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A Picky Eater

Dear Dr. Lanny: My 2-year-old is such a picky eater. She subsists on macaroni and cheese, yogurt, milk (see a theme here?) and, for some reason, broccoli. I introduce her to new vegetables and fruits, but it gets frustrating to have her refuse to eat anything unfamiliar over and over and over. Do I need to worry about whether she’s getting enough of the right things to eat?


A: This is actually one of the most common questions that mothers ask me. Even if it happens to be the father who comes in with the toddler, he’s usually carrying a note from Mom that asks, among other things, “How does my child survive on only _____ and _____?” And you can fill in the blanks for your own child. In more than 30 years of practice, I have never had a mother come in with a note from Dad. But that’s another story.

My first act, then, is to look at the child and ask myself, “If I saw this little one on the street, or in the supermarket, would I be concerned about how he or she looked?” Or, “Did I get a bad feeling looking at her as I walked into the exam room?” The answer, of course, is almost always, no.

The next step is to check the child’s growth chart. I love growth charts, and think they are an indispensable tool in pediatrics. Low-tech, but high value. The question is not whether your child is big or small—that’s largely a hereditary issue—but rather, is he or she growing consistently. Growth in the first year is a little more complicated, but by the second year your child should consistently maintain his or her position on a growth chart. If the growth chart shows your child to be growing appropriately, even if she is quite thin, and she passed the “supermarket” test, almost certainly all is well.

And finally, how is the child’s development (motor skills, social interactions, speech) coming along? If development is also progressing normally, there’s almost no chance this picky eater is malnourished to any significant degree.

In the case of a 2- or 3-year-old, the doctor should have another useful piece of information in the child’s chart. Routinely a blood count will have been done at a year of age. The blood count looks at a few things, particularly, is the child anemic (a low blood count). This is an indirect way of looking at adequate intake of iron, an important element in a complete diet.

How is it possible, a parent will ask, that my child can be OK on just Captain Chocula cereal and beef jerky? To be honest, I don’t know! My assumption, of course, is that the child is indeed getting more than the family relates. And when you question families further, you can usually tease out that there are many more foods than they realized, even if they are infrequent and irregular.

I firmly believe that until children are overwhelmed by television advertising for all the fast foods found in every town in the USA, they will ultimately eat what they need if offered a diversity of real foods. Otherwise healthy children are remarkably self-regulating and will not voluntarily starve themselves. By the term real foods, I mean the fewer additional chemicals, and the less processing, the better. If it looks the way it came out of the ground or off the tree, that’s good. If you check the label and you can’t pronounce the ingredients, that’s bad.

And lastly, like everything else in raising children—this too shall pass. Soon she will be a teenager, and you will long for the bygone days of feeding problems.                  

Dr. Alan Freshman, father of two grown sons, practices at Syracuse Pediatrics. Consult your own physician before making decisions about your family’s health care. Send e-mail to him at editorial@familytimes.biz.


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