By Patrick J. McGrath, OC, PhD, FRSC
Question:
Our three-year-old is difficult at suppertime. He is very picky about his food, refuses to try anything new, and tends to act out at the table. He often refuses to eat altogether. He often wants to sit on my knee and have me feed him and yet he still refuses to eat much of anything. We have tried having supper later, preparing things he really likes, and removing small privileges and giving time outs for impolite behaviour. Lately he has begun asking for food in bed.
We are considering having him experience the consequence of not eating his dinner (i.e. going to bed without it). Is that cruel?
Dr. Pat responds:
The first step is to have your child's weight and height checked by his family doctor. His family doctor can see if his growth is a problem and can also find out if there is a medical problem that is interfering with his eating. Tracking his height and weight will allow you and his doctor to know if he is getting into trouble with his growth. If you know he is OK, you will be able to relax more about his eating.
Reluctance to eat new foods is quite normal. Many children are picky eaters and yet they flourish. However, it sounds like your son's eating is creating family problems even if he is growing normally. Several strategies in combination could help him eat better.
He could be filling up on juice or soft drinks. Although juice is better than soft drinks, the Canadian Paediatric Society suggests limiting children's juice intake to between four and eight ounces a day. Replace it with water.
Make mealtime fun, but not a circus. Turn the TV off. He should sit at the table with the other family members for dinner even if he doesn't want to eat. Don't have him sit on your lap.
Take the negative emotion out of mealtimes. There is no need to lecture him. He already knows you want him to eat. Calm everything down at mealtime. Make it a pleasant time. Show him that you enjoy food but don't be over the top about it.
When possible give him some limited choices. For example, ask if he would rather have peas or carrots if both are being served. But don't overwhelm him with choice.
Put small amounts of several foods, e.g. a teaspoon, on his plate at every meal. Encourage him to try a bit of each food. Encourage him with praise. Make it so he will win. Then very slowly increase the amount that you give him.
It is always better to use rewards rather than punishment. But don't use sweets for rewards. It can make sweets more desirable. Use your positive attention and praise.
Ignore him making faces or rude noises or complaining about food. Turn away when he does this. If he is really disruptive, a two to three-minute time out and back to the dinner table is fine.
Don't coax. Don't beg. Don't negotiate. Definitely, do not feed him in bed.
Children his age should have three meals and probably two small snacks (usually afternoon and bedtime). If he chooses not to eat a meal, it is not cruel but very sensible to have him wait for the next meal or small snack. Make sure snacks are healthy.
Patrick J. McGrath OC, PhD, FRSC is a clinical psychologist and a researcher. He is Professor of Psychology, Pediatrics, and Psychiatry at Dalhousie University and Vice President - Research at IWK Health Centre in Halifax. He is also the CEO of the Strongest Families Institute, which provides mental health care to families across Canada.
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