When Picky Eating is a Bigger Problem

As a parent, we’ve all said at some point “try it, you’ll like it!”. Or, the tried and true “you used to like it, so why won’t you eat it now?”. I’ve personally been known to pull out my phone and dig through baby pictures so I can prove to my children that they “used to LOVE _____” while trying to convince them that the roasted and seasoned version is much yummier than the pureed kind. I stopped using this approach when my son insisted that the food smeared all over his baby face must have been from spitting it out, not because he loved it. Some days parenting feels like the most bizarre mix of unconditional love and infinite frustration!

As frustrating as picky eating can be, it’s normal for a lot of young children. Various studies have shown that picky eating is common in 8%-50% of young kids. I know, that’s a ridiculously broad range, but most parents will agree that this issue is more common than not at some point in early childhood. Kids naturally gravitate towards foods that are comfortable and familiar. For most of these kids, their food preferences will broaden as they get older.

But what about the kids who seem to only want the same 10-20 foods and can’t move beyond that? What about the selective eaters who won’t eat more than 5 or 10 different foods? This is when I recommend that parents talk with their pediatrician about their food concerns. Some kids are just super selective eaters who will likely remain selective eaters their entire life. Dr. Julie O’Toole from the Kartini Clinic has a great blog where she talks about that subset of kids who somehow thrive developmentally on cheerios, chicken nuggets and chocolate milk. To read some of her blogs go here: https://www.kartiniclinic.com/blog/

When should a parent be concerned about picking eating? A big red flag is when growth and development slows or stops. Those pediatric growth charts show your child’s normal growth patterns. A change in those patterns can be a sign that the eating issues are becoming a clinical problem. Because pediatric well child visits become yearly at age 3, this growth change can sometimes get missed until the next yearly appointment. It’s helpful to note if your child seems to be stuck at the same clothing size for some time or clothing is getting looser. If you suspect that your child is not adequately growing, make an appointment with your pediatrician.

Aside from growth concerns, is your child starting to reduce their food choices even further? Is the number of foods tolerated getting smaller and smaller? These are red flags. I’ve worked with kids who started with 15-20 food preferences and over a series of months to years gradually worked down to only tolerating 3-4 foods. As they got older, this interfered with their ability to eat with the family, travel, attend social events and school outings, etc. Even if their physical growth and development stayed on track, their issues with selective eating caused significant impairment with their daily social functioning.

Sometimes food avoidance may be due to temperature, texture or rigid taste preferences. I’ve worked with kids who could tell the difference between a major national brand of mac-n-cheese vs the generic brands. Their parents got quite skillful at locating restaurants that served the brand name mac-n-cheese, but overtime grew frustrated with dining options feeling so limited. These symptoms typically occur with children who have other sensory sensitivities and an evaluation by an occupational therapist or a provider who specializes in sensory issues can be beneficial.

A common issue I see in my practice is pediatric food avoidance due to anxiety. This anxiety sometimes stems from a traumatic choking episode or from an episode of vomiting. This can result in the child refusing to eat much of anything for fear that they may vomit or choke again. The fear of choking sometimes causes a child to avoid all solid foods or when eating solid foods, they obsessively chew to the point that they cannot eat a normal sized serving. The child knows they need to eat, but they just can’t get themselves to swallow an adequate amount of food. As pressure to eat builds, they may start hiding food or chewing and spitting their food into a napkin. As a parent, it’s incredibly frustrating and scary to watch your child struggle with this.

With anxiety based eating issues, malnourishment can cause an increase in symptoms of anxiety and depression. The brain does a lot of weird things when it’s not getting adequate nutrition. Think of a toddler who is hungry and how they behave. They get fussy, agitated, inconsolable and sometimes just lose their minds. With a good meal, you get your happy kid back. What I see working with malnourished kids is that their anxiety actually increases the longer the nutritional restriction lasts. Over time they can develop obsessive compulsive thoughts and behaviors and symptoms of depression and isolation too. Parents often say “I feel like I’ve lost my kid”. When symptoms of anxiety or depression seem to be triggering avoidance of food, an assessment with an eating disorders therapist can be helpful.

So, if you’re concerned about picky eating patterns with your child, I first recommend talking with your pediatrician. Your doc can help evaluate growth patterns, nutritional concerns and can often make some great recommendations for things to try. If it appears that the eating issues are more clinically concerning, then a referral to provider that specializes in eating issues for an assessment can be beneficial. Depending on what is going on, the referral may be to an occupational therapist, a registered dietitian or an eating disorder behavioral therapist. The objective is to get the nutritional intake back on track.

I will be posting later this month on Avoidant Restrictive Food Intake Disorder, so stay tuned and subscribe to the blog at: https://www.cristinashawphd.com