Three steps, a fussy appetite bust

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A picky eater favorite: Pasta and butter

This may be the one question I’m asked most often: How can I change my child’s appetite? Picky appetites in kids are common, but not necessarily normal or healthy. If your child has been eating fewer than ten foods for more than a year, something is amiss. Your child is probably not getting all the nutrients needed for optimal growth, learning, mood, and functioning. While a whole industry has evolved around foods just for that limited kid palate, consider what is done in other countries with healthier populations: There is no kid food. There’s just food.

That was the US, not all that long ago. Other than breakfast cereals, which were just getting steam as marketing vehicles for kids when I was growing up, we just ate food. Nobody blinked. It wasn’t because my mom was a particularly fearsome presence at the dinner table, demanding compliance. We liked the food. So we ate it, pretty much.

But times have changed. I know of many kids who are legendary-picky  – kids who eat only noodles or pasta with butter, and chocolate milk, day after day, year after year.  Or just coffee cake, and milk – literally. Some kids venture into as many as four foods – pizza, mac and cheese, grilled cheese, and noodles with butter (which is really just two foods, wheat and dairy).  I sigh a little each time I’m in a restaurant with a gorgeous farm to table menu, but pass by a table with the bowl of pasta, Parmesan, and butter for the eight year old, while everyone else enjoys the cornucopia we are so fortunate to have in the US.

There are myriad cookbooks full of tricks to slip vegetables and fruits into foods your child does like to eat. While you work on those, think about a longer term goal of seeing your child naturally gravitate to a variety of foods. Add these simple steps to trigger some innate curiosity in your child’s appetite. Allow at least two months for these tools to fully engage. It takes time for nutrients to be absorbed into spaces and places where they’ve been lacking for a long while, and get back on line doing their usual jobs.

Step 1 – Probiotics! You’ve no doubt heard about these friendly, helpful bacteria. Microflora, healthy gut bugs, probiotics – call them what you will – but make sure your child is hosting the right bacteria in his gut to support a healthy appetite. Eating a little yogurt every day – especially the squeezable fruity flavored kind – is not enough to do the trick. High daily doses of probiotics are needed to bust a picky appetite. These help digest food, produce nutrients we need, run interference on inflammation, maintain optimal pH for good digestion, and keep pathogenic bacteria, viruses, and mold species (yeast or Candida) under control. These gut microbes eat what we eat, and they eat first. They either leave behind toxins, or good stuff, depending on whether the intestine is harboring healthy or unhealthy microflora.

They also drive appetites. What I’ve observed for years in practice is just emerging in medical literature: Kids who have lost these good “bugs” tend to have either weak, picky appetites with reflux, or appetites that are ravenous but only for starchy foods or sweets. This is often a gut with Candida species (yeasts or molds) in control. Antibiotics kill bacteria but not yeasts or molds, so with each antibiotic dose, yeast microbes will flourish anew in the gut. As they crowd out the good bugs, they change gut pH over time so that digestion weakens, and can trigger reflux, constipation, or malabsorption. Yeast desperately needs simple carbs (as anyone who has baked with it will know), and this makes for fiercely rigid appetites in children whose guts are overly yeasty. Children may or may not show any other signs of yeast overgrowth besides that rigid appetite, so this often goes untreated. Confirmatory signs are large or painful-to-pass stools, constipation, ringworm patches, relentless red itchy diaper rash or rash at groin, urine or stool incontinence, bloating, a history of thrush in infancy… and, a penchant for bread, bread, sweets, pasta, bread, pizza, bagels, and bread.

What to do: Buy a high potency, high quality probiotic and have your child use it daily for at least three months. Look for a potency guarantee; a potency of 20 billion colony forming units (CFUs) per dose or more; mixed strains of Lactobacillus and Bifido species; and, no fillers. Many probiotics contain ingredients like inulin, which are added as food for the probiotic cultures – this is optional. Others have dairy ingredients, which are best avoided. There are many probiotic products out there – some of the best are only available on line or through health care providers. For more information about purchasing and administering these, see Special Needs Kids Go Pharm Free.

Sidebar: Kids whose guts are not colonized early in life with healthy microflora have more asthma, allergies, and problems with growth, feeding, and stooling. Besides taking antibiotics, kids can also lose these healthy microflora colonies if they were born via C-section delivery, if mom was given antibiotics while breastfeeding, or if they needed time in the NICU after birth.

Step 2 – Replenish zinc. This mineral has a big impact on appetite and power to improve a reluctant eater’s habits. Like most minerals, it is usually lacking in picky eaters’ food intakes. Most kids’ multivitamins don’t have enough zinc to overcome a poor eating pattern. Kids who have oral tactile sensitivity, who balk at varying food textures, who fall apart and stop eating if they encounter a novel texture, taste, or color in their food are often candidates for zinc replenishment. It’s a make-or-break nutrient for growth and onset of puberty too – so if your child seems later than expected in starting that pubertal boost, and has an appetite limited to starchy foods and milk, then there may be too little zinc in the mix. Besides a faint or mercurial appetite, other flags for low zinc are frequent infection, poor wound healing, skin that cracks near nails, white dots on nails, hypersensitivity to smells (and eventually, loss of sense of smell), or low taste acuity.

Zinc can be found aplenty in nuts, pork, dark meat poultry, cauliflower, eggs, some fruits and vegetables, and even pumpkin seeds. If this variety isn’t cpart of your child’s menu, add a chewable zinc lozenge or tablet (there are many on the market) that gives 15-20 mg zinc per lozenge; use it daily with food for 6-8 weeks, then check progress for appetite or other signs that describe low zinc. Your doctor can always check zinc status with a blood test too. 15-20 mg of zinc is a bit higher than the government’s dietary reference intake for healthy kids with good diets, but is workable because zinc has substantially lower toxicity than minerals like iron, and we’re talking about restoring a depleted status. I’ve dosed zinc to as high as 50 mg/day safely for children in my practice, but this is a path to take with professional guidance. Too much zinc can drive iron status downward, so don’t go overboard.

If a daily lozenge is a battle: Metagenics Zinc Drink (15 mg per teaspoon) is a tasteless colorless liquid that vanishes in juice, water, or any liquid. Available at many on line supplement sites or through health care providers.  Other liquid preparations abound; many of these add magnesium and calcium too. Use these only at the lowest effective dose. Questions? Send me an e mail through my contact form at NutritionCare.net, or check with your doctor.

Step 3: Restore iron. This crucial nutrient is overlooked for kids, more than you might think. Iron deficiency anemia is not uncommon in American children; many more may have marginal iron status, a condition that precedes outright anemia that your pediatrician can discern with a blood test for ferritin, a protein that stores iron. Though pediatric reference ranges for ferritin drop as low as 10 (depending on the lab doing the test), a ferritin level below 30 usually coincides in my experience with some compromise in learning, attention, behavior, sleep – and appetite. Kids with weak iron status or anemia may put non-food items in their mouths often, to chew on or even try to eat: Ice, snow, dirt, dirty snow, sand, pebbles, wood, fabric, plastic toys, pencils, paper, or other objects are typical choices for a child in poor iron status. Other signals for poor iron status are pallor, irritability, insomnia, dark circles at eyes, outright lethargy and breathlessness with little exertion, or recurring infections. If this describes your child, tell your pediatrician so your child can be screened for iron status. The most informative testing includes ferritin, serum iron, hemoglobin and hematocrit, total iron binding capacity (“TIBC”) and perhaps a blood cell count (CBC).

Examples of some iron rich foods are lentils, kidney beans, chick peas (garbanzo beans) red meats, liver, sesame seeds or sesame butter (tahini), eggs, or dried prunes. Wheat breads and cereals (not the gluten-free versions) are often fortified, but I have encountered children with weak iron status who were eating these fortified items daily. Picky kids usually shun the other iron rich foods, or eat them too infrequently for them to keep up iron stores.

Restoring good iron status is easy to do with gentle, low doses of supplements or herbs (licorice, nettles, dandelion, thyme).  Iron in good stead can help your child’s appetite broaden, and may trigger other benefits.  If your child isn’t using an iron supplement, you can add one – but don’t give doses above 5-7 mg of iron daily, without your doctor’s guidance. You can also check if your child’s multivitamin has any iron in it. If it has only 5 mg per dose or less, your child may need more. Check with your doctor. Given to excess, iron is toxic and even fatally poisonous so don’t use iron supplements without guidance.

What to do: Two easy tools to supplement iron when necessary are VegLife chewable  iron tablets (18 mg per tablet) for older children who weigh more or for children with very low ferritin, and Floradix Iron Plus Herbs liquid (10 mg in 2 teaspoons) for younger kids who need a daily reliable iron source. These are low dose and well tolerated by children in my experience.  The Floradix liquid vanishes well in dark berry juices. I prefer food based forms or gentle supplemental forms like ferrous bis glycinate. Ferrous sulfate (the form usually prescribed by doctors for anemia) seems to trigger more stomach pain, constipation, and nausea than food-based forms or ferrous bis-glycinate.

Give these three steps three months to work for your child. Changes will be gradual, so consider a pre and post log book on what your child is eating. Check in with your doctor if you’re not certain for dosing supplements.  If your child’s appetite hasn’t budged after these steps, I’d like to know about it!