Countless children across the nation are picky eaters, and families are on the lookout for effective solutions. With that in mind, Dr. Megan Pesch joins Kathy King to discuss her recent study on picky eaters and her insights on this common dilemma.
We’re glad to see you’re enjoying ReachMD…
but how about a more personalized experience?
Ms. King:
If a child is a picky eater, what’s the most effective way to intervene? We’ve heard children grow out of it, but is that true? Families with picky eaters want to know what works best, which is why today we’ll be taking a look at a study that dives deeper into this dilemma faced by countless families across the nation.
Welcome to NutritionEdge on ReachMD. I’m dietician Kathy King, and my guest today is Dr. Megan Pesch, a developmental-behavioral pediatrician at Michigan University C.S. Mott Children’s Hospital. Megan joins us to walk us through her study on children in low-income families who are picky eaters.
Megan, welcome to the program.
Dr. Pesch:
Thank you for having me.
Ms. King:
To start, can you define “picky eating” for us? Are we saying that it’s every day and every meal?
Dr. Pesch:
That’s a great question, and I think that is one of the central questions in this area of research because people define picky eating different ways. In our studies, we define picky eating as a child eating a limited amount of foods, rejecting those new or novel foods, and having really strong food preferences.
Ms. King:
And approximately how many children struggle with eating problems, either too much or too little, as they grow up? And does this change with age?
Dr. Pesch:
Great question. Picky eating specifically, we think it affects somewhere between 25% and 40% of children at some point in their life. We do tend to see developmentally a natural increase in picky eating in the early toddler to preschool years, and that totally makes sense because that’s when kids are really establishing themselves, establishing their autonomy separate from their parents. They like to assert that control. The question as to if children really outgrow picky eating is a great one. Some studies have found that children do, and that is kind of the old adage, but my own work has found that these kids actually may not outgrow picky eating.
Ms. King:
What are the contributing factors to this through the range of ages?
Dr. Pesch:
I think there is a certain amount of a child’s maybe natural inclinations or temperament, how they approach the world. So, if a child is a little bit more on the anxious side, naturally they may not be as open to new experiences, including new foods. There also is an element of genetics of picky eating which is something that I feel is really just starting to emerge, but we do occasionally see it run in families. Other times it can be children who are perhaps not exposed to a wide variety of foods when they’re younger, and if you grow up with less variety of foods, it’s going to be almost certain that a child would have a more narrow palate. Other times, though, there can almost be no seeming contributors, which I feel like is often the most common and what you hear from parents.
Ms. King:
So now that we’ve talked about picky eating in general, tell us about your study.
Dr. Pesch:
Sure. So we followed about 300 children from Southeast Michigan over the course of 5 years, and at 5 points during that 5-year period, we checked in with them and their mothers. We asked their mothers to complete a questionnaire to rate their child’s picky eating behaviors, and we also weighed and measured the children to get their BMI, to understand how their bodies were made up in terms of fat percentages and their growth. We also asked mothers to complete other questionnaires, which gave us a sense about their children’s temperament, basic demographics, and also how these moms approached feeding.
The goal of the study was really to see if there were different trajectories of picky eating, and what I had thought we would find and what I honestly was setting out to find was what predicts a child who “grows out of picky eating.” But the results didn’t show that these kids were growing out of picky eating. In our study, the children who were pickiest at 4 remained picky at 9 years old, so there was a constant level of high picky, there were medium picky eaters, which is almost like the normal eaters, and then low picky eaters, the kids that would eat almost anything. We also looked to see how their weight was correlated with those picky-eating behaviors, and interestingly, we found that the pickiest eaters were more likely to be of a healthy, normal weight, and the least picky eaters were more likely to be overweight or have obesity, which was a very interesting finding, and it does make sense if you think about the kids who are more open to accepting any type of food may get more calories in and may be heavier. But what was really interesting on the flipside, if you look at it the other way, the kids who were pickiest were less likely to be obese, and none of the kids were underweight, which was completely surprising. So it kind of begs the question: Is picky eating, to an extent, protective against obesity? Which was not at all what we were setting out to find, but sometimes the data tells a different story than what you would expect.
Ms. King:
For those just tuning in, you’re listening to NutritionEdge on ReachMD. I’m Kathy King, and today I’m speaking with developmental-behavioral pediatrician Dr. Megan Pesch about her recent study on children who are picky eaters.
So, Megan, diving deeper into the results that you found with BMI relating to being lower with pickier eaters, does that mean that they’re healthy just because their weight is good? Couldn’t there be other risks involved with the food choices that they’re taking?
Dr. Pesch:
Oh, sure, there definitely could, and we really don’t know that. We did ask the parents if there were chronic medical conditions, things like that, and children with chronic medical conditions, and I’m talking about kids who maybe need tube feeds or children who have a very restrictive diet, say, because of allergies, we did not include those kids in the study, so it was really meant to be kind of your typical child. So it is possible that children who were in that healthy, normal BMI range could have had other silent or under-the-surface medical issues going on, but I don’t suspect that that’s the case because these were pretty typical kids. We also don’t know about what their micronutrient status is, what their nutritional intake looks like, so that is a different marker than weight for sure.
Ms. King:
Keeping that in mind, are there many studies that show success in changing a person’s picky eating habits, and if so, what does the research show?
Dr. Pesch:
Interventions around picky eating, I think, are really the next step in this literature. There aren’t many studies showing interventions to kind of change a picky eater. I think there are studies that show ways in which parents can guide their children towards a more diverse palate, so those would be things like involving children in the purchasing and preparation of food or even growing. If you have a garden in your backyard, that’s fantastic. But things like helping children become involved in the cooking process, letting them choose their own vegetable at the grocery store, really making a big deal of it really increases that child’s positive association with that food and have them feel some ownership over it as well.
Other things that parents can do is role-modeling vegetable intake or whatever the desired food is. I always go back to fruits and vegetables because, as a mom myself, I know that’s where my struggle is, but it could be any type of food you really want to work on with your child. Other things like not forcing your child to eat a food that they really have a negative reaction to is important. And I know as a parent, it’s kind of like a gut instinct to say, “Eat your broccoli!” “You need to eat 4 bites because you’re 4 years old,” or whatever happens in your family. I think even though that might get the short-term goal done, meaning if might get the child to eat the food in the moment, it might create a more negative association with that food long-term and could actually backfire on parents and might end up making the child pickier or less apt to eat that food because they have that negative association. So those are a few of the things that parents can do.
Ms. King:
Many times we find that parents can contribute to the problem instead of helping it. Did you find that in your study?
Dr. Pesch:
In our study, we can’t really determine cause and effect just because we collected the data longitudinally and we didn’t do a randomized controlled trial, but we did see some trends in that parent feeding behavior. The kids that were pickiest had parents or moms who tended to be more demanding in their feeding behaviors, and those 2 behaviors—the moms demanding this and then the child’s picky eating—they ran very consistently together over the 5 years. By demanding feeding behaviors, I mean parents who might pressure their child to eat their vegetables more or say, “No dessert unless you clean your plate” or “You can’t have this candy.” Things like that are a little bit more controlling in feeding.
I think an important point though is that we don’t really know if that causes the picky eating or if it’s as a result of the picky eating, meaning if a mom is worried about her kid being picky, she might really put more effort into making sure her child eats their vegetables before they get dessert or things like that, so it’s a little bit of a “chicken and the egg” situation, and I do wonder if there are some contributors of both to the problem.
Ms. King:
Well, that’s all the time we have for today, so I want to thank you, Megan, for sharing your insights on children and picky eating. It was great having you on the program.
Dr. Pesch:
Thanks for having me.
Ms. King:
I’m Kathy King, and you’ve been listening to NutritionEdge on ReachMD. To access this and other episodes in our series, visit ReachMD.com/nutritionedge where you can be part of the knowledge. Thanks for listening.
Ms. King:
If a child is a picky eater, what’s the most effective way to intervene? We’ve heard children grow out of it, but is that true? Families with picky eaters want to know what works best, which is why today we’ll be taking a look at a study that dives deeper into this dilemma faced by countless families across the nation.
Welcome to NutritionEdge on ReachMD. I’m dietician Kathy King, and my guest today is Dr. Megan Pesch, a developmental-behavioral pediatrician at Michigan University C.S. Mott Children’s Hospital. Megan joins us to walk us through her study on children in low-income families who are picky eaters.
Megan, welcome to the program.
Dr. Pesch:
Thank you for having me.
Ms. King:
To start, can you define “picky eating” for us? Are we saying that it’s every day and every meal?
Dr. Pesch:
That’s a great question, and I think that is one of the central questions in this area of research because people define picky eating different ways. In our studies, we define picky eating as a child eating a limited amount of foods, rejecting those new or novel foods, and having really strong food preferences.
Ms. King:
And approximately how many children struggle with eating problems, either too much or too little, as they grow up? And does this change with age?
Dr. Pesch:
Great question. Picky eating specifically, we think it affects somewhere between 25% and 40% of children at some point in their life. We do tend to see developmentally a natural increase in picky eating in the early toddler to preschool years, and that totally makes sense because that’s when kids are really establishing themselves, establishing their autonomy separate from their parents. They like to assert that control. The question as to if children really outgrow picky eating is a great one. Some studies have found that children do, and that is kind of the old adage, but my own work has found that these kids actually may not outgrow picky eating.
Ms. King:
What are the contributing factors to this through the range of ages?
Dr. Pesch:
I think there is a certain amount of a child’s maybe natural inclinations or temperament, how they approach the world. So, if a child is a little bit more on the anxious side, naturally they may not be as open to new experiences, including new foods. There also is an element of genetics of picky eating which is something that I feel is really just starting to emerge, but we do occasionally see it run in families. Other times it can be children who are perhaps not exposed to a wide variety of foods when they’re younger, and if you grow up with less variety of foods, it’s going to be almost certain that a child would have a more narrow palate. Other times, though, there can almost be no seeming contributors, which I feel like is often the most common and what you hear from parents.
Ms. King:
So now that we’ve talked about picky eating in general, tell us about your study.
Dr. Pesch:
Sure. So we followed about 300 children from Southeast Michigan over the course of 5 years, and at 5 points during that 5-year period, we checked in with them and their mothers. We asked their mothers to complete a questionnaire to rate their child’s picky eating behaviors, and we also weighed and measured the children to get their BMI, to understand how their bodies were made up in terms of fat percentages and their growth. We also asked mothers to complete other questionnaires, which gave us a sense about their children’s temperament, basic demographics, and also how these moms approached feeding.
The goal of the study was really to see if there were different trajectories of picky eating, and what I had thought we would find and what I honestly was setting out to find was what predicts a child who “grows out of picky eating.” But the results didn’t show that these kids were growing out of picky eating. In our study, the children who were pickiest at 4 remained picky at 9 years old, so there was a constant level of high picky, there were medium picky eaters, which is almost like the normal eaters, and then low picky eaters, the kids that would eat almost anything. We also looked to see how their weight was correlated with those picky-eating behaviors, and interestingly, we found that the pickiest eaters were more likely to be of a healthy, normal weight, and the least picky eaters were more likely to be overweight or have obesity, which was a very interesting finding, and it does make sense if you think about the kids who are more open to accepting any type of food may get more calories in and may be heavier. But what was really interesting on the flipside, if you look at it the other way, the kids who were pickiest were less likely to be obese, and none of the kids were underweight, which was completely surprising. So it kind of begs the question: Is picky eating, to an extent, protective against obesity? Which was not at all what we were setting out to find, but sometimes the data tells a different story than what you would expect.
Ms. King:
For those just tuning in, you’re listening to NutritionEdge on ReachMD. I’m Kathy King, and today I’m speaking with developmental-behavioral pediatrician Dr. Megan Pesch about her recent study on children who are picky eaters.
So, Megan, diving deeper into the results that you found with BMI relating to being lower with pickier eaters, does that mean that they’re healthy just because their weight is good? Couldn’t there be other risks involved with the food choices that they’re taking?
Dr. Pesch:
Oh, sure, there definitely could, and we really don’t know that. We did ask the parents if there were chronic medical conditions, things like that, and children with chronic medical conditions, and I’m talking about kids who maybe need tube feeds or children who have a very restrictive diet, say, because of allergies, we did not include those kids in the study, so it was really meant to be kind of your typical child. So it is possible that children who were in that healthy, normal BMI range could have had other silent or under-the-surface medical issues going on, but I don’t suspect that that’s the case because these were pretty typical kids. We also don’t know about what their micronutrient status is, what their nutritional intake looks like, so that is a different marker than weight for sure.
Ms. King:
Keeping that in mind, are there many studies that show success in changing a person’s picky eating habits, and if so, what does the research show?
Dr. Pesch:
Interventions around picky eating, I think, are really the next step in this literature. There aren’t many studies showing interventions to kind of change a picky eater. I think there are studies that show ways in which parents can guide their children towards a more diverse palate, so those would be things like involving children in the purchasing and preparation of food or even growing. If you have a garden in your backyard, that’s fantastic. But things like helping children become involved in the cooking process, letting them choose their own vegetable at the grocery store, really making a big deal of it really increases that child’s positive association with that food and have them feel some ownership over it as well.
Other things that parents can do is role-modeling vegetable intake or whatever the desired food is. I always go back to fruits and vegetables because, as a mom myself, I know that’s where my struggle is, but it could be any type of food you really want to work on with your child. Other things like not forcing your child to eat a food that they really have a negative reaction to is important. And I know as a parent, it’s kind of like a gut instinct to say, “Eat your broccoli!” “You need to eat 4 bites because you’re 4 years old,” or whatever happens in your family. I think even though that might get the short-term goal done, meaning if might get the child to eat the food in the moment, it might create a more negative association with that food long-term and could actually backfire on parents and might end up making the child pickier or less apt to eat that food because they have that negative association. So those are a few of the things that parents can do.
Ms. King:
Many times we find that parents can contribute to the problem instead of helping it. Did you find that in your study?
Dr. Pesch:
In our study, we can’t really determine cause and effect just because we collected the data longitudinally and we didn’t do a randomized controlled trial, but we did see some trends in that parent feeding behavior. The kids that were pickiest had parents or moms who tended to be more demanding in their feeding behaviors, and those 2 behaviors—the moms demanding this and then the child’s picky eating—they ran very consistently together over the 5 years. By demanding feeding behaviors, I mean parents who might pressure their child to eat their vegetables more or say, “No dessert unless you clean your plate” or “You can’t have this candy.” Things like that are a little bit more controlling in feeding.
I think an important point though is that we don’t really know if that causes the picky eating or if it’s as a result of the picky eating, meaning if a mom is worried about her kid being picky, she might really put more effort into making sure her child eats their vegetables before they get dessert or things like that, so it’s a little bit of a “chicken and the egg” situation, and I do wonder if there are some contributors of both to the problem.
Ms. King:
Well, that’s all the time we have for today, so I want to thank you, Megan, for sharing your insights on children and picky eating. It was great having you on the program.
Dr. Pesch:
Thanks for having me.
Ms. King:
I’m Kathy King, and you’ve been listening to NutritionEdge on ReachMD. To access this and other episodes in our series, visit ReachMD.com/nutritionedge where you can be part of the knowledge. Thanks for listening.
Ready to Claim Your Credits?
You have attempts to pass this post-test. Take your time and review carefully before submitting.
Good luck!
Countless children across the nation are picky eaters, and families are on the lookout for effective solutions. With that in mind, Dr. Megan Pesch joins Kathy King to discuss her recent study on picky eaters and her insights on this common dilemma.
Countless children across the nation are picky eaters, and families are on the lookout for effective solutions. With that in mind, Dr. Megan Pesch joins Kathy King to discuss her recent study on picky eaters and her insights on this common dilemma.
Stay current with the best on medical education
