Welcome to Toddlers Made Easy, where there's no fluff, just practical, research-based, 15 minutes or less parenting strategies. For those of you who don't know me, I'm Dr. Catherine, a pediatrician with more than 33 years of experience. I'm the author of two parenting books, the founder of Healthiest Baby, and the mother of four amazing adult kids. And let's not forget Smudge, my great big golden doodle. Today, let's talk about a common struggle many parents face. Picture Sarah trying yet again to get her four-year-old Max to swap his usual waffles for some fruit salad. He's not having it, and Sarah's really trying hard to stay patient. She's hoping that by eating the fruit herself, Alex might just give it a try. Does this sound familiar? Let's dive into the world of picky eaters. Now I'm going to share a little personal tidbit with you. Full disclosure here, I really dislike fish. Somehow or other my kids love it. But I've tried it for its health benefits, but it's not easy to eat something you really dislike, and I really dislike it. So I really understand the struggle with picky eating. As a pediatrician, I've looked after thousands of families facing these issues, and I know how hard it is to have a picky eater. And that's why today's episode is about how to prevent picky eating habits, because I've found preventing a problem is much easier than trying to fix it. Now, you'll find these generalizations will apply to picky eaters as well. It's not just about preventing picky eating habits, but the focus is on that. So most toddlers are picky eaters at some point in their life. They need to feel that sense of control, and I know I tell you this over and over, but it is the reason for so many difficult habits. So again, toddlers need to feel in control over some aspect of their life, and that's why they assert their independence by controlling what they eat. Plus, they're not mini adults, and they don't necessarily approach new foods with the same openness and interest. Plus, from a developmental point of view, there are many weird little quirky habits that toddlers have around food, and let's look at some of these. They may love things one day and hate them the next. They may test limits around eating. They may not eat the same amount each day. And some toddlers are just more naturally hesitant around foods, especially new foods than others. Now studies indicate that picky eating ranges from about 14 to as high as 50% in preschool children. Picky eating can sometimes be a symptom of a larger emotional control issue rather than a standalone problem. So if picky eating is accompanied by significant behavioral challenges, I'd encourage you to consult with your doctor. That's what we're there for. Addressing behavioral and developmental problems early can make a significant difference. Now, in my experience, the average picky eater generally isn't really underweight or necessarily suffering nutritionally. Studies show that picky eating tends to be more prevalent in children whose parents are extremely strict or demanding about their eating habits. This can actually be a vicious cycle. A parent notices picky eating and becomes more insistent on the consumption of healthy or high caloric foods. And I know the intention is really good to ensure proper nutrition, but this approach can inadvertently aggravate the problem. Pressuring your child to eat tends to result in a reduced intake, and this finding is supported by research. So a no-pressure approach to eating, it will sidestep unnecessary and painful power struggles. And let me tell you, and you probably know this already, but parents rarely win food wars. Now, on the flip side, positivity can make a significant improvement with a picky eater. So a positive milieu at mealtimes, it can help change things. So let's look at how to foster a more positive eating environment. First of all, prioritize happy family meals. When you shift the attention away from food to an enjoyable social experience, picky eating tends to gradually improve. Ideally, make mealtime a tech-free zone and instead use this time for sharing, telling stories, bonding. You see, when tech is used to get kids to eat more, the improvements tend not to persist, as really all you're doing when you're using tech at mealtimes is to distract your child. So they're distracted instead of developing a positive relationship with food. Now research indicates that children eat more effectively and willingly when they're not coerced or rewarded for eating. So there are various forms of pressure, and sometimes we don't even realize we're doing this. But urging your child to eat to please a parent or using food as a bargaining tool can be counterproductive. So I'm going to give you some examples of things to avoid saying. Eat your peas to make mummy happy. You've got to finish everything on your plate before leaving the table. You need to take two more bites before you can leave. If you take one more bite, you'll get a cookie for dessert. This kind of pressure teaches kids to eat for reasons other than hunger, for reasons like pleasing their parents. And this can lead to unhealthy eating habits, obesity even. The goal is to encourage children to listen to their body and to follow their instincts, to eat when they feel hungry and to stop when they feel full or satisfied. Giving children autonomy over their food choices helps fulfill their desire for independence and can decrease picky eating. But here's what I mean by that. I don't mean they have a full range of control. So let's look at the breakdown of rules at mealtime. And this is after a year of age, because a newborn, a baby, an infant, they decide when to eat, but your role after a year is to decide where, what, and when your toddler eats. Now on the other hand, your toddler's role is to decide how much to eat, and even whether to eat. Let's look at a few more phrases to steer clear of Eat your veggies or you'll get sick. You like carrots, you ate them yesterday. Try this, you'll like it. Finish your food, think of the children starving everywhere. Now I know this isn't easy, but I also know you're a parent and that means you can do hard things. Other things to avoid is labeling food as good or bad. A funny thing can happen when we do that. Kids can think of themselves as being good or bad because of the food they've eaten. Now I would encourage you to serve one nutritious meal for the whole family, but always include what I call a comfort option, and that is a food you know your child will eat because they have eaten it many times in the past. Resist the urge to prepare a separate meal for picky eaters because that tends only to reinforce the selective eating habits. Now we've talked about creating a positive mealtime atmosphere, and let's just dig a little further into that. The dining environment, it really is crucial. So aim for enjoyable, relaxed mealtimes, and you know the benefits go beyond just nutrition. It strengthens your family bonds, it fosters a healthy relationship with food, it boosts self-esteem and communication skills, and even sibling relationships. Other ways to encourage your child to have a healthy relationship to food is to let them explore the food with their hands, even if it's messy, you know, up to a point, of course, and only if you feel up to it at the time, don't feel a pressure to always do that. Repeated exposure to new foods without pressure can encourage kids to try them. But when you first serve them, serve the new food in the tiniest, smallest amount. And try preparing this new food in different ways as well. You can discuss the food's color, the texture, and the smell as opposed to it's a healthy or unhealthy food. Now I know you've probably already heard this kind of advice, but it is important. So involve your kids in food-related activities, like making the shopping list, selecting produce, and helping with meal prep. Children eat often, so don't stress about one missed meal. Instead, focus on their weekly intake, which typically should include a bit from each food group. So in other words, you don't analyze did my child hit all the food groups with every meal, analyze it over the week. Now, while it's good to encourage trying new foods, avoid turning it into a conflict. Also, don't ask your kids to clean their plates. Now, one habit I've seen very frequently in my office is that when a child doesn't eat well, many parents will encourage their child to drink more milk. But the problem is this is a bit of a vicious cycle because milk is very filling, and then your child won't feel hungry and won't eat. So I'd encourage you, don't push milk. Get your child involved in mealtime planning and cooking, browse recipes together, experiment with new dishes, and make grocery shopping a joint activity if you feel up to it and it doesn't have to be all the time. So remember, changes in eating habits will take time. If you feel stuck, chat with your healthcare provider for some further support. Now before we go, I'd like to just share a story from Sheila about a problem she's having with potty trading her daughter. Now this may seem confusing that I'm including this question after talking about picky eating, but I've often found that many picky eaters are constipated, and so I wanted to discuss this now on here. I'm going to share the question this mom sent me. We first tried potty trading when my daughter was two and a half years old. Peeing went smoothly, but pooping was really a struggle. When we started, she actually held her poop for three days until we gave her a constipation smoothie. But this was really stressful for both of us, so we decided to back off. When we tried again at three years of age, she was more confident with the peeing and she was even using the big toilet. But for pooping, she still prefers her diaper and she often hides behind the curtains or even in the closet. We've tried sticker charts, rewards, reading lots of books about using the potty, but my daughter still refuses to poop on the potty. Now, I wonder if we've given this too much attention. I remember one time we celebrated a small success too much. Perhaps we put pressure on her. Now she's older and starting preschool, and I'm at a loss of what to do. She's a sensitive child and a bit shy. Dr. Catherine, what should I do? So Sheila, thank you for your email. It sounds like you've been really thoughtful in your approach to potty training, and that's fantastic, and there is no reason to be hard on yourself. Transitioning from a diaper to using the potty is a big step, especially for pooping and especially for some children. And there's several reasons why a child might resist to poop in the potty. Let's look at a few of these. They might have had a painful experience with a hard stool. It's easier to poop when you're standing. Some kids feel anxious about the process. Your child might be asserting control over something they can manage, or simply it may be an issue that they prefer privacy, and that also can go along with hiding to poop. So to help ease this transition, the first thing I would do is I would normalize the whole pooping process by explaining to your child how pooping is the body's way of getting rid of unneeded food. If your child's using a regular toilet to pee on, you might want to try a potty instead. Or at least use a stool and a toilet insert so your child feels safe on the toilet and only has to focus on one thing and not on being balanced. Also, I would really consider privacy concerns and offer your child privacy while she's in the bathroom. Constipation is one of the most common reasons for a child to avoid wanting to poop in the potty. And I see this every single day in my practice. If you think your child might be constipated, and let me tell you, you can have a poop every day and still be constipated. So instead of thinking about constipation, think, is my child passing hard and big stools? If the answer to that is yes, or also to be honest with you, it could be pellet-like stools, both of those reflect constipation. I would actually suggest you go look at something called the Bristol Stool Chart because it will show you pictures of what a normal poop looks like versus a constipated one. Now, if your child does seem constipated, I would increase the natural fiber in their diet from fruits and vegetables and increase their water uptake. Usually that works best at preventing constipation, but if you think your child is already constipated, I would use a daily constipation smoothie until her stools are soft. If you're potty training and you've tried the constipation smoothies for a week and she still has either pellet-sized stools or generous stools, I would actually talk with your healthcare provider because often a stool softener is needed. Also, limit your cow's milk intake to no more than two cups a day. So, Sheila, with regards to your daughter, the first thing I would do is use constipation smoothies to get her to a soft stool. Regardless of whether you think she's constipated, it's easier to pass a soft stool, especially when sitting on the toilet. So I would keep her soft for at least a week before saying a word about pooping on the toilet. You want her memory to be that of passing a soft stool, so she thinks of it as something easy to do. Then I'd explain to her that you'd like her to have a poop on the potty because she's doing just such a great job with peeing on it. You might want to also ask your child, what makes her afraid of using the potty to have a poop and how can you help her? So we're going to do the dietary changes. I'd for sure offer your child some privacy. I'd encourage her to take some toys or books with her into the bathroom during potty time. And although we generally don't want a prompt for decreasing the pressure, I would invite your child to use the potty after mealtimes, as the body has a reflex to go poop then, and it may make it a little easier. You might also consider just asking your child to sit on the potty and have her poop in the potty wearing a diaper as an initial step. I think you've done a fantastic job of taking a no pressure approach. Now I would encourage you to keep up the no pressure, but to give her a little nudge towards making the change because sometimes we need that, and that's our job as parents. I'd love to hear back from you and let me know how things go. I hope this gives you enough ideas to get started with. If you're looking for more support over these crazy awesome toddler years, please check out our online courses. We've got toddlers made easy and potty training made easy, and these are big-hearted approaches to all those tricky toddler moments. You'll find the links in the show notes. Have a wonderful week. Thank you for listening, and I'll see you next week.