Kids, Vegetables, Diet, and Rewards

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My now 10 year-old daughter used to eat almost everything that we put in front of her when she was a toddler.  Lately, however, she has decided that all she wants to eat is macaroni and cheese or mashed potatoes.  My now 7 year-old son, on the other hand, spent the years between age 3 and age 5 subsisting largely on “chicken nuggets” and multi-vitamins, and little else….  (The first time that I was able to persuade him to eat some broccoli, at age 5, after suggesting that he dip this much-maligned vegetable in ranch sauce and grated parmesan cheese, I was moved nearly to tears!)

Most kids are fussy eaters, and getting your child to eat a healthy, balanced diet can be a serious challenge, if not a perpetual struggle between parent and child.  As with most aspects of child-rearing, there are a number of recommended strategies to get Junior to eat his or her vegetables, and other healthy foods.  However, many of these strategies turn out to be utterly ineffective in practice.  Certainly, one of the most commonly recommended strategies is to offer reluctant young eaters various types of rewards for healthy eating (and which is, in my view, tantamount to bribery, but which has probably been resorted to by most of us parents during times of diet-related desperation, and with varying results).  (As I discuss in my bestselling evidence-based book, A Cancer Prevention Guide for the Human Race, fresh vegetables, whole grains, and reduced meat intake have all been associated with a reduced risk of developing both cancer and cardiovascular disease.)

Given the never-ending mealtime struggles in our own home, I came across an interesting new research study related to this very topic, and which appears in the current issue of the American Journal of Clinical Nutrition.  In this innovative little prospective, randomized, controlled clinical study, 173 children, ages 3 to 4 years, were divided into three groups.  All of these children were exposed to vegetables, 12 times per day, that they were known to dislike after these vegetables were first introduced.  The first group of children received a tangible reward (a sticker) each time after being served a vegetable that they had initially disliked.  The second group of children received praise as a reward upon being served vegetables that they too had disliked upon initial presentation.  Finally, a third group (the “control group”) was served vegetables that they had also initially disliked, but this group of children did not receive any rewards (i.e., no stickers and no praise).

The findings of this study, while not terribly surprising, offer parents a potential strategy to improve the diets of their (our) vegetable-hating kids.  Of course, the children who were repeatedly served disliked vegetables, and who received no stickers or praise, continued to refuse repeated servings of these vegetables.  However, the toddlers who were bribed with stickers (a material reward) significantly improved their intake of the offending vegetables over time, and this improvement in vegetable consumption persisted when the children were reevaluated 3 months later.  Importantly, the children in this “material reward” group were also significantly more likely to develop a liking for these same vegetables over time!   The third group of children, who received praise (a “social” reward) along with each serving of undesired vegetables, sadly, and somewhat unexpectedly, were no more likely to increase their consumption of these vegetables over time, or to develop a liking for these vegetables, than the kids who were in the “no reward” control group!

In this clinical study of toddlers, offering children a material reward (stickers, in the case of this clinical study) in conjunction with repeated introductions of initially disliked vegetables resulted in a significant improvement, over time, in the willing consumption of these vegetables, as well as in increased “liking” of these same vegetables.  Positive reinforcement through praise was, however, completely ineffective in getting these little tykes to eat (and like) their veggies.

In the case of my son, “the vegetable-hater,” the Broccoli Breakthrough occurred on an evening when I took him and his sister out for dinner.  In exchange for the privilege of the three of us playing a family card game during our meal, and as a result of my inspired suggestion that he combine two foods that he loved (grated parmesan cheese and ranch dipping sauce) with a food that he hated (the aforementioned broccoli), the miracle of witnessing my little guy downing several florets of broccoli coated in ranch sauce and parmesan cheese finally came to pass.  I was so overcome by that moment, two years ago, as was my daughter, that I remember it like it happened yesterday.  Moreover, knowing that my wife would almost certainly doubt my incredible claim that this event had actually occurred, I documented this miraculous development with my cell phone camera on the spot, and emailed it to her from the restaurant that night.  Nearly two years later, I am happy to report that while both of our kids still challenge us in our ongoing efforts to get them to eat a healthy, balanced diet, our son (and daughter) will still regularly eat that most despised vegetable among children, broccoli!


For a groundbreaking overview of cancer risks, and evidence-based strategies to reduce your risk of developing cancer, order your copy of my new book, “A Cancer Prevention Guide for the Human Race,” from AmazonBarnes & NobleBooks-A-Million,Vroman’s Bookstore, and other fine bookstores!

On Thanksgiving Day, 2010, A Cancer Prevention Guide for the Human Race was ranked #6 among all cancer-related books on the “Top 100 Bestseller’s List” for Kindle e-books! On Christmas Day, 2010, A Cancer Prevention Guide for the Human Race was the #1 book on the Amazon.comTop 100 New Book Releases in Cancer” list!

Disclaimer:  As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity

Dr. Wascher is an oncologic surgeon, professor of surgery, cancer researcher, oncology consultant, and a widely published author

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