Dr. Bob: I have a 5-year-old granddaughter who used to eat everything when she was 2-3 years old. Now she refuses to try new foods and eats very few foods (chicken and potatoes). She is thin and pale. I have gotten her parents to give her a multiple vitamin each day. Do you have any suggestions on how to get her to eat a well-balanced diet?
Answer: Your questions has many facets so let’s address them individually then discuss an overall approach.
- Your description of your granddaughter as thin needs further attention. It is important that her current growth be considered in the context of her overall growth since birth. Children are monitored by the doctor with height and weight charts on a regular basis. It could be that her slender physique has been present all along so there is less concern. Her physique might also be related to her parent’s physique. Remember that genetics can play a factor in growth.
- If her paleness concerns you, this can always be checked with a simple test of the hemoglobin in her blood (a finger prick). If that is normal and there are no other concerns by the doctor, I suspect that her skin color is normal for her. It would be appropriate to share these thoughts with her parents.
- It is not likely that your granddaughter suffers from any significant medical condition that has led to her food preferences but that can sometimes occur. Usually there will be some other signs or symptoms and/or a change in the growth charts.
- Multivitamins are probably not necessary but do not harm the child.
- In my experience, food preferences change frequently.
For an overall approach, I would note the following.
- It is hard to understand why preferences change, and most of the time it is best to try not getting frustrated with the change. It is appropriate to accept the changes but continue to offer additional choices that the parents eat without much emphasis. For example, adding green beans to the plate, in addition to her chicken and potatoes is a good idea. But start with just one green bean.
- Don’t get frustrated when your attempts to encourage her to try other foods aren’t working. NOBODY wins food wars! If parents insist on certain things and children refuse, power struggles only lead to everyone getting upset, and food will be a source of contention. This is more likely to cause difficulties in the future.
- It is very reasonable to encourage eating some alternative foods and offer a treat (food or non-food) as a reward. This reward should be measured and delivered as promised.
- Do not make food refusal punishable by going to bed without a meal or being ostracized or shamed. Food refusal should not lead to any physical or verbal arguments.
- Parents often had limited diets themselves when they were growing up. I would encourage them to share this with their children – “You know when I was your age I would not eat [fill in the blank {like carrots}]. I started eating other things and I found out that they were good. Just like pizza…I didn’t like that at first but later loved it.”
- Make sure that the parents and grandparents are all on the same page. Children can easily see any inconsistencies and play parent-against-parent or parent-against-grandparent.
The good news – by and large, it does get better over time. Don’t make the child feel guilty with their choice and continue to support and nurture them. Remember, you were a child once also.
Dr. Saul is Professor of Pediatrics (Emeritus) at Prisma Health and his website is www.mychildrenschildren.com. Contact Dr. Bob at askdrbobsaul@gmail.com with more questions.