Raising Healthy (and Happy) Eaters: How and Why

The information in the previous article is all well and good, you know WHAT children need to be eating, but HOW do you get your kids to eat more of things they need? In my experience, a few things are key: exposure, small switches, structured choices, getting kids involved, and a no-pressure approach.

The ​Logistics

Exposure
The first and most important factor is exposure - they can’t eat what they aren’t offered. Presenting new foods in plain sight enough times will eventually desensitize the child to them, but most of us lose heart and give up too soon. It can take 10-15 exposures for a child to like a food (usually fewer for younger kids, more for older kids), but more than 90% of caregivers stop offering after 3-5 tries (1). Exposure can include looking at, touching, licking or eating a food; this method is used successfully in pediatric feeding clinics for the most picky of eaters, so stick with it.​

Small switches
Rome wasn’t built in a day. Chances are your child has had a limited palate for a while, so it may take a while to adapt it. Try making small changes to already accepted foods and build from there, one step at a time. Starting from familiar territory and making minor variations can make the process of change more manageable for your child. Slow and steady wins the race!

• If your child strongly favors pasta, try switching to a wholewheat variety, or better yet, a legume-based pasta (e.g. Tolerant or Explore Cuisine). The lentil varieties hold up better than bean-based ones, in my experience; they offer plenty of fiber and iron, and most children don’t notice the difference.
• If your child is attached to chicken nuggets, have them work with you in the kitchen to make a homemade version (like this one), with wholegrain breadcrumbs, then branch out to incorporating ground chickpeas or almond flour in your crumb mixture.
• If your child’s favorite food is pizza, try switching to a wholewheat crust or even a cauliflower crust (available at the store, or homemade).

Structured choices
Feeding children can be exhausting, especially if they tend to reject most of the foods that you offer. We can quickly resort to becoming a short order cook, making each child whatever they’d like for dinner, to avoid the drama. Offering choices is good - choices empower a child, and we want that, but they shouldn’t disempower the adult. As the parent, you can set the boundaries and let them choose freely within those parameters. For example, rather than the open-ended “what would you like for dinner?”, try “would you like salmon or chicken for dinner?” You’re setting the options, they make their choice. Or instead of giving them an opt-out “would you like vegetables with that?” (I’m guessing, NO!), try “which vegetable would you like with that”? Whether they want veggies isn’t up for debate, the decision is centered on which one they’d like. You could narrow this further with “would you like baby carrots or baby tomatoes for snack?”. These simple linguistic tweaks can work wonders with younger children - they still have a choice in what they’re eating, but you’re in charge of the options.

Kids in the kitchen
When children (and adults!) get involved in the preparation of meals, they are more invested. In my experience, kiddos are much more likely to try a meal that they’ve played a part in making, and they often sample the ingredients along the way. There’s something about being away from the dinner table - especially if it’s a battleground in your house - that makes them more open to trying things. Kids of all ages can play a part in meal prep:

• 2-3 year olds can tear lettuce for a salad, wash vegetables, help mash potatoes, stir ingredients in a bowl, sprinkle salt and sugar, sort silverware and set the table.
• 4-5 year olds can help weigh, measure and mix ingredients, squeeze citrus, make toast, roll and shape dough, and drain and rinse beans.
• 6-7 year olds have better fine motor skills so they can use measuring spoons, cut herbs with scissors, form meatballs or falafel, scoop cookies, peel potatoes, whisk eggs and learn to use a knife for cutting soft foods.
• 8-9 year olds can read well enough to follow simple recipes, and are usually trustworthy enough to be taught how to use knives for dicing and slicing most foods. They can operate can openers, graters, blenders and food processors, with supervision. They can find ingredients (and reach most of them), make sandwiches and pack their own lunches.
• 10-12 year olds can often work independently in the kitchen, especially if they’ve been working along side a parent up to this point. You can engage them in meal planning, and, assuming they’re tall enough (and responsible enough), they can do hands-off tasks at the stove top, like putting rice and pasta on to cook, and more (depending on the child.)

**However old your child is, supervision is needed - accidents can happen in kitchen at any age.
Kids can also help with the growing of foods, if you have a spot for a small vegetable garden or a window box for herbs, and with shopping for them at the grocery store - it’s an opportunity for them to have some autonomy e.g. let them choose which color peppers to buy this week, or pick out a fruit they’re curious about trying.

​The Approach

Bribery and rewards
When dinner is a contentious issue it’s common to fall into rewarding and/or punishing children for their eating habits. Who among us has not promised dessert if the vegetables are eaten, or threatened to withhold it if they aren’t? Most of us probably experienced this growing up ourselves! The research shows that this actually backfires most of the time (2): the promise of reward foods may increase the amount that the child eats in some instances, but it actually decreases the amount that they like the target food (while increasing their liking of the reward food). It increases the status of the reward food (which is usually something sweet and less nutritious) and diminishes the status of the food you want them to eat more of. What this means is, all that they get out of it in the long run is that ice cream is worth the unpleasant task of eating vegetables. In later life this ‘food as reward’ mentality can translate into “I am treating myself to a pint of ice cream tonight because I had a hard day”, or “I haven’t earned dessert because I haven’t been to the gym today”. (For the record, you are always absolutely entitled to eat ice cream, without having to ‘earn it’ by way of a good or bad day!) Bottom line: incentivizing food consumption with other more favorable foods seems to be universally negative, according the research. Incentivizing with non-food rewards, like stickers or verbal praise, may be a bit more effective: it can increase the number of times a child is willing to try a food, meaning that they get more exposure to it, so if stickers or high fives get you there, go for it. ​

At the end of the day, carrot and stick methods might get your kids to eat more of the foods you want them to eat (or might not), but ideally we want dinner time to be a pleasant experience for all, free of tantrums and free of cajoling. When kids feel pressure, most of them dig their heels in, and before you know it you’re in a power struggle over food. Plus, rewards have been shown to undermine intrinsic motivation in kids (the desire to do something for its own sake) (3), so you have to ask yourself what your ultimate goal is. If - as I suspect - you want them to grow up to make nutritious food choices, so that they can lead healthy lives, then intrinsic motivation is ultimately more important than whether they eat three more bites of butternut squash tonight.

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Divide and Conquer
To avoid food fights there are some tried and true methods you can employ, the most important being Satter’s ‘Division of Responsibility’ around meal times. This method is endorsed by the American Academy of Pediatrics and the Academy of Nutrition and Dietetics, among others. It works like this: parents are responsible for the What, When, and Where of meals, and children are responsible for How Much, and Whether they eat. For example, the parents decide that it is chicken soup for dinner, served at the dinner table at 6pm, and the child decides whether or not they’re going to eat it, and how much they’re going to eat. Sounds simple? It can be! The hard part is for all parties to stick within their own lane: children can’t dictate what/where/when dinner is, and parents can’t dictate how much the child eats (which includes not physically feeding them). When I implement this with families, the first thing I usually hear is, “but what if they don’t eat anything?” It’s difficult, but you have to trust that your child will not starve themselves (this is a widely used model and I haven’t seen any reported cases of starvation yet!). If you’re providing regular meals and snacks throughout the day, they aren’t ever going too long without the opportunity to eat.

It is important that eating times stay pleasant, and messaging stays positive: e.g. “I trust that you’ll eat if you’re hungry”, rather than “I’m not giving you anything else tonight so don’t blame me if you’re hungry later!” Then move on to a new topic of conversation. Power struggles take two - don’t engage. Even if they don't want to eat anything, they can still sit at the table and talk about their day; there is more to family meal time than the food.

In my experience, this method works best with some preparation: hold a family meeting and acknowledge that meal times are hard, for everyone, and let the children know that you have a new plan to make dinner more relaxed and enjoyable. Lead with the things that you’re going to do to let them be in control at the dinner table (“you can eat as much or as little as you like, we won’t pressure you”), and then follow with what you are going to do to simplify your own life (“I am going to make one meal for everyone”, and “I’m not going to offer snacks close to dinner”). Then you can all brainstorm a list of favorite meals together - this way, everyone knows that their favorites will be in the rotation, so even if tonight’s dinner isn’t something you child likes particularly, they know that their preferences are as valid as other family members’, and their turn will come. You can even have this be a regular occurrence, with a weekly family meal planning meeting; this can be a great way to track progress on evolving preferences too.

Stealthy strategies
There are plenty of recipes out there showing you how to hide vegetables in food so that your kids won’t notice them (e.g. puréed veggies in a pasta sauce, or fruit smoothies disguising greens). That’s not necessarily a bad thing - if you can feed them something more nutritious without drama, great. However, I don’t advocate working too hard at it, or being actively deceptive - ultimately, we want to teach the child to enjoy different foods, and to empower them to make their own food choices. If they find out you’ve lied to them they might not take it well, and it may undermine their trust around eating even further. Plus, I mentioned that multiple exposures are a reliable way to increase liking for a food: if spinach is hidden away in a fruit smoothie, they aren’t really getting exposed to it.

Finally, when children know what they’re eating they can also vocalize their opinions (beyond yum or yuck!), and start to articulate their preferences. For example, one of my children strongly prefers their vegetables crunchy, which means they like raw carrots much more than cooked, and kale chips much more than kale salad. It isn’t that they don’t like kale or carrots, it’s that they don’t really like them prepared a certain way. I can work with that! Building vocabulary around food helps everyone.

Sensory explorers
It might seem to make sense to emphasis the health benefits of eating more vegetables, after all, health is one of the main things that motivates adults to eat a balanced diet. Unfortunately, kids aren’t particularly responsive to health messaging (they have little understanding or interest in the state of their future arteries) and it can actually backfire: if you’re being told to eat something because “it’s good for you”, the implication can be that it isn’t enjoyable, it’s just something you have to eat for health reasons. We are familiar this phenomenon as adults: if someone offers us ‘healthy’ cookies vs. regular cookies, many of us assume the healthy ones are less palatable.

So how do you sell it? Focus on sensory information. Little kids are learning their colors and building their vocabulary, food is a great space to exercise those skills. Talk about the visual properties like color and shape, talk about texture (bumpy vs. smooth, juicy vs. dry, crunchy vs. soft), flavor (salty vs. sweet, strong vs. mild), temperature, smell, etc. Older kids can kick this up a notch, making taste predictions based on appearance, using more descriptive vocabulary, comparing new foods to other foods they’ve eaten. The goal isn’t to eat a certain quantity of the food, or even to enjoy it, the goal is to approach it with curiosity. This also builds on the last point, about them getting better at articulating their preferences - they can start to tell you that they like the flavor but not the texture, or they like the texture but not the smell, and so on. This allows them to voice dislikes, but in a constructive manner: keep things focused on the specific qualities of the present meal and away from generalizations, for example, “I don’t really like these refried beans because they’re smooshy” gives you both more room for exploration moving forward than the blanket statement of “I don’t like beans”, period. Let them play with their food - it's all part of the exploration process!

Tasting charts
Weaving together the concepts of food exploration and non-food rewards like stickers, I find that tasting charts can be helpful, for all involved. Ones that encourage kids to eat a rainbow of fresh fruit and vegetables every day are great, like the one below from Raddish Kids, a cooking club for kids with meal kits, and I also love the veggie discovery chart (at the end of the article) from CookSmarts, a family-friendly meal planning service). The former is great for younger kids, who are learning their colors: for each color of vegetable that they eat, they get a sticker (or check mark) on their chart, with the aim of eating as many different colors as possible in a given day or week. The CookSmarts veggie discovery table is more detailed, providing an extensive list of veggies to explore, with a slightly different stickering approach: each time the child tries a vegetable they can place a red, yellow or green sticker next to it, to indicate whether they liked it. If they don’t like it they use a red sticker, if it’s okay, a yellow sticker, if it’s pretty good, a green sticker. There is space for five stickers next to each vegetable: regardless of whether something gets a red, yellow or green, the assumption is that you will try it again, and again, and again (and again, and again!). This gives children exposure and also tracks how their taste preferences develop: things that start out with red stickers may evolve into yellow sticker foods, and so on. This is also a helpful chart for the adults in the household, because it lets you keep track of which vegetables are preferred, as well as just being a helpful prompt when it comes to making a shopping list.

Don’t judge
Try to avoid value judgements around food. While our intentions are pure when we tell kids that foods are good for them or bad for them, it can lead to disordered eating down the line if the messaging is too heavy-handed. Restricting junk food excessively can lead to secretive eating, or overeating those forbidden foods when the parent is not around (4) (something I’ve experienced firsthand). Secretive eating behaviors can also be accompanied by feelings of guilt, shame, or being ‘bad’. Some professionals prefer to use the concepts of go foods vs. slow foods with kids, to indicate that some foods promote health while others don’t; I think this is probably fine, as long as the latter aren’t overly restricted. Value judgements around food often spill over into negative self-talk, which we have all seen in adults, e.g. “I’m going to be bad and eat another slice of cake”. This type of thinking is a hallmark of diet culture and is something we want to avoid. Also avoid having these types of conversations about your own food choices in front of your child - they are always watching and learning. If they see you making a big deal about turning down the same dessert that you’re encouraging them to work for, that’s a confusing message. Food is meant to nourish us and to be enjoyed; if food sparks feelings of guilt or fear for you, or your find yourself obsessing over food choices, it might be worth talking to someone about your relationship with food.

Lead by example
One of the most reliable ways to get kids to eat a diverse range of nutritious foods is to do it yourself. If children see others enjoying those foods - caregivers and peers - they are more likely to enjoy them (5). You’re going to have a hard time selling the salad if one of the parents is avoiding it, even more so if they are actively discussing their dislike for it. You don’t have to put on a performance, but if your children see you enjoying your food, they’re likely to be more enthusiastic eaters themselves. For many of us, this might mean making shifts in our own eating habits (most adults don’t eat the recommended amount of fruits and vegetables each day either). This can be an opportunity to explore foods with your child - try new produce items, try new ways of preparing familiar ones, find what you like and your children may well follow. Getting a CSA or veggie box delivered can be a good way to get out of shopping ruts (I too end up buying the same vegetables from the store each week, out of habit, despite the variety available!).

​Why?

This might all sound like a lot of work, and you might be asking yourself if it’s really necessary. Eating well isn’t just about getting adequate nutrients, a healthy relationship with food is key. Many of us grew up with the ‘clean your plate’ approach, but in today’s society with oversized portions and an endless supply of food, this isn’t necessarily helpful anymore. Really, we want to be teaching our kids to listen to and honor their bodies - to identify their hunger and fullness cues, and to respond to them appropriately. This means stopping eating when you’re full, without being forced to finish your plate, and having second helpings if you’re hungry, without being restricted arbitrarily or being admonished for being ‘greedy’. Kids grow in spurts, so their appetites will ebb and flow accordingly.

Ultimately, we want to raise competent eaters who follow internal cues of hunger and satiety, have a good relationship with food, and can continue to feed themselves well outside and beyond our homes. That is more likely to happen if we encourage autonomy and create a pleasant atmosphere around eating. As with many things in parenting, our short term goals (eat the broccoli!) may be at odds with our long term goals (raising competent eaters). If you are offering your child a variety of nutritious foods without pressure, and modeling healthy eating (both in terms of what you eat and how you talk about food), you are doing your part. Don’t stress about them starving, or whether you could be doing more to persuade them - that part is up to your child. Trust that they will eat, that they will grow on track, and that they're developing healthy eating habits that will last them a lifetime.

If you would like some help implementing these methods with your children, including specific guidance for your family’s unique challenges (e.g. how to adapt their favorite foods, step-by-step support to set up the Division of Responsibility, ways to present meals to increase the odds of them being eaten, and scripts for dinner time meltdowns), or if you would like to address your own relationship with food, please reach out to me for a remote consult.