It’s all over Google and Pinterest: “Smart Ways to Sneak Vegetables in Your Child’s Food,” “Foolproof Ways to Sneak Veggies into Kids Food,” “100+ Hidden Veggie Recipes,” “15 Foods You Can Sneak Vegetables into.” Recipes are named for this practice: “Sneaky Pasta Sauce,” “Hidden Veggie Sloppy Joes,” “Hidden Veggie Smoothie.” There are even cookbooks devoted to successfully hiding vegetables in kid’s food. It’s one of the most common pieces of advice parents give each other when commiserating about picky eaters who refuse to eat vegetables. However, this common practice of sneaking foods is problematic. Here are three reasons why:
Instead of sneaking foods into your child’s food, here are some things you can do:
Try these tips to make trying healthy foods fun and enjoyable for both you and your child!
Many families of children with Autism Spectrum Disorders (ASD) encounter feeding challenges. Though the estimated prevalence rates of feeding challenges among those with ASD vary greatly in the literature, there is general consensus that they are more prevalent than in the general population. These challenges are associated with the core symptoms of ASD. Here's how:
1. Social Interaction Difficulties
Feeding is a social experience from infancy. From the start, typically developing babies learn behaviors such as leaning in towards the caregiver and opening their mouths. When this social component doesn't develop or is delayed, feeding can be impacted. Further, it may be challenging or aversive for a child with ASD to participate in the social aspects of feeding. For example, there are many social components to sitting down at snack time or the school cafeteria. If those components are challenging, mealtimes may be negatively impacted.
What can we do?
Look at the entire picture. The social skills required to participate in a mealtime can be thought of as a prerequisite. If a child doesn't even want to sit down with peers at snack time or with the family at dinner time, the actual eating part is bound to be affected. Work on one step of the equation at a time.
2. Language and Communication Difficulties
ASD is also associated with difficulties in communication, which can have a big impact on mealtime behaviors. Effective communication is so important for a successful mealtime. Children communicate their needs and desires throughout a mealtime: "I want more of that," "I don't like the taste of this," "I'm hungry," "I'm full," and so on. So, you can imagine how not being able to effectively communicate these things can lead to challenging behaviors during meals. The child that can't communicate that he's all done and keeps being offered food is bound to cry, scream, throw food, etc.
What can we do?
Give children a way to communicate their needs effectively. For a child that is nonverbal, it may be providing a photo to show that he is all done, or a sign to request "more." I'll devote a post to this in the future.
3. Behavior Challenges
The final core symptom associated with ASD is behavioral challenges. In regards to feeding, here are some common ones that can have a big impact:
Ritualistic behaviors/need for routine: the child needs to eat the same food in the same environment (same spot at the table, food presented on the same plate, with the same silverware, etc.).
Attention to detail: children may refuse food based on what seem like minute details to us. For example, I've worked with multiple children that wouldn't eat food that was broken or that was presented outside of a wrapper.
Sensory difficulties: This is where texture difficulties come into play. Many children with ASD will refuse entire groups of textures. For example, a child might only eat foods that are crunchy but avoid anything that feels "mushy" in the mouth.
What can we do?
Introduce change in gradual steps. Show the child that change can be associated with positive outcomes. For example, you might just change spots at the table and really praise flexibility with trying something new. Make simple changes before you do anything about the food. I'll talk more about how to do this in future posts, as well.
The literature tells us that feeding challenges in children with ASD tend to be more prevalent, more restrictive, and longer lasting than what we might see in a "typical picky eater." The most important implication is to act early! As soon as you notice challenges, intervene. Waiting for a child to "grow out of it" will only cause stress and bigger problems down the road. Stay tuned for coming posts with more information about simple interventions you can implement!
Here are a number of different utensils you can use to make trying new foods a little more fun. Mixing up something as simple as a utensil also teaches a child that change is OK and trying something new can be a positive experience.
1. Toothpick: not only is it fun for kids to spear things, but it is also a great fine motor task. In addition to use toothpicks just as utensils, you can make mini "fruit kebab" skewers. Get the colored toothpicks and incorporate some sorting and counting into your mealtime as well! You can also look for the plastic cocktail toothpicks at the grocery store or the umbrella ones that go in drinks. Lots of possibilities!
2. Tongs: A simple search on Amazon will show you a wide array of mini tongs perfect for little hands grasping food. You can go with the basic colorful ones or more exciting ones with little hands on the ends.
3. The Nuk Brush is often used for oral motor sensory input and has been shown effective in the research in increasing food consumption by using it to distribute food in the mouth.
4. A Chinese soup spoon. Use it on the big side as intended or flip it around to practice drinking from the handle side.
5. Other foods! The possibilities are endless here. Pretzels to dip into different new foods or spear food with, banana to lick yogurt off of, and so on. The beauty of this one is that you can use a new food as a utensil to introduce different textures without the pressure of eating. For example, if your child loves yogurt and you would like them to eat apples, use the apple as a utensil to eat the yogurt with! The exposure to touching and licking food off the apple can add to future willingness to try the apple itself.
Even just switching up colors and shapes of the utensils you are using can make a huge difference. What else can you think of?
Picky eating is a common concern for parents of preschoolers. Both in my experience as a consultant and in reading the research literature on food selectivity, it is clear that parents gravitate towards a few common feeding "solutions" with their picky eaters. These are outlined below as well as ideas for more effective, long-term solutions.
Common Solution #1: Offering the same foods in the same environments
You want your child to try new foods, but after a long day, who needs that added stress? Parents often stick to what they know works. Do you find yourself making the same two foods for dinner on the regular? Or allowing your child to eat in their spot in front of the TV just to get some calories in them? No need to be embarrassed - you're certainly not alone.
Why it's a problem:
Every time you allow your child to have the same food in the same environment, you continue to build a history that this is how it will be. Every time makes it that much harder to change it in the future.
What to do instead:
You don't need to make drastic changes. Think of little changes you can make just to teach flexibility to start. Change one little thing about the meal every day. At first, it doesn't even have to be about trying new foods. Some examples include:
- Cut the grilled cheese sandwich a different way
- Move the chair where your child sits
- Use different plates or utensils
- Add food coloring to foods to make them look different without changing the taste
- Add something different (but preferred) onto the plate
Essentially, you are teaching your child that meals don't need to stay the same but that change isn't stressful. If you jump right into offering a totally different meal, you show your child that change is stressful. This way, you can have fun with it while working your way up to trying new foods. Make sure you praise tolerance of change!
Common Solution #2: Allowing "drive-by" grazing
Your child won't eat at the table with the family, so in desperation to get something in them you allow them to come grab bites in between other activities such as playing.
Why it's a problem:
Your child learns that this is what mealtimes look like. The social and communication aspects of mealtime are lost, and eventually it will be very difficult to change this habit.
What to do instead:
Encourage sitting at mealtime without the pressure of eating food. Start with just a few minutes. Many families will start fun family traditions such as sharing exciting parts of the day, singing a song, or playing a game. At first, have your child come sit down for a couple minutes and make that time as fun as possible. Gradually introduce a plate with food and model eating while enjoying the social aspect of mealtime.
Consider the expectations for your child. If you tend to have a long, social family mealtime, make sure the expectations for your child are realistic and developmentally appropriate. A good rule of thumb is to expect 2-5 minutes per a child's year of age. So a four year old may be able to sit still at the table for between 8 - 20 minutes.
Common Solution #3: Feeding your child at a separate time from the rest of the family
Feeding your picky eater is a stressful experience, so you want to get it over with before the rest of your family eats.
Why it's a problem:
Your child becomes accustomed to mealtime being solely about food consumption and you miss out on family social time.
What to do instead:
First, this requires a philosophical change to view mealtime as about more than just consuming food. Even if you are initially focusing on feeding your child separately, still have him come sit with the family (as discussed in #2 above). You can also offer highly preferred foods for sitting with the family and work on introducing new foods at the other times.
Keep in mind that the common "solutions" outlined above are short-term fixes. It may be easy to just give in and make a special meal or let your child graze all day instead of join mealtimes. It may take away some stress. However, you are creating a long-term problem. Long-term solutions will take much more time and will have to happen in very small steps. As I've written before, celebrate and praise the small successes!
Photos used under creative commons by sung hoon Choi,
"Hey cat, you want to jump in the ketchup?" asked my 2 year old daughter as she dipped her cookie cutter omelet cat into her ketchup and then into her mouth. "This is soooo silly!"
Cookie cutters are a must have tool for playing with food and encouraging trying new foods. They are inexpensive, easy, and mess free! Here is just an example of how we used it with a thin egg omelet. Other foods you can use them with include: bread and tortillas to spread new foods on, lunch meat, fruits, potato pancakes, etc. The possibilities are endless! If you are looking for shapes small enough for small foods, look for play dough tools.
We often make the mistake about focusing only on the actual consumption of food when feeding our children. It is important to remember that mealtime is a sensory experience involving all the senses. Here's how:
Visual: Presentation matters. For example, which of the meals below looks most appealing? Chefs are specially trained in creating visually appealing meals. The way you present a food to a child makes a difference. Think about favorite colors, combinations of food on the plate, and the dishes used to make your child want to come sit at the table.
Tactile: If you don't want to touch it, why would you want to eat it? Think about this when presenting food to your child. For example, holding a banana in the peel is a very different tactile experience than picking up slices of banana. You may present some utensils as an option or first just get your child used to touching a new food before asking them to taste it.
Smell: Good smell leads to willingness to taste. This is a conditioned phenomenon. From the time we first start eating, we learn that when something smells appealing to us, it will taste good too. Good smells can also increase our appetite (think of the hunger that hits you when you smell cooking garlic). Encourage your child to smell foods before asking them to take a taste. Talk about how foods smell and make sure that the smells at mealtime are appealing to your child.
Hearing: This one may sound odd, but think of mealtime experiences in various places - a crowded family restaurant, a busy cafe, a small romantic restaurant, or in your own dining room. Sound does shape our experiences. Negative experiences with mealtime in an overwhelming environment can have an effect on how we perceive food. Trying new foods should happen in an environment that is pleasant to the child.
Taste: Finally, of course taste is important in the mealtime experience. If something tastes good, we are much more likely to eat it again. We often start by giving children bland foods to try: plain peas, broccoli, carrot sticks, and so on. Don't be afraid to experiment with food combinations, spices, and condiments to ensure that foods taste good from the start! More tips on how to do this will be coming on the blog!
Introducing a new food can be daunting. Take this common scenario for example: you want your toddler eating more vegetables so you put some peas on his dinner plate. You then plead with him to just eat a bite. He finally does and then spits the peas out. You try to get him to eat some again, desperate to get the vegetables in him. This turns into a power struggle complete with screaming and tears until you finally give up. Chances are you won't present peas for a while, if ever again. However, research shows us that continued exposures to a new food do increase rates of consumption. Therefore, it is important to continue to expose a child. So, how do you present a new food and avoid the battle? Extremely gradually. Here are some steps to try:
1. Put the new food on your plate and model trying it. It is common that a child's first experience with a food is the first time they even see it. Wouldn't you be wary trying something if you've never even seen it before? Making mealtime a family affair is crucial. Talk about how the food looks, tastes, feels in your mouth, and so on.
2. Put the food out in a bowl and model serving yourself. Encourage your child to serve the food onto his plate as well. Do not put the pressure of eating on him - simply praise any new interactions with the food.
3. Encourage your child to explore the food with all the senses before even talking about consuming it. Look at it, touch it, smell it.
4. Take baby steps when it comes to tasting and consuming the food. Don't do too much in one exposure. Start with kissing it, putting the food to the teeth and tongue, and then eventually baby bites. Don't forget to praise any new interaction with the food! Make the presence of the food as positive of an experience as possible!
Stay tuned as this series about introducing foods continues!
Why does feeding matter?
Before discussing what a feeding problem might look like, it is important to consider what successful feeding looks like. This won’t be the first time I make this statement: feeding is not solely about growth and nutrition. We have a bad habit of equating normal growth with normal feeding. On multiple occasions, concerned families have told me that although they are stressed about mealtime, their pediatrician informed them that there is no problem because their child’s growth looks fine. Again, I reiterate, feeding is about much more than growth. So, what else does feeding entail?
Socialization: Think back to the last few special events that you’ve been to – birthday parties, weddings, etc. Was there food? Of course there was! Food is often the cornerstone of our social events. Mealtime may be one of the few times that a family sits down together. We often schedule get-togethers at restaurants and socialize while we eat. Mealtime is a time of relationship development.
Communication: Mealtime is an opportunity for a child to learn and practice important communication skills. Children have a chance to indicate likes and dislikes, practice manners, and learn functional communication to get their needs and wants met.
Skill Development: As children learn to eat, they develop many different skills. They learn oral motor skills as they try different textures. They learn fine motor skills as they use utensils to spear their food and bring it to their mouth. Children learn to gradually expand the amount of time they can sit in one place.
Feeding is important and feeding challenges can occur regardless of where a child is on a growth curve. It is a complex process with many components to navigate through. The last thing we should be doing is blowing off concerns by referring back to growth charts and nutrition. If any of the components mentioned above are impacted, we need to be determining where the feeding challenge lies and how to best intervene.