We're kicking off our Picky Eating Series with an interview from Alexia Hall, RDN

Everyone has encountered a picky eater at some point in their life—some of us have probably been picky eaters ourselves!

We know how much of a struggle it can be to care and cook for a child with particular food preferences.

While one worry is that they may not be getting all the vitamins and nutrients they need, it’s possible that picky eating could be a sign of a more serious issue.

This is where Alexia Hall, a Registered Dietitian Nutritionist (RDN), comes in. After parenting a picky eater herself, Alexia sought education on the subject, and today, after earning her credentials, she strives to be the source of information and help that she wishes she had access to when her family needed it the most.

Here’s what she had to say about what it’s like to be and work with an RDN:

How does one become an RDN?

To obtain this national credential, a person must pursue a didactic program in dietetics, which is a five-year degree program at an accredited university that includes chemistry, microbiology, anatomy and physiology, medical nutrition therapy, and advanced metabolism.

This prepares the student to undertake a year-long internship that gives critical experience in both inpatient and outpatient settings at an accepted medical center. Then the dietitian must pass a national exam.

Once these steps are complete, the registration is granted, which enables an RDN to work alongside a medical team, evaluating a patient, and designing and implementing interventions that are related to specific nutrition-related disease states.

A dietitian must also obtain at least 75 continuing education credits for every five years of a certification period, learning and specializing in their chosen field.

What does your process typically look like when you meet a new patient?

My initial meeting with a new patient in private practice generally lasts a few hours. In this appointment, I work hard to gain my patient's trust and instill confidence that we will be able to work as a team to find a solution to their health challenges.

We spend a lot of time discussing any medical diagnoses, symptoms they might have, and evaluating any nutrition labs (or determining which ones we need to obtain). We also determine if we need to refer out to have evaluations done by other specialties.

We spend a lot of time exploring the family’s lifestyle habits, their diet history, and their relationship with food in order to individualize the most effective plan going forward.

If a child exhibits behaviors of pick eating, what could this possibly mean?

There are several reasons why a child could be picky.

On one end of the spectrum, it could be related to some kind of anatomical issue that disrupts comfortable eating. It also could be a sensory issue related to body awareness, motor skills, or taste and texture dysfunction. It could be biochemical (such as a nutrition deficiency or an imbalance created by a disease), or it could be influenced by epigenetics.

And on the other end of the spectrum, it could be a behavioral component or a strong reaction to a food-related traumatic event.

Could picky eating be a sign of a more serious issue?

Yes, it could. As dietitians, we are trained to look for specific disease states that disrupt normal eating behaviors such as Eosinophilic Esophagitis (causing choking symptoms upon eating) or Gastroesophageal Reflux Disease (causing pain in the chest upon eating).

What are some behaviors or signs that you look out for when determining if the child's picky eating is behavioral- or health-related?

I ask questions about a child's early eating habits, and how long the symptoms and food refusals have been present.

• Were they previously a good eater and then suddenly changed, or have they always been this way?
• Are there physical symptoms present, like coughing with thin liquids or complaining of pain in the chest after eating?
• Are they able to eliminate waste properly every day?
• Do the kids refuse certain textures or temperatures and request the opposite?
• Do the symptoms include vomiting, retching, gagging, or hiccupping?
• How are their small motor skills and are they age-appropriate with other children?

These are just a few of the symptoms we explore when evaluating a new patient.

What are a few ways to help a child who is a picky eater simply because their tastes are not adventurous?

One of the first items we tackle is encouraging everyone in the family to sit for the family meal, without the distraction of TVs or other screens.

Research shows this is the best way to establish a confident and positive relationship with food. Parents provide the best role model for children who learn by mimicking the positive behaviors of adults.

In addition to that, establishing specific meal time guidelines, such as parents choosing which food and which time, and allowing children reasonable choice around foods, especially when deciding if they are going to eat something and how much.

Eating at scheduled meal times generally provides more nutrient-dense foods as compared to eating at snack times. Eating together encourages a healthy parent-child relationship as well as feelings of positive social wellbeing in a child.

If this type of meal plan is something new to the family, it may take a few specific steps and time to get there. Keeping mealtimes short (about 20-30 minutes) is often helpful for a young child, as is an opportunity to run and play for at least a few minutes before joining the family for dinner.

Allowing a child to help in the preparation and the selection of foods is another way to encourage that adventurous spirit, especially if mom and dad are in on the taste-testing game.

Positive language around food is crucial for the success of a new feeding program.

What are some early signs of more serious outcomes that parents can look out for?

A child who is not attaining typical growth patterns and milestones is a definite sign of a more serious outcome.

A child who also has consistent physical symptoms preventing age-appropriate feeding is another. If food reactions, such as vomiting, abdominal pain, choking, or gagging occur frequently, a more comprehensive evaluation by a medical provider such as a Gastroenterologist (GI) or an Ear Nose and Throat (ENT) specialist might be necessary.

What are some of the bigger challenges you face with your job?

Time is always an issue! These are often complex issues that require frequent support visits with a dietitian or other health personnel that are often not covered by insurance.

Time is almost always a factor for busy parents and families as well, especially those who work full time and have limited time at the end of a day to focus on a single family member.

These issues are becoming more common though, and there are several good books and lots of research to help assist those going it alone.

How does it feel after diagnosing and/or working with a patient? How does it feel to see them thrive?

It feels amazing to watch a child thrive who has been struggling!

When a child begins to feel successful with eating, you can see joy and confidence shining in their eyes, both literally and figuratively.

The kids and their parents light up when they tell you about new foods and confidently report both their successes as well as strategies they have created to deal with the inevitable setbacks.

Health is apparent in the glow of their skin. Growth charts and nutrition-related labs show improvement, symptoms begin to resolve, and families report more joy around the family dinner table. This is why I do what I do.

Is there anything else you'd like to share or touch on?

These challenges touch many people, myself included. My child had severe food intolerance as a young child. We received help from a dietitian, and I want to provide this same help to other people, sharing what we spent a lifetime learning.

I felt alone when we were initially confronted with this challenge, and I want to help other families feel supported. There are many strategies and many providers out there who can offer help.

Don't wait, find the help and support you need to help your family thrive!

Thank You:

Alexia Hall, RDN
Kitchen Curative