When Picky Eating Becomes Problem Eating

Many parents bemoan picky eating: after all, there’s very little that is more frustrating to a parent than preparing a delicious, well-balanced meal only to watch your child feast on nothing more than a pile of dinner rolls. But the truth is that picky eating is normal for young children, so let’s take a look at what “typical” picky eating looks like in order to better understand when it is becoming problematic – and what to do if it is.

A recent study showed that 46% of children are picky (or selective) eaters – that’s almost half! Selective eating typically starts around 15-18 months of age, which is about when toddlers begin to develop food preferences and favorites (alongside a whole host of other delightful opinions). Carbohydrate rich foods like crackers and dry cereal are often preferred foods, but when you, as a caregiver, take a step back, you’ll likely notice that while your child drops some foods from his repertoire, he adds others, resulting in a diet that that is actually pretty varied. In fact, when you look at the diet of a selective eater over the span of a few days, you will notice he accepts and eat foods from all food groups. 

You’ll know it’s time to raise your concerns when you start to see typical selective eating turn into extreme picky eating. When this happens, you’ll notice some specific characteristics, including the avoidance of entire food groups, the acceptance of only a certain food textures (i.e., smooth creamy or dry crunchy), acceptance of only a very limited number of foods, and extreme change in temperament associated with eating/feeding (i.e., full tantrum vs. a few tears over not getting a preferred food).  

Dr. Katja Rowell is an expert in working with families with extreme picky eaters. She has authored such books as “Helping Your Child with Extreme Picky Eating” and “Conquer Picky Eating for Teens and Adults.” Extreme picky eating, as described by Dr. Rowell, happens when “the amount or variety a child eats is so little that it impacts his physical, social, or emotional development, or causes significant family conflict or worry to the parent.” 

This kind of extreme picky eating can come about for a variety of reasons. There might be a medical or GI trigger, such as abdominal pain or reflux associated with eating. There might be an oral motor component where the child’s feeding skills are delayed and he doesn’t yet possess the skill to eat higher texture foods. There could be a sensory component where the food doesn’t feel right in the mouth. Or, there could be past trauma, like history of choking, which can cause anxiety with eating or oral aversion. But oftentimes extreme picky eating results from a combination of factors.

When children get to this state of extreme picky eating, it often causes parents to worry about nutrition and growth to the point that they adopt inappropriate feeding practices, including bribing your child to eat by offering treats and desserts or threatening your child with punishment if he doesn’t try a bite. But rather than resorting to these practices, we would encourage you to seek out a feeding team. This team could (and should) include your primary physician, a feeding therapist who is experienced with sensory processing, and a dietitian. Together, the team can help you to identify any underlying problems contributing to selective eating and formulate a treatment plan to overcome these barriers in order to incorporate new foods into the diet while monitoring your child’s growth and nutritional status.

But the most important takeaway from this particular piece is this: take a step back to look at the whole of your child’s eating. Refusing behaviors at one or two meals likely won’t tell you the whole story. Instead, try to watch for trends and responses over time. And if you’re concerned, reach out to your team – we’re here to help you!

Lisa Grentz, MS, RD, CD, Lead Dietitian