Taming the Picky Eater: Strategies for Stress-Free Mealtimes

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Welcome to the Where Parents Talk podcast. We help grow better parents through science, evidence and the lived experience of other parents.

Learn how to better navigate the mental and physical health of your tween teen or young adult through proven expert advice. Here's your host, Lianne Castelino.

What effective research based strategies can help parents tackle picky eating and at the same time support their child's nutrition? Welcome to Where Parents Talk. My name is Lianne Castelino. Our guest today is a feeding therapy professional.

Dena Kelly is also a licensed professional counselor and board certified behavior analyst with more than a dozen years of experience in feeding therapy.

She designs in depth feeding programs and equips professionals and caregivers with the skills needed to apply evidence based strategies to improve the eating habits of children. Dina is also a mother of two and she joins us today from Phoenixville, Pennsylvania. Thank you so much for making the time.

Thank you. Thank you so much for having me.

Really interesting topic because many parents have gone through it and it seems like you'll never ever get past it if, you know, depending on where you are, you have spent over 20 years working with families and what led you to focus specifically on feeding behaviors?

Yeah, so I fell into it by accident, actually.

I was in my graduate program of study and was looking for an internship placement and ended up at an autism clinic, which is an area that I knew I wanted to work in, pediatrics, autism. And they had within that autism clinic an outpatient intensive feeding therapy program.

So I was put in there for one of my semester and never looked back from that point on.

So once I got in there and was really able to see how life changing it is for the child and the family when eating is less stressful, was so rewarding for me that I knew that this was definitely the path that I wanted to go. And so over the last almost 15 years now have really focused primarily on feeding interventions for families. Families.

So give us a deeper glimpse into that, Dina, if you could, in terms of, you know, what impacted you when you had that interaction with those children.

Yeah.

So you know, when, when a family's struggling with feeding challenges or a significant food restriction, you know, high level picky eating, is that it impacts the whole life of that child and the family. So it limits their ability to have calm family dinners, to go out to a restaurant, to travel.

You know, most parents will report that they spent all day dreading dinner time because it would end up being such an exhausting experience for them. And so once we work on, you know, an appropriate intervention for that child.

And for that family, it reduces a lot of that stress and anxiety and allows the child to access social experiences that they didn't get to before. It usually allows the family unit as a whole to get along better because that stress has been reduced.

And so it's just significant impacts across the board for children, especially with autism that are in a lot of other therapy programs as well, is that once they are actually eating well throughout the day, is it allows them more stamina to get through the day. They're less cranky, they're more focused because their bodies are actually feeling better.

So it gives them the opportunity to excel in those other therapies when they're. When their oral intake, their feeding intake is improved.

I guess most of us would really associate picky eaters with younger children typically. But I wonder what current trends you're seeing as it relates to older kids, tweens, teens and adolescents.

Yeah, so that's most of my caseload right now, as crazy as it is, is actually the older kiddos. And that actually started around the time Covid hit.

So when Covid hit for us, when there was a major influx in families of older kids calling in, because prior to that, you know, when you think about the school age dish, you know, elementary, middle school children, there's a lot of hustle and bustle, right? They're gone all day at school. They come home, it's like, quick, let's do some homework and a snack and maybe we're off to a sporting game.

And they're grabbing food from the drive through. They're just grabbing snacks. They're kind of on the go.

And what happened during COVID is that everybody was home and then they were home for every single meal. And then we were getting these panicked calls going, oh my gosh, all he wants is McDonald's every day. Or he's not eating anything other than chips.

I never really noticed because we hadn't sat down for family meals because things were so busy. And now that we were forced into not being busy, we're noticing that. So we have that.

You know, though, I definitely saw a big trend coming up in that respect.

But the other big component is that for a lot of kids and, and this I can't yet explain with feeding challenges, don't always have the growth concerns matched with it. So there are kids that could be solely eating one specific food, and they can continue to grow in height and weight.

And so what happens is throughout the years, they'll go to their yearly checkups at the pediatrician's office, and they'll report that that child is picky and they're struggling to get in a variety of foods, but often from a medical side, if they're growing in heightened weight, they're continuing to be told, just wait and see. It's a phase. They're going to grow out of it, don't worry. And those years continue on.

And the longer that children go with continued avoidance of eating, the more difficult it gets to be able to expand that variety.

And so if you get into those years of 9, 10, 11, 12, you know, into those teenage years, oftentimes it's actually snowballing and becoming a bigger and bigger and bigger issue.

And so then I have the families reaching out and their child's 13, 14, 15 going, I've known this has been a problem since they were two, three or four, but because they were growing, because there wasn't really any nutrition concern that they were initially looking at, we didn't do anything. And now this child is not going to birthday parties. They don't want to hang out with their friends at the mall.

They, you know, aren't eating during the school day because there's nothing for them to eat. And so now this child is struggling socially. It's leading to more anxiety, it's leading to stress in the family, all of those sorts of things.

And so it's that wait and see category that they usually end up getting to that point. It's. It's much more uncommon to see a child that was eating really well and then in that tween or teenage started to develop the food challenges.

It's usually something that if in hindsight you look back, most families will say they've seen it all along.

So then along those lines, Dina, is it possible to pinpoint root causes here? Right. Like you talked about COVID as an example. But like picky eating among children seems to be so prevalent.

Is it something that parents are doing as well or what's contributing to this?

It's a combination of a few different things. Right. You know, developmentally, appropriately, children are going to go through that no phase, right.

Or that time where they want to just assort assert their authority and they are in charge and they are going to be in the one giving the instructions and that sort of a thing. And so that's appropriate and should be happening.

But what happens when you have a child that has potentially some predisposition for this feeding challenge, then paired in an environment where when they do say no or they do engage in some refusal behaviors at mealtime, get removed from that meal time, get provided with a much more preferred food item, get a whole lot of attention and engagement when they're engaging in those sorts of refusal behaviors at mealtime.

Sometimes paired the biological part with the environmental part ends up being this recipe that ends up putting that child in more of a restrictive eating pattern. So the other thing to look at is, is how restrictive they're actually getting with their food.

So you know, we, we hear that term picky eating and it should be a phase often, but usually with picky eaters, even though their variety of food may not be as exciting, expanded as you know, an adult would be, or even an older child might be, is that they have foods usually in each food group that they're eating, even if it's only a select few. And usually they can generalize those foods to a variety of different environments.

So even if the child only wants to eat chicken nuggets, they'll eat chicken nuggets.

Whether you order it off of the kids menu at a restaurant, whether mom makes them at home, whether you get them while you're on vacation, whatever you're doing. Chicken nuggets, that's going to be a win food, right?

With the more restrictive eaters or kids that are struggling more internally what they're eating, they're going to want the specific chicken nugget from the specific place that the brand or restaurant and that's it. They can expand past that. And so usually there's more of that internal struggle with sensory sensitivities.

Sometimes, you know, kids have higher gag reflexes or certain senses are heightened. You know, we have kids that have bigger challenge being around certain smells or certain feelings of that texture.

That consistency can really throw them for a loop as far as what they're actually exposed to eating. But, but most kids, most people are internally motivated to eat and enjoy eating.

And so usually, you know, if they're in a typical pick eater stage, they're going to continue to expand out of that. They're going to be willing to try some new stuff because it's interesting and they like eating.

When we're seeing that significant avoidance and lack of actual interest in food is where you're having more of the concern.

And that's often where parents have more of the inconsistency as to how they handle that, which can lead to then again more of that snowball as far as how they're going to move forward in that situation. So sometimes they get frustrated and so they get heightened and respond in an angry way.

Maybe sometimes they actually Just shut down and get frustrated in that way. And they say, forget it, do whatever you want. I'm not even going to, you know, require that you do anything today.

Sometimes they might negotiate with them and they go back and forth on, if you just take this bite of food, I'll give you this. If you do this, I'll give you this. And get into all of that. So.

So it's definitely a combination of both the physiological and the environmental factors.

Now one of the really interesting pieces of your story is that you transition from a hands on sort of intervention based support to program development and training caregivers and parents on the very things that you've just outlined there. So what motivated you to make that pivot, to make that shift and how has your perspective evolved as a result?

Yeah, so the pivot started again back during that Covid time, right when everything shut down and everybody went virtual. So did in person, person therapy programs. And so we really had to do this shift of, you know, I used to be very hands on in this program.

The parents would watch from the side as I was working through a meal time with the child and starting to learn the interventions that they needed to do.

And now we were stuck in this situation where that wasn't actually possible and so had to quickly get creative on how we would move forward with that.

And what we were able to see is that there's even better, bigger benefit to doing it as a parent training approach and being able to empower the parents to get the, the confidence and control back in their kitchen and around meal time to be able to give their kids the confidence to be able to actually do better with their eating. And so now when I do programming for families, it is in their home.

The parent is taking the lead, the child is in their own kitchen where they're expected to eat most of their meals. They're eating foods that the parents are cooking. And so it's all part of the process of ultimately what we want them to be doing.

Expanded from that is that now a big part of what I do is actually training professionals because what I was seeing was that there's this whole population of kids that need intervention that can't necessarily access it from a private provider like me. But also these professionals that are already working with these kiddos but don't necessarily have the skills to do feeding intervention.

And so by actually training the professionals that are so interested in learning to expand their knowledge for feeding, now they're gaining professional development and those families are able to access some of that care that they wouldn't necessarily have been able to access privately.

Part of your approach involves applied behavior analysis. Can you take us through what that is and why is this considered an effective tactic for feeding therapy?

Yeah. So ABA provides structured individualized approach to each family.

You're looking at how you can understand and, and improve the behavior of that child. And, and that's really across the board, but obviously in our case specific to feeding.

And so what we're looking at is both what's reinforcing that food refusal, meaning what's keeping it going, and, and what can we actually use to reinforce actual eating consumption. So when kids are really struggling with a feeding disorder, they're not internally driven by to eat, they're not motivated to do it. Right.

I, for me, I love to eat. I could smell food cooking in the kitchen and I'm already hungry. I could be full.

And if somebody brings out a treat that looks really good, I'm still going to eat it. Right. But our kids that are struggling with food selectivity are not necessarily motivated to eat in the same way.

So I equate it a lot to thinking about other just mundane or non preferred tasks that a kid might have to do.

You tell a child to clean up their toys or brush their teeth or put on their pajamas, some of those things that they don't necessarily have an interest in doing. But if you can pair those things with things that are motivating to them, it gives them more of a drive to do it.

So you tell the child to clean up their toys, they say no, but you say if we clean up our toys, we can get to the park. Right.

Is that then they may be more likely if they really want to go to the park to put their toys away, even though that wasn't super interesting to them in the beginning.

And so with food, while obviously there's some more complexities than just putting toys into a toy box, we have to think a lot about the different textures and, you know, smells and colors and all of the sensory components that come into food.

And thinking about that when we introduce those to our kids is that we do have to look at if this, if the act of eating is not motivating to you is what can we do to be able to help provide some of that motivation and push to be able to get you more interested in trying those foods.

And so a lot of Abi is really looking at the environment as a whole and that child as an individual and being able to say what can we do within this child's environment to be able to help provide them, you know, that. That extra ohm for that motivation to be able to make this behavior change.

So really interesting example that you provided there with the younger child and the park. What would that look like with a tween or a teen, for example, when, you know, things become ever more interesting and challenging.

Could you give us an example of what that could look like in a household?

Yeah. So a lot of what we're looking at when we're looking at a intervention program is first and foremost is looking at how we structure mealtime.

A lot of times there's just so much inconsistency, again, between schedules, between expectations, between what the family's eating versus what the child's eating. And so there's a lot of work that comes into play before you even get to that table with that child.

So it's looking at structuring actual planned meal time.

So it's not just throwing some food down and saying, I'm going to go do some other things and you need to be able to eat, is that you're purposefully planning a time in which you're sitting down with your child and you're going to, you know, present that. That food for them. You're also looking at what is their eating behavior outside of that mealtime. So a lot of kids that.

That have food refusal or struggle with eating often graze throughout the day. So they're found snacking on a lot of foods, some chips and crackers or candy or those sorts of things.

And so if they're doing that from the time they get home from school until mom says it's time for dinner, they're usually not very hungry.

And so one of the other things when it comes to structuring those meal times is looking at can we have some actual gaps between the last eating and the next eating. So it allows our body the actual opportunity to have some digestion and start to develop that need for hunger. Right.

And that body's need for food, even if the child isn't super motivated and wanting to do it, but it's giving the body the opportunity to digest those foods and be more interested in what is going to be provided. And then the third part, especially with the older kids, is they have to be involved in the process.

So a lot of this food anxiety comes from lack of control and the unknown. Right. So a lot of times families are just making dinner, they're throwing some stuff down for the kids. The kids have no say.

They've never seen this before. It doesn't smell Good. They don't want it. And so with all of my older kids, they are involved. They are in the driver's seat of this program.

So we sit and sit, and I will say, okay, here is, you know, all of the foods on mom's dream list for you to eat. Let's see how we can look through some of these foods and find ones that you can look at and say, I might try that. Or that doesn't sound so bad.

Right? And being able to allow them to pick and choose some of those foods along the way.

And what happens with the older kids is that after a few foods that seem easier to them, they start to actually gain some confidence and they start to realize, I can do this, and this isn't as scary as I thought it was. And so with each new food presentation, it gives them more and more confidence to be able to move further along and try harder and harder foods.

But even with the older kids, we have to put some motivators into place. So my older kids usually have a bigger thing that they're working towards.

I've had children that want a new doll or want a new Lego set or want something that maybe mom and dad have said no to, they didn't really want to buy, or it's not really something that they would get on a regular basis, but it's something that if they meet their feeding goals, they can actually work towards.

And so, you know, if they're not motivated by actually eating the food, but we know it's something that they have to do, is that if they can, you know, work to do, that is that they can earn this thing that they potentially want. And usually by the time they get to the point of earning the thing, they have actually expanded their variety.

And you're starting to see that they're.

They're more comfortable eating those foods without necessarily needing more things, is that they've now built up the confidence to be able to realize that foods aren't as scary as they thought that they were.

So much of what you're describing really is placing the onus on the parent paying attention, as you alluded to, in terms of what their child is doing with a food item around foods in general.

So then how can a parent distinguish when picky eating becomes a true feeding disorder versus just a phase that they're going through at whatever age they're at.

So a couple things. The. The typical picky eating phase that falls in the developmental appropriate category. Right. Is between that age about 2 to 3. Right.

And so if a child's experiencing this older I would usually argue that they're out of what we would would categorize as developmentally appropriate picky eating. But two is it's really going to be what is the impact of that child's eating on their life.

So even if they're younger, you know, children's food intake impacts everything. So it will impact their sleep, it will impact their toileting, it will impact their behavior, right?

When we think about the idea of us as adults feeling hangry, right when we go too long without eating and we might be shorter tempered, right? Or feeling just exhausted and lethargic near the end of the day, wanting to let the same thing happens to our kids.

They're quicker to tantrum, they're quicker to be more frustrated or non agreeable to listening to a parent. They're struggling to fall asleep sleep at night.

You know, they usually are struggling with constipation because they're not getting in all of those good nutrients and it's impacting their ability to sit at the table and eat something, to go to a restaurant, to go do all of those sorts of things. So if you're seeing that your child eating behavior is impacting their whole day, that's where you're going to be to be looking at.

You know, we've got something that we want to be able to work on, on some intervention for.

But I will say, you know, across the board I it is, it is much better to receive intervention and help even if potentially that child would have grown out of it than it would be to not and continue to wait.

So because none of us have that crystal ball to be able to say this two year old's going to be fine when they're versus this two year old is still going to be struggling when he's four. I would recommend if the parents have the resources to be able to get that child at 2 into some feeding program, you know, from the get go.

Because most families like you said are thankful for really understanding how to look at mealtime differently. We all come into mealtime with so much, much emotion and so much want and drive for our kids to love the food as much as we do.

And the reality is most don't early on even, even kids that don't have feeding struggles don't necessarily love all of the foods that they're eating even when they're younger. But we as parents don't. You love that? Isn't that so good? Or why don't you want to eat that?

It's so good and so you Know, we, I really work to teach families to be able to say we want meal time to be, you know, an enjoyable experience, but we don't need to focus on whether or not the child is loving the food that they're eating. We just need to make sure that they're ultimately getting in those foods so that they can get in their good nutrients.

It allows them to be, you know, engaged in social activities. It's not impacting their daily behavior and sleep patterns at night.

You know, it's so interesting, as I hear you describe it, what's really striking is, you know, how much influence a parent's relationship with food can have on this whole equation before anything else happens. So if you, you know, let's say don't like to cook or grew up with unstructured meal times or have food aversions yourself, etc. Etc.

And now on some level, maybe imparting that, you know, bias on your children, that's going to be like a tall mountain to climb at one point.

Yeah, I mean, yes, it, it certainly can be.

And so, you know, I think that's where parents often find, you know, my approach and programming very eye opening for them to be able to realize how much of, of theirs, you know, whether it's eating struggles or eating infatuation, right. They put on to their child.

You know, I've had families that will come to me and the mom will say, you know, I actually struggled with an eating disorder when I was a teenager. And so I'm really, really scared to put any boundaries into place with meal time because I don't want my child to struggle in the same way.

And so while that's super valid, right.

And understanding as to why they want to allow their child to have free access to any food whenever they want it and whatever they want to do is that the research actually shows that when done effectively, a feeding intervention program does not lead to any sort of eating disorder in the future. It's a very different dynamic.

And eating disorder is much more focused on body dysmorphia and not specifically to the foods or lack thereof that they're, that they're eating.

And so while I understand the concerns that parents have for that, it usually, you know, can be worked through as the parents start to realize that their child is struggling with a different feeding challenge and not specifically in a body dysmorphic eating disorder.

When we talk about challenges for a minute, you know, what are some of the more common reasons children would want to avoid, avoid a certain food, be, you know, against a certain Food. And how can parents manage that situation without creating an environment or shame or blame or any of that?

Yeah, so the majority of the time, I will say, usually involves a sensory characteristic of that food. Once in a while, it could be a specific incident that occurred.

So I've had some kids that might have had a choking incident or perhaps got the stomach bug right after eating something. And so then they associate food, or specifically those foods, with bad, and they don't want to eat that anymore.

But most of it comes from sensory characteristics of the food. So the way it feels, the way they're chewing it in their mouth, the way it smells, the way it looks, the color, any of those sorts of things.

And so with that, what we look at is, is meeting the child where they're at and helping to shape it to some of the other foods that they can eat.

So a child that's only eating crackers, goldfish, you're not going to give a piece of salmon to, you're not going to give broccoli to right away because they're only eating goldfish. And that is a very, you know, different consistency and texture and flavor and all of those things.

But if we can, could teach the child that the goldfish is actually very similar to a cheez it, which now, you know, is a different shape, but is going to have a similar crunch and a similar flavor. Right. And then we can work from maybe that Cheez it to like a piece of toast with some melted cheese on it.

So now you still have the crunch and you still have the cheese flavor, but now you're on a real piece of bread with some real cheese. And you work your way up to ultimately getting that child to a grilled cheese or a cheese sandwich of some kind.

Now you've been able to transition from goldfish to sandwich, more real food. Right.

In a way that met them where they're at and worked them through their sensory characteristics of that food, and they could build that trust up along the way. Sometimes with the kids, it's just some slight varieties. So taking, you know, they're already eating strawberry yogurt.

Let's look at doing a new flavor of that yogurt or keeping it strawberry yogurt, but change the brand of that yogurt.

So really, some small little steps towards changes based on wherever that child is with the foods that they're already eating so that they can gain that trust along the way.

So then at what point should a parent be looking at potential red flags that would indicate the need for professional intervention? What does that look like.

So as soon as the child's eating is impacting their day, and perhaps they might try some of these things that, you know, we were talking about here at home.

Oftentimes, even if it's just, you know, some of these basic interventions that we're talking about today, it's helpful when you have the support of a feeding specialist or professional to be able to help, be that sounding board for you and help you work through that.

You know, I, I have even professionals that will say, after they've worked with me for a while and they've done some other kids and they, they could be pretty independent on their own, is that they'll say, but you're still just a phone call away. Right? They like to be able to know that they have that opportunity to have that support in place. So, you know, even families that.

That think that they can say, you know, okay, I'm going to go in and I'm going to put in this structure and I'm going to lower my expectations so that we can meet this child where they're at and get them started on the right foot.

Having somebody to be able to help guide them, even through that process, if it's a big change for what their family is typically used to doing, can be really helpful.

So my recommendation is always, if meal time and the child's eating is impacting that child's whole life and the surrounding family, reach out and get some help, even at a consultative level, to be able to get the support to help make those changes in your household so that you can have a more improved meal time.

Speaking of households, you are a mom of two tweens. Curious, with all of your experience and expertise, what does mealtime look like in your home? Have you ever had to deploy any of these strategies?

Strategies?

Yeah. You know, I. I laugh that I was doing this before either one of my children were born. So.

So, you know, just like, you know, different medical professionals will avoid certain activities for their kids off of fears of things that they have seen. For me, you know, with feeding, I, right off the bat, started my children off of breast milk onto regular textured food because.

Because my own internal angst was that there would be a struggle transitioning from puree to regular texture, but also setting those boundaries in place as to what mealtime looks like, what they're expected to eat, what they're going to see on their plate. And so I really strive to make sure that there's a fruit or a vegetable in all of their meals. And certainly while some meals are easier than others.

You know, we have the expectations that are in place, so we're not having the tantrums at meal time. We're not having, you know, the child saying I don't want to eat and running away.

We're not struggling with those because we've set the groundwork from the beginning of what's expected at mealtime.

We're almost out of time, Dina. But I did want to ask you to tell us a bit about Focused Approach and what makes the programming that you deliver and your work unique.

Yeah, well, I really work to combine both my behavior analytic background with my clinical psych background to come together and create an individualized program for families and for professionals to be able to teach whatever it is that they need in their specific situation.

So really being able to work through a family's emotional state when it comes to this food refusal with their child, but also being able to recognize what that child is feeling and how, you know, we can help them work through that themselves.

But I really strive to make sure in my programs that they are customized to each individual family so that they can get the best success possible for them.

One quick piece of advice for a parent or a family in the middle of what we're describing in terms of that stress at the table with a picky eater.

Yeah. So, you know, advice is hard. Right? We talked about a lot of these things. But I, but I will say you're not alone.

I think, you know, is always the biggest thing I want to strive to families, I feel like they often feel like they're out on their own island and struggling with this and nobody else is struggling with it because they see all these other kids eating really well and it's only their child that's struggling. But the reality is this is a huge issue for a lot of families and with a lot of children. And so you're definitely not alone.

And there are supports out there to be able to help improve the struggles that you might currently be having.

Lots of really excellent tips and advice. Dina Allen, licensed professional counselor from Focused Approach and food therapist.

Thank you so much for your time and and sharing your insight with us today.

Thank you so much. To learn more about today's podcast, guest and topic, as well as other parenting themes, visit whereparentstalk.com.