As many parents know, children can be notoriously picky eaters. In some cases, their chronically fearful approach towards food amounts to what is considered a serious psychiatric condition.
But a new survey of adults who were, and continue to be, finicky eaters suggests that rather than forcing a child to eat foods they don't like, parents will probably make more headway by embracing a non-confrontational approach at mealtime.
"Let's start with what didn't work," said co-senior study author Nancy Zucker, director of the Duke Center for Eating Disorders, in Durham, N.C.
"When individuals perceived that they were being forced to try or eat something -- for example, that they were being made to stay at the table until they finished or that they were making their parents angry or disappointed if they did not eat the thing that they were asked -- adults with ARFID [Avoidant/Restrictive Food Intake Disorder] symptoms recollected that this was not a helpful eating environment to promote food adventurousness," Zucker said.
"Alternatively, when adults recollected that their parents really understood how hard it was for them to try new things -- and conveyed that they understood what they are going through -- this was an important, helpful strategy that allowed for collaborative problem-solving between parent and child, to figure out ways to expand their dietary variety," Zucker added.
Just over 19,200 adults participated in the online survey, which was launched in 2010 and continued through 2020. About three-quarters were women, and nearly nine in 10 were white. When surveyed, all said they were currently picky eaters to some degree.
But about half said their chronic eating issues had triggered serious weight loss and/or malnutrition, while also undermining their ability to work and maintain relationships. And the study team determined that this group most probably suffered from ARFID, a psychiatric condition first officially identified back in 2013.
Still, about four in 10 survey respondents said that their attitude towards food was somewhat improved as children when their parents chose positive, encouraging and engaging tactics.
Such tactics included framing meals in the context of cultural or nutritional learning; engaging the child in meal preparation; focusing attention on particular food groups; and always offering children "safe" food-flexible options that didn't pose a perceived threat.
In addition, parents also seemed to get good mileage by "exposing children to novel cuisines, or experimenting with ways to hide the taste of food -- with the child's knowledge -- as baby steps to make the food more approachable," Zucker noted.
Another important factor: ensuring that mealtime has a consistent structure. About 40% of those surveyed said that knowing what to expect at mealtimes was helpful in making them -- as kids -- feel that they were being asked or encouraged to eat something, rather than forced.
The survey results reflect the fact that "individuals are more likely to repeat things that they enjoy and to stop doing things that they find aversive," Zucker said.
Her advice: Aim at slowly expanding a child's food horizons through encouragement and support, rather than by mandating a quick fix.
"When a child has ARFID, not only does the child experience impairment, but parents can suffer tremendous emotional losses and grieve the absence of enjoying delicious food with their children," Zucker acknowledged. "It is understandable that parents would wish that a switch would flip" from one day to the next.
But while "their consumption of, and attitude towards, a variety of foods can indeed change," the process is more likely to unfold "as a journey, rather than a breakthrough," she explained.
Lona Sandon, program director of the department of clinical nutrition at the school of health professions at UT Southwestern Medical Center in Dallas, agreed.
"Nobody likes being told what to do," she said.
"That includes being told what to eat whether you are a kid or an adult," Sandon stressed. "If you have aversions to certain tastes, textures, colors or smells of foods, feeling forced to eat something is just going to increase anxiety around eating and make things worse."
Her advice: "Whether you have just a picky eater or a child with ARFID, it is important to not turn mealtimes into a power struggle. The key is to be patient, willing to experiment, and avoid demanding or forceful feeding."
At the same time, "parents will also need to work with other therapists as well to address any psychological aspects [to the problem], and a speech therapist to determine if there are any physical concerns with swallowing certain textures or thickness of liquids."
If and when a child is diagnosed with ARFID, Sandon urged parents to "seek professional help from a team of health professionals, including a registered dietitian nutritionist, to assure the child is offered a diet that provides adequate calories and nutrients for growth and development."
Zucker and her colleagues published their findings online Nov. 10 in the International Journal of Eating Disorders.
There's more about ARFID at the National Eating Disorders Association.
SOURCES: Nancy Zucker, PhD, director, Duke Center for Eating Disorders, and professor, psychiatry and behavioral sciences and department of psychology and neuroscience, Duke University, Durham, N.C.; Lona Sandon, PhD, RDN, LD, associate professor and program director, department of clinical nutrition, School of Health Professions, UT Southwestern Medical Center, Dallas; International Journal of Eating Disorders, Nov. 10, 2021, online