If you eat this.. then I'll give you...

When is it appropriate to bribe kids to eat non-preferred foods?  Parents ask me this question on a daily basis.  Generally I suggest to CAREFULLY use reinforcements.  Some general tips:

1.  Don't use preferred foods as a reinforcer.  When children have very few preferred foods, we need to be careful about using these select foods to reinforce tastes of non-preferred foods at the risk of loosing the preferred food completely.

2.  Generally it is better to set a routine than to "bribe" your children to eat.  (ie: At the beginning of each meal, help your children explore the non-preferred foods, even if they don't eat them.  Do this consistently, and soon your children will become used to the smell, sight and taste of these non-preferred foods.  Then, offer them their meal.  This way you are not bribing them, but simply adding a step to your mealtime routine.)

** Remember that it takes OVER 15 CONSECUTIVE presentations before your child will consistently chew and swallow a new/non-preferred food**

3.  As always, avoid distractions while eating.  If your child will only eat while walking around, with the TV on, or with toys on the highchair, then you will need to gradually reduce the dependence of these supports because this is not a functional way to eat.  Often children use distractions to avoid taking part in mealtime. 

4.  Don't get in a power struggle.  The main problem with reinforcing children for eating non-preferred foods, is that if they refuse even after you "bribe" them, then they have begun a power struggle, which is what you want to avoid with all children, but especially picky eaters.  

Occasionally, it is necessary to use a preferred item or food as a reinforcer for trying a new food, however do not make this a habit.  Most children will continue to try/eat a new food if they like the taste of that food, so a reinforcer each time is not always needed.

Seek help from an OT or Physician if you still have questions regarding reinforcements.

Mouse Bites

The most common thing I hear in my clinic is, "My child only eats 3 foods, and I've tried EVERYTHING".  Most of the time not only have the parents not tried slow, gradual introduction of new foods, but the other common mistake parents make is that they try new foods in a sporadic and uncontrolled way.  Some things to remember when trying to introduce new foods to your toddler/picky eater:

1.  SMALL QUANTITIES.  Children are more likely to try new foods when the serving size provided is very small.  Usually, during my feeding sessions I will take a dime sized amount of whatever the parent has provided and present this on a separate plate for the child to "explore".

2.  LET THEM "EXPLORE".  Children are messy, and they enjoy touching their food.  In addition, they learn about the food presented and are more likely to try it when they are allowed to touch it.

3.  "MOUSE" BITES.  Animals are a fun topic when it comes to children and toddlers, and therefore referring to their bite sizes in terms of animals makes it fun and exciting for them.  A "mouse bite" is the smallest bite a child can take to experience how the food feels on their teeth and in their mouth.  One of my patients told me, "Ms. Liz I'm not going to take a mouse bite, but I will nibble."  So, if this is the case, let your child "nibble" and at least begin to bring new foods to their mouth, lips and teeth.

4.  PRACTICE, PRACTICE, PRACTICE.  If you want your child to eat a new food, you need to present multiple opportunities for them to touch, like, kiss, and take mouse bites of that food, before you expect your child to pick up the food and eat it.  It is a very slow process, and every child goes at their own pace.

**Most important tip:  If your child is underweight, has not gained weight, or is loosing weight, it is essential that you contact your pediatrician and get a referral for a feeding therapist.  The longer the feeding aversions have a chance to develop, the harder it is to desensitize and get children to eat new foods.***

If you have special tips that have worked for you and your family, please share a comment with other blog followers, so they can learn from you and your experiences with picky eaters :)

When to introduce...

Well as new parents, everyone always reads books and surfs the web for the most recent posts by parents, magazines, authors, etc, on when to introduce new things to your baby.  The reality is, trust your instinct.

1.  When to introduce... PUREES :  There is a lot of debate about this topic, however infants should not be eating purees until they can hold their head up and sit up independently (6 months).  Recently, parents have been coming into my office with the advice from outside sources to feed purees at 4 months.  This may work, although it does have the potential to create more aversions, tactile defensiveness, and negative mealtime environment.  Bottom line- Between 4 months- 10 months (or 12 months), your babies PRIMARY nutrition should be from formula and/or breast milk.

2.  When to introduce...CUPS:  An open/sippy cup should be introduced when you are beginning to introduce purees (so ideally at 6 months).  Cup drinking is an important milestone to teach your child jaw stability, tongue lateralization (moving tongue side-to-side), lip closure, etc.  Your child will not be successful with this, but try to spend some time teaching them how to do this.

**Helpful tip:  Use a dixie cup filled with an inch or less of water/formula/breastmilk to begin.  These are small and easy to manage if your little one decides to spill it all over the place.

3.  When to introduce...UTENSILS:  I can't tell you how many times a 2-year-old walks into my office and their parent tells me that they have not introduced utensils yet.  It is so important that you begin to offer a spoon (for exploration purposes) at 6 months (or when purees start).  It can be messy, so if you want to only do this one meal a day, then that's fine as well.  By the age of 12 months, children should be feeding themselves 100% of a meal (with exceptions of course), using fingers AND utensils.

4.  When to introduce... MELTABLE SOLIDS:  The first question you might have is, "what are meltable solids"?  This is a "solid" that melts with moisture:  graham crackers, Cheerios, Gerber puffs, Saltine crackers, Biter biscuits, yogurt melts, Mum Mums, Rice cakes, etc.  These are GREAT first finger foods to introduce because they will melt in your child's mouth.  These should be introduced (provided your child has had all kinds of purees and is moving them in his/her mouth without spitting them out with their tongue), by 8-10 months of age.

**As always please post questions and comments below**