Meg Salvia Nutrition | Blog

Book Review: Extreme Picky Eating in Kids

[fa icon="calendar"] Sep 22, 2017 2:02:26 PM / by Meg Salvia, RD

HelpingYourChildWithExtremePickyEating.jpgTitle: Helping Your Child With Extreme Picky Eating: A Step-By-Step Guide for Overcoming Selective Eating, Food Aversion, and Feeding Disorders

By: Katja Rowell, MD and Jenny McGlothlin, MS, SLP

Date: 2015

Publisher: New Harbinger Publications


Quick Summary:
Recommended: Yes
Good for: Parents of younger kids or adolescents with ARFID or picky eating, may be helpful in some cases for adolescents or young adults/adults who themselves are struggling with ARFID (but probably not as widely applicable)
Not good for: Other types of eating disorders 


This is one of the more useful resources I've seen lately for parents with kids and adolescents with extreme picky eating patterns, and it is rooted in a framework of providing solid, realistic guidance rather than vague insight and philosophical principles that are difficult to apply in real-world settings. 

A strong pro is that a lot of the material in the book relies heavily on Ellyn Satter's Division of Responsibilities model. Shifting towards decreasing the pressure and urgency at meals can feel like a scary transition, often because there's a learning curve (for both parents and kids) and a lot of exploration of boundaries. This can look like a step backward before it looks like a few steps forward, and that can feel pretty vulnerable and uncomfortable for parents who are looking to improve the nutrition status of their kids or promote weight gain over a short-term time frame. 

The approach doesn't feel like magical thinking, however. It recognizes the essential component of needing to meet nutrition to support growth through childhood, adolescence, and young adulthood. Rowell and McGlothlin also do a good job of including a lot of different eating styles and challenges in their recommendations and vignettes; readers will see the utilization of tools across the spectrum from enteral nutrition (tube feeding or G- or J-tubes) to a limited selection of foods, to the concept that progress will look different for different families at different times. 

A few of my favorite excerpts:

Regarding Ellyn Satter's Division of Responsibility: "Negotiation blurs the lines of the division of responsibility. If your child thinks that saying the right thing or whining might get her what she wants - but maybe not - that uncertainty increases anxiety." (pg 88, emphasis mine) I have found over and over again that consistency in feeding patterns and expectations (with some of my ARFID clients' parents and adolescents with other eating disorder diagnoses) helps really manage the degree of anxiety adolescents feel at the table. Shifting expectations and a sense of "will they or won't they follow through" intensify battles and charged emotions. 

On sugar: "Blaming or demonizing one macronutrient or food doesn't support good feeding or nutrition... Almost universally, children like sweet tastes... [research] suggests that the biological drive for growth is part of the reason for children's preference for sweetness and that children outgrow their taste for super-sweet foods." (pg 51)

And again on desserts"Pause and register your reaction to the idea of allowing your child to eat dessert with dinner, even before anything else. Serving dessert with the meal feels threatening to many parents who worry that their child will only eat dessert -- which they might for a time -- or that without bribes, they won't eat anything 'healthy.'"(pg 123) The authors go on to recommend limiting dessert to one appropriate serving, noting that decisions about quantities also depend on age and appetite. The emphasis is on the parental role of being in charge of what is presented for dinner. 

On worrying about fruit & vegetable intake and GI symptoms: "Chronic constipation often fuels worry about fruit and vegetable intake. Low fiber and fluid intake contribute to chronic constipation, but increasing fiber and fluids alone rarely solves the problem. Once there is significant constipation for weeks or months, the colon stretches, and it takes up to six months for the colon to return to its proper shame and function. Chronic constipation can lead to decreased appetite, abdominal cramping, and even vomiting... Over time, it's hard for the constipated child to recognize what their body is telling them." (pg 49)

"We live in a culture where children (and adults) find it almost impossible to feel good about food and their bodies. Increasingly, eating disorder and obesity-prevention experts stress that nutrition education focused on external cues (calorie counts, for example) rather than on self-regulation encourages disordered attitudes and eating. Pushing 'healthy' foods can make children like them less, while demonizing or forbidding 'junk' foods can make many children obsess about, hide, and hoard these foods. How we think and feel about food impacts not only our enjoyment of food, but how we absorb nutrients and our ability to self-regulate." (pg 131) 


Topics: Nutrition, Resources

Meg Salvia, RD

Written by Meg Salvia, RD