March 20, 2009

The Problem with Picky Eaters

Should we intervene with picky eaters?

This is both a medical and philosophical question. The medical question is easier, so I’ll deal with that first.

If the child’s picky eating has left them without enough vitamin intake (if they ate zero vegetables, for example), they probably should take a vitamin. Luckily, there’s a lot of good-tasting vitamin choices available. For iron deficiency, it’s a little more difficult, because the iron supplements often taste bad. But there’s now orange juice with iron, and vitamins with iron which might help. For kids who don’t have any dairy, there are many calcium-fortified foods and drinks. If the child has a problem with creamy-textured foods, that’s sometimes a problem with fat-soluble vitamins A, E, and D, which are usually found in milk. Most soy milk and rice milk is also fortified with these vitamins. But supplements are available for these too. In short, if there's a medical problem, we'll deal with it medically.

The philosophical question is related to the saying, ‘if it ain’t broke, don’t fix it.’ By the time they’re 2, half of all children are considered picky eaters by their parents. So if this is a pretty typical part of child development, do we need to change it? Should we even try?

Research has suggested some of the answers. It turns out that preschoolers who are very picky eaters were often picky toddlers, and these were picky babies who had difficulty nursing and were often fussy. When they became older children, better able to say what they didn’t like, they often had difficulty describing the hesitation they had with certain foods. But many of these very picky eaters remain very sensitive to certain flavors, textures, and smells. Some also were sensitive to other sensory inputs, such as noises, clothing textures, and temperature of the environment.

When I was in medical school, I had the great good fortune to work in a laboratory that studied taste and smell, run by a brilliant scientist named Linda Bartoshuk. Though I personally focused on some of the curious effects of hot peppers in the mouth, the lab studied many interesting phenomena. When I was there, I learned that what I had been taught about the sense of taste was mostly wrong. Bitter taste, in particular, seemed to be genetically determined. It was often more intense in women of childbearing age, and less intense in girls and older women. It was usually less intense in men. Some people simply could not taste one of the test chemicals, while for others it was intolerably intense. Researchers in the lab photographed tongues (including mine) with a microscope, and meticulously counted the taste buds. It turns out that there’s a wide variation in the number and kinds of taste buds people have. Both this and the variations in what we can taste and how intense that taste is can be related to how certain foods taste to us. Professor Bartoshuk and her former student Valerie Duffy, now a professor at the University of Connecticut, collaborated on a great research study that's important to the way we should probably look at this issue. These scientists looked at how intensely adults experienced bitter taste. Then they tested how much these same adults liked asparagus, kale, and brussels sprouts; they also asked about how many servings of vegetables these people ate. Maybe it's not a surprise that those who had the most unpleasant and intense bitter taste perception ate the fewest vegetables. So it's not because their parents were inept about teaching good eating habits. And not because their parents didn't find the right bribe to use to get them to have one more bite of vegetables. It's because the vegetables just didn't taste good.

I have always been interested in doing this kind of experiment in children, which nobody's done. But there are complex issues when experimenting on kids, and that's why it hasn't happened.

Knowing this influences my approach to this common question. The child may not, in fact, be perceiving as delicious what we perceive as delicious. To them, it might be too intensely flavored, even bitter enough to make them gag or vomit. This might be built into their tongues and brains, and won’t improve with nagging or bribing. In other words, it's not necessarily behavioral—which is why behavioral approaches may not work, and could return unwanted consequences.

We could end up causing lasting harm, leaving them with serious food and eating issues that might result in eating disorders and self-esteem issues when they are older.

It’s an unfortunate coincidence that this issue seems to coincide developmentally with the time that most kids are naturally learning to exert control on their environment and their parents. It will take an intelligent parent to figure out when these typical eating issues leave off and the child’s quest for independence and control take over.

So what is the perceptive parent to do? That's the next post.

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Please let me know what you think. Do you know a child or situation like this?