Super picky eating behavior in toddlers

Judy Converse MPH, RD, LD of Nutrition Care for Children, responded to my post about super picky eating behavior in toddlers:

"I saw your post on this topic and have to jump in.  I'm a licensed registered dietitian in private practice who has specialized in pediatrics since 1999.

Here's the scoop: Doctors always tell parents not to worry about this.  Partly true: Some defiance around foods is normal at the toddler stage.  But, toddlers are also naturally curious when they are developing typically.  While they can have jags with a certain food for a bit, these should pass, as should the tantrums that can come with presenting new foods.  A natural curiosity to put things in the mouth and try them normally extends to foods.  In my experience, kids who simply will not do this usually have nutrition problems that need correcting.

What is not normal is for kids to continue exceedingly rigid eating patterns into school age years.  If a kid still eats five or fewer foods at age four, that is a red flag for me.  While they may get enough total calories to keep growing (sometimes they don't), they pretty much can't eat a diet that adequately meets their needs for learning, developing, sleeping, pooping, talking - all the things toddlers must learn to do.  If a child is truly entrenched in this, a nutrition assessment can find out if it really is cause for concern, or if all you need to do is add a good multivitamin with minerals and wait it out.

A big clue:  Kids currently get many, many more meds than prior to 1980. Antibiotics in infancy and toddlerhood can change eating patterns. Children with entrenched, rigid food preferences often have had antibiotics either very often (five or more rounds) or very early (in the first 8 weeks of life).  Adjusting the gut ecology back to normal often triggers an abrupt change in food preferences in children.  So, for parents really tearing their hair out, try antifungal therapy for intestinal Candidiasis.  This can be prescription or naturopathic (herbs and probiotics) - et voila - your picky eater suddenly picks up fish, steak, and broccoli.  The hardest part is convincing your pediatrician to try this - they are trained to believe this is only relevant if thrush is foaming out of your child's mouth or anus.  My experience with this is that it does matter if there is intestinal candidiasis without thrush, and that it responds very nicely to treatment.  There are medications like Nystatin that are very safe for infants and children for this.  Even Diflucan is now used in infants.   

Long short, no need for parents and kids to struggle through this.  You can find out whether it matters or not with a good nutrition assessment, and fix it."

Great information. Thanks, Judy, for setting the record straight and for giving us more clues to start piecing things together for our own kids.

Comments

[D]

Is there a test for it if there are no other outward symptoms?

[Heather]

If an infant gets really early antibiotics can a nursing mom help the cause by using probiotics in her own diet?

[Hilary Gerber]

D - there is extensive research on the safety of probiotics in infants. You can buy probiotic powders that are developed specifically for infants. It is fine for moms to take, too. (Again, lots of good research, in pregnant and nursing moms).

Nursing babies do pick up most of their inherent flora from their moms, but antibiotics in one or both members of the nursing relationship can alter the yeast and bacteria balance in both.

I also wanted to mention that a sudden severe restriction in diet can happen after a GI illness, regardless of antibiotic administration, which I guess can also alter intestinal flora in some cases. When I encountered this phenomenon (which is also documented by research) with my own son, I just patiently continued to reintroduce foods repeatedly with no judgment, just as you should to a baby (and I gave him probiotics) and he now has a healthy and varied diet.

[Elizabeth]

That's interesting. D had a ton of antibiotics as a newborn, because he spiked a fever and they had to rule out sepsis. But he ate just fine as a baby -- it wasn't until he was 2 or 3 that he became a picky eater. I sometimes worry that it was forcing him to take the anti-malarial medication when we went to Africa that triggered his picky eating.

But he ate a few peas yesterday!!!

[amy]

My daughter has a very restricted diet at age three still (dry and crunchy or smooth liquid only), and I wonder if her having thrush as an infant could still be affecting her. I feel fairly certain that getting my ped to consider Judy's suggestion would be a fruitless endeavor. On the other hand, my daughter has never liked to put anything in her mouth except her hand, so now I'm back to tactile defensiveness as primary cause for her diet issues. Arg! Sometimes more information is simultaneously exciting and frustrating.

[amy]

My daughter has a very restricted diet at age three still (dry and crunchy or smooth liquid only), and I wonder if her having thrush as an infant could still be affecting her. I feel fairly certain that getting my ped to consider Judy's suggestion would be a fruitless endeavor. On the other hand, my daughter has never liked to put anything in her mouth except her hand, so now I'm back to tactile defensiveness as primary cause for her diet issues. Arg! Sometimes more information is simultaneously exciting and frustrating.