Got nutrition? Tips for handling picky eaters

Along with 10,000 of my colleagues, I recently attended the Food and Nutrition Conference & Expo in Boston, the world’s largest annual meeting of food and nutrition professionals.

The evidence-based educational sessions covered the entire life cycle from conception to end-of-life, and there were many presentations pertaining to children and adolescents.

Digestive health was a major theme at the meeting. Probiotics and fermented products were featured at the expo. And there were educational sessions on feeding your microbiome and influencing the gut-brain highway.

Other topics included reducing plate waste in schools; where kids fit into the new 2015 Dietary Guidelines for Americans; the management of life-threatening food allergies in early childcare and school settings; food insecurity; integrating cooking and tasting activities into nutrition education programs; and the health effects of natural foods high in saturated fat, such as coconut and butter.

Let’s zero in on a fascinating presentation that may be of interest if your child is an extremely “picky eater.”

The topic of avoidant or restrictive food intake disorder was presented by registered dietitian nutritionist Jill Castle, creator of The Kids Healthy Weight Project (an online nutrition and feeding course for parents) and The Nourished Child Podcast.

Your child may have the disorder if she experiences the following: Refusal of foods with certain characteristics — such as wet or slippery foods — or entire food groups; poor feeding or eating skills; problems with chewing, swallowing, or choking; delayed fine motor skills; underweight; anxiety with new foods or a new eating environment; or avoids social eating situations.

Children with the disorder often suffer from constipation, iron-deficiency anemia, vitamin C and vitamin A deficiency, low bone density, delayed puberty, and slowed growth. Perhaps not surprisingly, about half of these cases co-exist with other medical conditions such as attention deficit hyperactivity disorder, obsessive-compulsive disorder, autism, anxiety, and depression.

What can you do if you are a parent or grandparent of a child you suspect has avoidant or restrictive food intake disorder? Diagnosis is made by a mental health provider and a team approach is used including a psychologist or psychiatrist, registered dietitian nutritionist, speech language pathologist, and occupational therapist.

Therapy often includes cognitive behavioral therapy, exposure and desensitization therapy, self-comfort techniques, and family-based treatment where the family takes complete ownership of the feeding process.

Nutrition therapy may include:

• Food challenges where the child is encouraged to take one bite at a meal three nights in a row, then moving on to the next food challenge.

• Food chaining (e.g. rice cake to rice cracker to Rice Krispie Treat to rice).

• Three new foods every day after school for two weeks.

• A food log of trials and the encouragement of the child to evaluate her progress.

What does not work is pressure to eat, offering rewards, and unproven special diets, i.e. gluten-free, casein-free.

Ultimately, the goal is to provide the child with food courage, eating confidence, and a meaningful acceptance of food.

Christine M. Palumbo, a registered dietitian nutritionist and Fellow of the American Academy of Nutrition and Dietetics, practices in Naperville, Ill. She has firsthand experience with avoidant or restrictive food intake disorder with a young family member who is still “working on” his feeding skills. Follow her on Twitter @PalumboRD, Facebook at Christine Palumbo Nutrition, or Chris@ChristinePalumbo.com.