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Questionable things ‘experts’ say #4 (the “failure-to-thrive” picky eater)

Posted by on Aug 8, 2011 in Blog Posts | 15 comments

I recently worked with a family who’s child was “failure to thrive,” with years of extreme feeding difficulties, feeding therapy, GI visits etc. I was dumbfounded to hear what happened when the child expressed a  liking for cucumbers and raw spinach.

When the family happily reported he was actually enjoying foods for the first time, the G.I doc’s stern response? “Don’t bother with those foods. Not enough calories! Douse them in ranch and then give them to him.” Argh!

This little guy was showing a first glimmer of pushing himself along with eating. He was, for the first time expressing an interest, and eating, of his own free will… food. I don’t think it’s a coincidence that he sought out foods he had likely never been pushed or encouraged to eat. By denying and spoiling those first steps to a healthy relationship with food, that doctor was doing more harm than good.

Remember that integral to learning to like new foods is to have a pleasant time at the table, to actually enjoy the experience, and not be in “fight-or-flight” mode. Anxiety kills appetite for the small and picky child. Small children who are pushed to eat more or try more foods will likely eat less and grow less well. Attitude is step one when learning to eat. This little guy was starting with cucumbers and spinach, but given time, patience and lots of neutral exposures to a variety of foods, he will push himself along with his eating.

To parents of extremely picky children, or those with feeding disorders, what were the first foods you remember your little one really enjoying? Were you able to sit back and enjoy it, or were you pressured to do more, faster?

How about you? Were you a “picky eater?” What do  you remember about the first foods you learned to like?

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  1. Jenny

    It’s so hard to know what to do when your child isn’t gaining. My natural instincts didn’t seem to be working out, but there is so much conflicting information about what will work.

    I found this website to be very helpful. Not only did I feel less alone, but it helped me find the help my daughter needed.

    Best to you all. Jenny

    • katja

      Hi Jenny,
      It is really hard to trust the process! There is a great thread right now on FB on ellyn satter’s site. (scroll down to Kevin’s question and the mom’s advice.)
      I have seen the site you refer to, and while overall it has some great info, and I’m glad it helped you, I have HUGE problem with this phrase…
      A good therapist / feeding clinic (intensive feeding program) will achieve feeding goals in a matter of weeks or a few months. If it takes longer consider switching to another feeding clinic or therapist who can do the job in a timely manner. A competent feeding therapist / specialist will never suggest tube placement (unless the child is not safe to eat by mouth). A competent feeding therapist / specialist will always take care of the problem. Poor therapy can not only delay the proper intake of nutrition, but can also lead to a tube placement.

      Putting a time-line on the process is not helpful. I also dislike his emphasis on the therapist, “taking care of the problem.” Perhaps for some oral motor issues, the therapy is the site of the most progress, but most families I work with have been frustrated with their feeding clinic experiences, and when the kids “failed” were given no hope or options. I also TOTALLY disagree with his comment on feeding tube placement. Such a blanket statement is scary to me. Sometimes a feeding tube is the best thing for the child (There is a great section on feeding tubes in Child of Mine.) Feeding tubes can support nutrition and a starving brain while the family rehabilitates the feeding relationship.. Anyway, I am so glad you found the help you needed, and glad you like my site. I hope you have found joy in feeding again! I now how much worrying about health and nutrition can sap that joy…

  2. Kirsten

    I agree that is absurd. To take perfectly healthy foods and change so that the child gains. So what happens when down the track the child’s body not only catches up but possibly outruns the ‘failure to thrive’ and becomes OHMYGODFAT!!!,! It will be “give up the ranch dressing and eat only cucumbers and spinach.” Basically we can’t win for losing. If were not failing to thrive then were thriving too much. What ever happened to just letting kids grow up without endless interference and labels?

  3. Pene

    My older brother was a very picky eater. For years, I can remember him only eating bread and tinned spaghetti. My father only convinced him to eat pancakes when he was seven or eight by telling him they were like bread, and my mother used to sneak mashed vegetables into just about everything they gave to him.

  4. albe

    We experienced the same thing with my very small (but ultimately healthy) daughter, who was a picky eater as a baby and toddler. Her GI doctor kept pushing things like Carnation Instant Breakfast on us (which I couldn’t understand, as it seemed to be mostly sugar, and she never drank it anyway) and told us to eschew things like unadorned fruit. We were supposed to put syrup or cream on everything sweet (like fruit) and oil and butter in everything else. For a couple of years I added oil to almost all everything. But she loved (and still loves) plain fruit, without anything extra on it, and I refused to mess with that, even though her doctor disapproved.

    What I observed from our years of trying to pack in calorie-dense foods was that it had very little effect, from what I could tell. She just ate less of them. It just resulted in food battles and the day I finally gave all of that up for good was the day we started to move towards non-stressful mealtimes. Now at 3.5 she eats a decent variety of foods, and is still not quite on the charts, but is clearly normal, healthy, and thriving. A while back my mother found all of my old baby records from birth to age 2 and I was stunned to see that at each age, I actually weighed the same as my daughter or slightly less. Back then, my doctor saw it as no problem. And now in 2011 it is viewed as a problem for my daughter, when it seems like she’s just influenced by her genetics.

    • katja

      I love this, and I’m excerpting it for a talk I’m giving soon about FTT and growth concerns. research supports your experience. Even in infants, when the formula was concentrated, the babies just drank less of it. I think it’s sad how we have lost a sense of trusting our bodies, and how everyone has to conform… Thank you for sharing your experiences. I think your words will give other parents courage to stop pushing, which can be very, very scary…

  5. Amber

    That’s absurd. I really think the medical community is taking this whole thing too far. We’re all either fat, in danger of becoming fat, or too skinny. Just let the kid eat the veggies he likes.

    I wasn’t much of a picky eater but I used to fight with my dad over things I didn’t want to eat. When I was really young my dad would cook dinner and he often made steamed broccoli and carrots as a side. I loved broccoli and liked raw carrots but steamed carrots are absolutely disgusting to me. I never wanted to eat them and he wouldn’t allow me to leave the table until I finished them. I was a daddy’s girl and he was usually a pushover but that was one thing he never budged on, I was not getting up from the table until I ate those carrots. He also used to include a cup of mandarin oranges in my lunch every day, even though I hated them and I always gave them away.

    He’s normally very sensible and laid back but I think he has some issues with food. I know he grew up really poor and had to fight with his siblings over food sometimes so I wonder if he did those things because he wanted to make sure I always had enough to eat. I’m almost 30 now and he’s always sending me home with these huge packages of steak and bags of garden veggies.

    • katja

      It is absurd, and they are crazy. You push, push push, then shockingly, they might overeat because their own internal cues have never been respected. (See the last comment where the mom of a tiny child pushed for years, and the daughter now seems to be gaining weight rapidly…) The “good eater” finishes her plate, but somewhere the definition changes to portion control and weight maintenance. It’s not fair to raise kids that way. Sorry you were pushed with certain foods as a kid. I think it’s very compassionate of you to think about his eating past to understand his actions. Makes sense! How sweet too though, that he sends you off with care packages! This food and eating business is complex, isn’t it. It ain’t just calories in, calories out!

  6. Elizabeth

    I always struggle with a related problem with one family that lives a couple hours away and frequently stays with us when they come to our town. Both their kids were extremely premature and had growth issues – the younger is 3.5 and has had a feeding tube since before she was 1. Their mother always pushes as much rich food as she can, all day long. (The little one is not permitted to drink water, ever. She drinks milk with extra cream added.) The older one has suddenly become quite plump, which I suspect is her normal shape (she looks a lot like both her parents), but her mother is still in the mindset of pushing her to eat.

    I’ve mentioned Ellyn Satter to the mother, but I don’t want to push an agenda on them, even if I suspect it would be better for their kids. My problem is that I can’t really enforce my house rules when they visit, given that they’re following doctors’ orders. But it seems unfair to my daughter to not be allowed to share in whatever snack her friends are eating when they visit, so she often ends up with lots of extra “treats” at odd times, throwing off her regular eating schedule. (Last time the visit also disrupted her sleep schedule so much that she got sent home from daycamp as a discipline problem on the Monday after the visit.)

    Right now the visits are infrequent enough that I don’t worry about it too much, but it bugs me a bit, and it could certainly become more of an issue over time. I also don’t really know what to tell my daughter about the different rules. I don’t have a big problem telling my nieces to knock it off when they start rummaging around in my refrigerator 20 minutes before dinner, but this is different somehow.

    Any thoughts?

    • katja

      Oy. You guys don’t throw me any easy ones! Maybe I will throw this out to the group in a large post? I have some thoughts, but my readers are amazing resources. Would that be OK with you? I’ll chime in with my thoughts at that time if that’s OK. NOT an easy one!

      • Elizabeth

        Yes, that’s fine. I’m sort of relieved that it’s not an easy one – it means that I’m not just being dumb in not being able to figure it out. 🙂

  7. Anne

    I have been and continue to be a “picky eater” at 40 years old, and it’s still a huge struggle for me to try new foods or to add foods to my mental list of “safe” (much less “enjoyable”) foods to eat. I have HUGE anxiety issues about putting anything in my mouth that is unfamiliar, and in general, I reflexively hate the taste of anything I haven’t tasted already.

    As an adult, I empathize very much with my loved ones who try to traverse the very, very shaky tightrope of encouraging me to try new things without exerting the pressure that will cause me to shut down entirely at the prospect. I do need constant encouragement external to me, though — left to my own devices, I’d eat nothing but brand-name carbs that I’ve eaten since the age of 3.

    I often feel that I wish that my parents had pushed me more to expand my food palette. My mother felt very strongly that it was wrong to force a kid to eat anything, and she would never do anything like telling me I had to eat everything on my plate. When I went through a year or so where pretty much the only thing I would eat would be hamburger rolls filled with ketchup and then squished flat (who knows where that came from!) then that’s all that I ate, period. I don’t think I had a single green vegetable from about 1975 to 1989. And sure, I avoided lots of anxiety because I wasn’t forced to eat green vegetables…but I also avoided all of the nutrition that such food would have provided.

    I don’t know whether a different approach would have helped me develop more nutritious and healthful habits. I do know, though, that continuing to be so “picky” is not only deleterious to my health, it’s also oftenttimes socially awkward and detrimental to my success at work. I look forward to reading more here and seeing if I can re-train myself more positively!

    • katja

      There was a better way! I think there is a lot in between forcing a child to eat foods and letting them only eat the same thing meal after meal for years. Have you ever read any of Ellyn Satter’s books? You might find a lot of insight in reading Child of Mine (even though it starts at infancy-age 5) you may see some of your history in there. I really enjoy my work with adult picky eaters. it is very tricky! Also, Secrets of Feeding a Healthy family would be a great resource (also Satter) Even though it says, “Family” the first third is about adults and their eating. Also has an article in the How to Eat section about adult picky eaters. if you’d ever want to explore working together, let me know! I do this work via Skype, and so far have had some nice successes! Keep it in mind 🙂 I find that the anxiety, the guilt, the shoulds, the pressure (spoken or not, from others and from self) really get in the way of being able to approach new foods. My approach is kind, curious, slow, informative and, I think, fun!

      • Kate

        I wanted to give a second hurrah for Secrets of Feeding a Healthy Family. My husband and I both were only open to eating a small selection of foods and with that book, we have greatly expanded our palette. We don’t like everything we try, but we have been pleasantly surprised several times with new foods. The changes have, for the most part, come pretty easily, we really just had to take the first step (I don’t want to downplay how scary the first step was, but after that it got easier for us). We were motivated to change and neither of us had any physical issues that would throw up any roadblocks.

        Anyway, Satter’s books give you a roadmap, but let’s you set the rate at which you’ll follow it.

        • katja

          Thank you Kate! I love your stories you have shared over the years! I should link to my adult picky eaters posts again for your wonderful comments alone! I’m so glad you talk about how hard it is to start, but your comments always seem so joyful and kind. Love that! Some of the adult picky eating experts talk about “how far we can push” the adult picky eater. I just don’t they they get it…


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