Hello.  I have a 9 year old daughter that has been a picky eater all her life.  Her diet consists of pizza, pizza, pizza, Rice-a-Roni with lots of A-1 sauce sometimes, spaghetti sometimes, Goldfish, and Doritos.  She will not touch fruits or vegetables.  The only meat she gets is what is finely ground up into spaghetti sauce or what is added to the Rice-a-Roni.  

She is currently seeing a counselor that believes we can work this out.  My daughter is otherwise a well-behaved child that does very well in school, is outgoing and enjoys a variety of activities.  Eating has been the one issue that is a problem.  

My concerns, besides the obvious lack of nutrition and poor eating habits, include the possibilities of eating disorders as she reaches the teenage years especially since ballet and other styles of dancing are some of  the things she enjoys the most.  Her physician has always been aware of my concerns but has always insisted that she is growing and developing normally.  

One thing the counselor has suggested is that I try to incorporate some of the foods mentioned above into recipes that also include other foods.  I am completely at a loss on how to incorporate Doritos or Goldfish into anything nutritious.  Do you have any suggestions on recipes or behavior management that fit this situation?

  Thank you very much for your time and attention.

My own thoughts are that I cannot imagine how it got to this state, and it's too late now for you to do too much about it directly.  I am not criticizing-- I never had this problem, and while I would like to think my "management" prevented it with my own family, I've gotten brought up short several times on other issues that left me no choice but to eat humble pie.  In other words, I haven't walked in your shoes. 

It strikes me that nine years old is a little old to do much of anything positive without professional help. Two years old or so, and you can trick them.  At five or six, you can be sneaky.  At nine???  I think not.  Sneaking healthy food into a diet of spaghetti, pizza, Doritos and Goldfish is just going to cause more problems.

I saw a TV program a few months ago about a six-year old child who had what a therapist called "oppositional disorder"; the parents were absolutely going out of their minds and the entire family was disrupted and dysfunctional, just trying to control their son's behavior.  One big issue was food, and just giving in and ordering pizza for him every evening restored order and tranquility to an amazing degree.  One would hope that sooner or later the kid got tired of pizza and tried something else!     

My son probably would have been diagnosed that way, too.  He was a very intelligent, inventive, hyperactive, astoundingly strong and most difficult small child to raise.  We coped by making deals with him about almost everything, but basically he had to learn to control his own behavior all the way and we just had to stand by, advise, try to help him learn, and not let him get into too much trouble or danger along the way.   In the long run it worked out fine; short term, it was h-e-double toothpicks.

My youngest daughter was the only one in our family that was "picky" about a number of foods, and it turned out she had a broad range of food allergies that eventually, in her mid-teens, became most severe and nearly life-threatening.  Have you had your daughter tested by an allergist?  It's just a thought-- maybe not a valid one.

You may benefit from counseling for yourself on how to handle this situation, at this point.  In any case, I've asked dietitian Jessica Setnick for her advice about the problem.

It sounds to me like the counselor mentioned is some kind of therapist, so I think that's okay and a smart way to go.  The pediatrician says the child is growing normally, so that's good, too.  Having a pediatric dietitian evaluate the child would be ideal also, partly for the mother's comfort level.  He or she would tell her if the child's intake is in fact nutritionally adequate, or recommend supplements if indicated, as well as provide child feeding guidelines, etc. 

"Two books I recommend for parents of picky eaters are 'Secrets of Feeding a Healthy Family' and 'How to Get Your Kid to Eat...But Not Too Much', both by Ellyn Satter.  These provide the parents with insight into the 'balance of power' (she calls it the "division of responsibility) and how it affects the child's ability to eat a variety of foods.  The second one is not meant to be read straight through, but rather used as a reference book.  One can look through the table of contents to find the chapters that apply to one's specific situation.  

"As far as incorporating the preferred foods with other foods,  I cannot say what the physician did or did not say, nor what the mother heard,  but there might have been some kind of a misinterpretation there.   I personally wouldn't recommend mixing the preferred foods with other foods, but rather providing the preferred foods along with a variety of others on the plate or at the table.  The child should be allowed to eat the foods of her choice, but should also be exposed to and offered other foods not currently on her list (whether she eats them or not).  This is the only way she has the opportunity to learn.  There should never be any nagging, forcing or tricking going on.  

"Concerning the mother's worries about  eating disorders, if the child is as restrictive an eater as the mother describes, she may already have the kind that is called a 'childhood feeding disorder'.  In my opinion, however, there is no more reason to worry about her developing anorexia or  bulimia from her current eating habits than you would worry about any child who was interested in dance, although she is somewhat at greater risk because of her dancing.  All the more reason to get her hooked up with a dietitian so that if she has weight or eating concerns later on related to dancing, she will have someone to talk to.  But  for now, the issue is:   

"Counseling without ever having met the parent or child is certainly not the best idea, so please interpret my words as general guidelines for anyone with these issues.   I still recommend that the mother see a child feeding specialist in her area, if she is not already doing so.   I can try to help her find one if she wants to tell us her area, or she can visit www.eatright.org to search for a dietitian by zip code.

Thanks for your excellent advice, Jessica.  Best of luck, Cindy, and write back and keep us posted.  We're concerned and we care.

Related pages:

• All About Picky Eaters 
• Is Total Control a Good Thing?

My son is now 11.  He has always been a fussy eater.  We are slowly turning his attitude to food around. (My daughter is 13 and eats everything - now he is thinking differently about food; her attitude is helping him try new things.)  Below are a few things we have tried.  We have an improvement in our son's fussy eating habits which has been gradual from about 9 onwards, the last 6 months being the best yet.

"There is a movie called "The Midnight Feast" about children at boarding school and a boy who knows how to cook.  Basically the school headmaster is on a healthy food kick, the boys form a club, get enthusiastic about food and have midnight feasts in the kitchen when everyone is asleep.  We watched it together and talked about it after.  Just after watching this movie the teacher at school used Mulberries as a treat for good behavior.  Bingo, in this situation my son tried them.  We then had a lovely session up a Mulberry tree picking and eating berries and laughing at ourselves.  I explained to my son what a lovely time I had with him and how I was so pleased he decided to try this food,  otherwise we would have missed out on this experience.  We also picked blueberries and I joked the whole time with my son that I would make a blueberry pie and we would get up and have our own midnight feast.  These sorts of occasions provide the ideal time to chat about food enjoyment, likes and dislikes without feeling like you're pressuring your child. 

"Upon receiving complaints at the dinner table I replied "This is what the family have for dinner.  If you don't like it you may leave the table and go to your room.  There is nothing else to eat and you will have to wait till breakfast for your next meal."  Most times he at least made an attempt at eating the meal.  Stick to your guns on this one - don't give in and provide an alternative meal no matter how bad or guilty you feel.  Obviously some of the family meals have to consist of foods she loves to eat, but try to balance it out with some new ones.  We all have our favorite meals but we cant have them all the time.  A family meal is one we eat together and the others like to have their favorites as well which may not necessarily be hers.

"Tried to make him aware of the feelings of the person preparing meals and how disappointing and frustrating it is when only complaints are received, especially when the cook was trying to provided a balanced healthy diet and spent all that time preparing etc.  Ask him how he would feel if he was the cook and you complained all the time.

"When trying new foods there were options.  We could force him, which we didn't want to do, or he could try them himself and control the situation.  The deal was, chew and swallow two mouthfuls and if you really don't like it you don't have to finish it but it will be served at a later date so you can try it again.  Some of these food were ones that could be used as a whole meal later and he just got a sampling of it.

"Give him a new food and ask him to try it.  He used to be shaking his head "no" as in he didn't like it and shuddering at the taste, before he had even put it in his mouth and chewed it.  It was a mental thing, he had convinced himself beforehand that he wouldn't like it.  He used to complain about black marks (browning on meat or veggies from cooking) or pick bits out here and there to examine them.  Once his attitude to trying something new had changed I told him he needed to just pop a mouthful in and chew and try to enjoy the flavour as a whole, rather than try to pick the food apart. 

"In the last six months he has come along in leaps and bounds.  We now have him eating mild curry, berries, gravy and casseroles, different soups to tomato, lamb cutlets, some ethnic dishes, Chinese food, fish and even tuna casserole.  He is actually proud of the fact that he is eating a wider variety of foods and I regularly praise him and tell him I am pleased for him too.

"This week he tried to get out of eating a meal that he was not really keen on, I explained this happens to all of us from time to time.  When he was told there was nothing else and if he was hungry he should eat it, he actually ate it without complaint even though he was not really happy about it.

"Your child is old enough to start cooking and to be able to have discussions about their feelings and other people's feelings towards food.  Help her choose a new family meal from a cookbook (maybe one you know the rest of them will eat) let her help prepare it and see the satisfaction she gets from others eating food she has cooked. 

"We tried to change his attitude to food by getting him interested in all aspects of it.  I kept telling him jokingly he had to become a chef so he could cook for me instead.  Try to get her interested in the whole food process so she can see what is involved in getting meals to the table.  Planning, buying, cooking and eating.  Encourage her to cook, obviously with supervision.

"My husband, son and nephew are all fussy eaters with my nephew being the worst.  When we got married I told my husband (who doesn't cook) it was bad luck if he didn't like my cooking because he could always learn himself.  When I made him more aware about food and nutrition his attitude changed somewhat.  He now eats a wider variety of foods too.  He was also asked not to make negative comments about any foods at the dinner table.

This is a great letter from someone with a really positive attitude and creative solutions.  She's writing in response to Cindy's letter about some serious concerns regarding her 9-year old daughter being  an extremely picky eater.  This is "food for thought" for anyone with a picky eater.  Thanks so much for writing and sharing your experiences and solutions.

My story sounds just like Cindy's, the one you have on your website.   My son, though, is 13.  We worry lot about him not gaining weight.  We are wanting to do something.  What did Cindy end up doing.  Any advice?     Is there anything one can take to make them hungry, to make them want to eat?  I had heard there was.      Thanks.

Really, Diane, there's not a lot you can do at that age.  I don't have any words of wisdom from personal experience on this; mine all had appetites like they were expecting a famine.

The excellent advice that Jessica Setnick gave Cindy, including the books she recommends, 'Secrets of Feeding a Healthy Family' and 'How to Get Your Kid to Eat...But Not Too Much', both by Ellyn Satter, may be a help, but less so at 13 years of age than Cindy's daughter at 9.   

Boys have less eating disorders than girls, but it's not unheard of.  I assume you've had him to a pediatrician from time to time, and that he's healthy.  If they didn't do a blood analysis, you should insist on it, as low iron levels (sometimes caused by poor diets)  can also result in poor appetites, as can other disorders.  If you're not satisfied with your doctor's opinion, you can ask for a referral to an internist or a specialist in adolescents.  You can insist your son take a daily multivitamin with minerals, preferable with a meal or snack.   That's the only safe thing that MAY increase his appetite, and if not, will help insure that he isn't too lacking in some basic nutrients required for good health.

You MUST not nag him about eating, as at that age kids become very oppositional when fussed at.  Just keep lots of what he will eat on hand, especially the healthier choices he enjoys.   Let him snack whenever he wants, but try to gently steer him towards more nutritional ones by having them in stock and handy.  If he insists on pizza for breakfast and bacon and eggs at night, why not?  Skip the skirmishes and save your energy for the big battles.

If he has friends, does ok socially, is active physically, gets reasonably good grades and isn't getting into trouble, he's probably going to be okay.  If not, the thinness may be a danger signal, and you may need to get him to a counselor that specializes in adolescent behavior.   

By the way, if he's only gotten thin recently and is growing taller rapidly, it may be within normal range, and when his testosterone kicks in and growth slows, he may begin to eat you out of house and home!  Let's hope so.  If you are really worried about this, and have already consulted your pediatrician or family doctor, you may wish to consult a dietitian if only for your own peace of mind.  Sorry I can't be of more help, and keep us posted.

Jessica Setnick, MS, RD/LD....Another Follow-up

I agree with your advice, except that I think the books, 'Secrets of Feeding a Healthy Family' and 'How to Get Your Kid to Eat...But Not Too Much', both by Ellyn Satter, would very much help a mom of even a 13 year old.  They would help her compare what is normal eating for a child her son's age with what he is actually doing, and she may find his eating is normal, as you suggested in Another Picky Eater.   On the other hand, they may help her identify some unresolved feeding issues from earlier in his childhood, if that is when they occurred, and therefore have more information to help a counselor or dietitian help her son, if it comes to that.

I might also recommend asking him if he thinks his eating is normal, or if he wants help with it.  She might be surprised by his answer!  If there is something he isn't happy with (even if it differs from the mother's concern), that would provide a great opportunity to get him in to professional counseling, either with dietitian or therapist, depending on the nature of his concern.

My fiancé does not eat vegetables. He is 39 years old.  He eats meat, cheese, candy, lemonade, soda pop, potato chips, pizza (with meat).  How can I work vegetables into his diet without him knowing?  He can pick out a chopped bell pepper in tomato sauce from a mile away.  He does take a daily multivitamin, but no vegetables or fruits at all... HELP!!!

This isn't a funny dilemma.   "Love conquers all" doesn't make up for future poor health and the financial problems that can accompany it.  Anyone who follows that kind of diet is inviting eventual health problems; it would astonish me if it didn't catch up with him big time at some point.   I really don't have a answer, just some ideas:

• First, nagging isn't a solution.  You probably already know that.  But you can "accidentally" leave articles where he can see them on the benefits of veggies and fruits and the dangers of a fast-food diet.

• Encourage him to get a blood test for cholesterol levels.   You may have to wait until he goes to the doctor for something else.

• Try to find a multivitamin that contains antioxidants, beta carotene, so on.   Warning:  this is no substitute for a proper diet, but it's better than nothing.

• Maybe he's bought into the "real men eat meat" belief.  If you know of any non-threatening men (your relatives, husbands or boyfriends of your friends, his pals, etc) who really go for veggies, invite them to dinner often and serve a smorgasbord of produce (as well as meat, naturally).   Let him sort through his food to pick pieces of green pepper out while others happily chow down; perhaps he will learn something by example.  You might coach relatives as to your motives, but not others; men tend to stick together and you don't want someone tipping him off.

• Work within his diet.  Tomatoes have excellent nutritional value; try to order pizza with extra sauce.  Provide ketchup, mustard and pickles. Use barbecue sauce.   Don't buy soda for him, but keep lots of lemonade on hand.  What about iced tea with lemon, full of antioxidants?  Will he drink that?

• Little by little add extra seasonings.  Herbs are veggies too.  While he won't get enough to make a big difference in his nutrient shortfall, it will help some and also accustom him to a flavor other than meat. 

• I hope you have a blender or food processor.  Does he eat meatballs, meatloaf, macaroni and cheese, potatoes au gratin?   Start with small additions of onion, garlic, green pepper, carrots, anything you can hide in the sauce or the ground meat.  Grind veggies VERY fine, practically liquefied.  Don't overdo it until he gets used to the flavor.   

• Try vegetable fritters, apple fritters, onion rings,  oven fries, well-seasoned popcorn.   Will he eat corn on the cob?  What about baked beans?  Attack one problem at a time; don't cut salt, as it sounds like he's accustomed to saltiness. 

• What about sweets?  Pies, puddings, etc. can contain fruits.  Even cocoa or baking chocolate (chocolate is a veggie too) can add nutrients to his diet (not candy bars or other commercial "chocolate" products, which usually contain very little actual chocolate).   Try homemade fudge or brownies, made with baking cocoa.  Will he eat nuts in it?  They're veggies.  Walnuts especially contain valuable nutrients.   What about sneaking in a few raisins?  Chop them fine if necessary.

• Try to not be an enabler.  Take a page from Al-Anon.  While this problem isn't quite in the same class as an addiction, it can have almost as serious consequences.   Read "Is There a Terrorist in your Kitchen?"

• I'd like to recommend a book - "Stealth Health: How to Sneak Nutrition Painlessly into Your Diet".  It's made to order for both picky children and persnickety adults.  The author has multiple tricks up her sleeve to help you disguise nutritious edibles to look and taste like junk food.

• How about it?  Does anyone out there have any ideas?  Have you dealt with this problem successfully?  How?  

KVH's future happiness may depend on your help!  Send in your advice.

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