself daily. She uses an app to monitor her food intake. She avoids all starchy carbohydrates and desserts.

What to Do:
Make time to eat with your dieting teen. Teens who eat alone are more likely to under or overeat. Dieting teens frequently say they’ve eaten when they haven’t.  Even if the whole family cannot eat together try to ensure that the dieting teen eats with at least one parent.  At a minimum sit with your dieting daughter while she eats. 
Avoid power struggles. If you demand that your child eat, she may make up for later by restricting, exercising, or self inducing vomiting.
Limit special foods that she may request. If you buy 35 calorie bread, pounds of fruits and veggies, spray butter, nonfat everything, your child may have a difficult time reintroducing regular foods. Make it a family rule for everyone to eat the same dinner. Once your child starts eating her own diet foods it is very difficult to reintroduce mom’s spaghetti and meat sauce.
Adolescent girls who diet have a 20% chance of developing an eating disorder within one year. Signs that signal that your child may require intervention include an increasingly restrictive intake, rigid and obsessive thoughts about food and a significant weight loss. Enlist the help of a treatment team before its too late.