Illustration: Sam Woolley
What happens if your picky-eating child doesn't grow out of it? What if you're begging a 15-year-old to just taste a green vegetable? After all, by the time they're adolescents, kids have spending money, autonomy, and access to plenty of junk food. So what is a parent supposed to do when the strategies they used when the kid was six simply don't work anymore?
"It's tricky by the time they're teens," says Katja Rowell, a family physician who works with parents and kids on eating issues ranging from eating disorders to garden-variety picky eating. "Turning things around when kids are younger is easier."
They maintain that parents aren't helpless, even if they have teens who would rather go out with friends for fries than eat pot roast with Mum and Dad.
A quick note: Experts don't necessarily agree on how to address picky eating, because feeding is an enormously complex medical and psychological issue. (Consider all the mechanisms that go into developing oral-motor skills, appetite, sensory and taste sensitivities, social conditioning around food and meals, body image for older kids - the list goes on.)
Some doctors and therapists recommend a behavioural model described here by Virginia Sole-Smith of the New York Times: "Think of it as the Pavlovian approach: It's a form of 'behaviour modification,' a psychological tactic in which food refusal is classified as negative behaviours to be systematically replaced with positive ones."
This can include positive reinforcement when a child swallows or takes a bite, or even holding a child's hands down or force-feeding.
Then's there what Rowell describes as a more "responsive" approach, also called a "child-centred" model: "We try to tap into the teen's motivation, and we facilitate the teen's internal curiosity and drive to do well with eating."
Ellyn Satter, the author of Child of Mine: Feeding With Love and Good Sense, codified this responsive approach with a "division of responsibility" philosophy, which has become the basis for much of the current child-feeding advice: The parent decides what to serve and when to serve it. The kid decides whether to eat and how much (of what's on offer - no negotiating or bargaining for something else).
There's always something the kid likes to eat on the table, like bread or rice, and every member of the family gets their favourite meal as the main dish once in a while. Family meals are paramount; good manners are important, and otherwise you trust that your kids will learn to sample the various foods on the table in their own good time. (I wrote about using this method with my preschooler and baby a few years ago if you want to see how the division of responsibility plays out in real life.)
A parent faced with a picky-eating child (or a child who refuses food entirely, as Smith-Sole describes above) is faced with a truly bewildering array of treatment options and advice, ranging from forcing to coaxing to bargaining to Satter's structured laissez-faire method.
Rowell says, "[There are] very much competing schools of thought, and it would be great for parents to know this so that they know they have a choice. If what a therapist recommends increases anxiety, power struggles, vomiting or gagging, it's probably not going to help with the long-term goal of the teen having a good relationship with food." She and McGlothlin wrote a helpful primer on finding the right help and on spotting treatment that is not working or is counterproductive.
To get an idea of how a parent might handle an ordinary (i.e., not traumatised, and with no other medical issues) picky-eating teen, I asked Rowell and Cristen Harris, a professor at the Department of Nutrition and Exercise Science at Bastyr University and a faculty member at the Ellyn Satter Institute, for their best advice.
Know You're Not Alone
It might seem like every kid but yours is enjoying bok choy and salmon, but parents of picky eaters have a lot of company. While it's tricky to estimate exactly how many children, teens, and adults are picky eaters (because it depends on the definition of "selective eating" used while surveying), experts put the number for children at anywhere from five to 25 per cent.
Skye Van Zetten, who maintains the blog at Mealtime Hostage, says that 25% of children are picky eaters and about half that number will remain selective into their teens and beyond; 26% of adults self-identify as picky eaters.
Similarly, there's no hard and fast rule for what makes a picky, or selective, eater: Some experts use a cutoff of 20 foods, but Rowell says she's seen patients who eat 15 foods who are on the right track, and she's seen patients who eat 40 foods but panic around new food and can't eat in the school cafeteria.
"We say that 'extreme' picky eating is when a child or teen eats so little [either in amount or variety] that it impacts his physical, social, or emotional health, and/or if the concern around his eating causes significant worry or conflict for the family. These families need more support, which might be a book, some phone calls with a [registered dietitian] who specialises in this area, or intensive therapies [depending on the severity of the problem]."
Appeal to Your Teen's Desire to Change
Rowell and McGlothlin acknowledge that the strategies that work for small children don't necessarily work for adolescents. But parents of teens have one big advantage: If the parent can tap into the kid's own desire to expand their palate, they have got an ally.
Perhaps the teen himself wants to be able to order something other than chicken nuggets on prom night, and is willing to work towards finding new foods to like. "Or they say, 'I need to eat better so I have better stamina on the soccer field,'" says Rowell. "It's helping them connect with their motivation. If you try to make them [eat better], it will backfire."
To help teens slowly change their ways - to be willing to try new foods, or to learn to respond to their body's satiety cues so they don't under- or overeat, parents can try a few strategies to reduce stress and address the root of the problem.
If you have been locked in a years-long battle with your kid about her food, you might need to hit the reset button. Rowell suggests a conversation that starts like this: "'We've haven't really been enjoying mealtimes for a long time.' Acknowledge that things aren't working.
A phrase I really like is 'We're a problem-solving family, and we'll figure this out.'"
Ellyn Satter's short book on feeding teens, Feeding With Love and Good Sense: 12 Through 18 Years offers a sample conversation with a teen on how to open up this discussion. It starts like this:
"You: You know, I have been trying to get you to ______ (eat your vegetables, eat less, eat more, not snack, put your feeding tactic here). You don't like it, and I don't like fighting with you about it. From now on, I will plan and prepare meals. I will include a food or two at each meal that you generally eat. Then you can decide whether and how much you will eat of the foods I have included in the meal. I also expect you to show up for dinner on time and hungry. Comments? Criticisms?" (The rest of the book is helpful, too, in strategising on how to deal with selective teens.)
Make a Plan for Regular Family Meals
At this point, commit to family dinner at set times, a recommendation that is at the heart of almost every expert's advice on feeding kids. Now this is easy with a four-year-old whose afterschool activity is Paw Patrol; it's lot trickier with older kids juggling activities, athletics, and social lives. But parents can make this happen, even if it's not every night, even if it's not 6PM, even if it's not the whole family, and even if it's not dinner.
Maybe some nights that means that family dinner is at 8PM when the kids get home from hockey, or if that's not possible, maybe it's a regular family breakfast instead of dinner. It doesn't have to be perfect, but you are emphasising that your family values shared meals of food everyone enjoys on a regular basis.
Dr. Harris acknowledges that "there are some seasons when that's harder. Even if your teen is home late, sit down with the child and share a meal."
But both Harris and Rowell stress the sociability and manners of sharing meals (a primary point of all those French Kids Eat Everything kind of books: families in other cultures regularly come together for leisurely dinners, meals at which it would be horribly rude to say yuck or demand a different entree, and kids get to see their parents, cousins, and neighbours tucking into different kinds of food with gusto).
The idea is to take the emphasis off what is on the table and whether your kid will eat it, and put the focus on enjoying time with your family. There should be no electronics or phones at the table.
Eliminate the Power Struggle
This is part of the reset that both Rowell and Satter recommend: Serve meals that include something palatable for everyone on the table. "Part of the parent's leadership role is that everyone gets food they like," Harris says.
This doesn't mean that you make hamburgers every night to please the one picky-eating teen, but it does mean that when you make chicken cacciatore, there is something else on the table that she can fill up on. "What can be added is side dishes — bread and butter, tortillas, or rice, for example," says Harris.
Basically, you're addressing everyone's preferences - there's something on the table that everyone can eat — but you're not short-order cooking.
Everyone should come to the table hungry. "As the parent you're still holding the line with structure, says Harris. "When a person arrives at a meal they should be appropriately hungry but not famished. You might say to your teen, "'We eat dinner at 6 or 6:30, so you need to finished with with your afternoon snack by 4 or 4:30.'"
Rowell calls this "supporting appetite": allowing yourself to actually get hungry for a meal (and so enjoy it more).
And everyone gets their favourites for the main dish sometimes - even the parents. Sometimes it's shrimp and grits for dad, sometimes it's nuggets for the six-year-old or pizza for the teen. "We have pizza nearly every week in our family," says Harris.
Everyone at the table (including you!) Satter writes, gets to pick and choose from what's on offer without comment, keeping the emphasis on conversation.
Include Regular Desserts and Occasional Junky Snacks
"Often there's too much limitation to what you might call 'forbidden foods'," says Harris. "We suggest offering a serving of dessert regularly (not necessarily daily), and periodically at snack time offering an unlimited amount" of a beloved junk food, whether that's cookies or chips or whatever your kid loves.
"They should experience for themselves that there's enough tasty food available. Offer forbidden food often enough that it becomes ordinary." The idea is that kids will never learn to regulate themselves, out in the world's candy aisle, unless they have opportunities to, well, practice regulating themselves.
Be Prepared to Call in a Professional
But what if you have been doing all this, and your kid still limits her foods to just a few items? Then it might be time to talk to her pediatrician or an eating specialist to determine if something else is going on. "Extreme picky eating goes along with anxiety," says Rowell.
Depending on the problem, a therapist, a speech language pathologist, a registered dietician or a registered dietician nutritionist, or an eating-disorder specialist, can help figure out why the teen is reluctant to eat and help her find her own path toward healthy eating.
"Any of these professionals who does a thorough history to spot red flags could prove helpful. This is so very tricky as I believe that there are many people who offer "feeding therapy" who are under-qualified to do so, and there is the potential for real harm." (See her post, linked above, on spotting therapies that might be doing more harm than good.)
Rowell says that they could be a "sensory avoider" - kids who can't manage mixed textures, or things that are smooth, or things that are slimy; or they could be "sensory seekers": they need food that has crunch or spice. If a teen's eating is so restricted that you're concerned about baseline nutrition, a dietitian can help with small tweaks - adding protein powder to a smoothie, for example.
A professional, says Rowell, "can help the family tease out what the hang-up is - whether it's texture, or reacting to pressure," or even an undiagnosed issue like OCD, anorexia, or avoidant/restrictive food intake disorder (Arfid).
Rowell cautions parents to look out for red flags, like losing weight, an unhealthy preoccupation with body image - saying things like "at least I'm not getting fat" - over-exercising, or ritualistic behaviours, or a sense that anxiety is overwhelming or not getting better.
A professional can also work directly with a teen for solutions; as Rowell points out, most teens want to be empowered in this arena - after all, they don't especially like feeling apprehensive about going to a friend's house for dinner or to an unfamiliar restaurant; they want to feel energetic enough to get through their busy days too.
Even if the problem is something as extreme as Arfid, teens and adults report that getting a merely getting diagnosis and treatment was a relief — because once you get past the judgement and shame, Arfid is a health condition to be managed like any other.
Let Go of the Rope
Back to ordinary, non-Arfid picky eating: If the power struggle is really entrenched - "if you're really struggling with that dynamic," says Rowell - "you might have to let go of the rope," provided there's not a safety issue like extreme weight loss.
This doesn't mean checking out entirely and washing your hands of the problem - but it might mean offering to facilitate whatever steps your kid wants to try, like therapy, driving him to Coles/Woolworths for snacks, buying him Rowell and McGlothlin's book to work through on his own, or helping him find cooking shows that he might find interesting.
It might mean stepping out of his relationship with the dietician or therapist entirely and letting them handle it (while continuing to offer family meals in a low-key way and helping him access whatever resources he needs to).
Unfortunately, it might also mean accepting that this is just way your kid is. I have one very selective eater and one more adventurous one, and my primary goal right now is to not make the problem worse. As that survey showed, plenty of adults are selective eaters, and in those cases, the parent's job is to help a teen, particularly an older teen, learn to navigate the grown-up world with these challenges.
Keep an Open Mind about Your Own Issues
In my now eight-year experiment with feeding a picky kid, I've been forced to confront my own flaws: I'm not an especially adventurous eater myself. There are textures I cannot bear. I have hang-ups about my weight and worry about eating too much bread/pasta/meat/cheese/dessert/whathaveyou.
Consider the number of adults who say "I was a picky eater as a child, but that was because my parent was a terrible cook," or had parents who were very selective eaters themselves, or had very restrictive ideas of what "healthy" food was, or who were constantly commenting on their children's weight and appetite.
I've known several friends who say they didn't know until adulthood that vegetables didn't have to be boiled to death. This is a case in which we don't know what we don't know about our own biases, hangups, and prejudices about food.
So I try to remind myself that my son will graduate to be an eater in kitchens that are not my own, and the broader culture will expose him to new flavours. In the meantime, my mail goal is to support him where he is, encourage good manners, and let him enjoy the foods he is willing to eat.
Fingers crossed he grows out of it by the time he's a teen.