When Does Picky Eating Become Something To Worry About?

Having dedicated more than 30 years of my career to the study of eating disorders and the delivery of effective treatment, there's not much I haven't seen when it comes to anorexia, bulimia and EDNOS. Additionally, after raising children, I have come to understand a thing or two about the tendency of children to be picky eaters.

My three eldest children were relatively easy eaters -- they certainly had their preferences, but there were never tantrums or outright refusals to eat the food on their plate. Just when I thought I had avoided the dreaded picky eating drama altogether, the fourth child challenged my sanity as a parent. For years, it was a struggle to get him to ingest anything that wasn't frozen, processed "chicken" pressed into the shape of a dinosaur, and I recall one particularly intense public meltdown when "something green" (the smallest piece of cilantro that you have ever seen) made it onto the plate with said "chicken." Like most children, however, my son grew out of this phase and began consuming a wider range of foods as part of a well-balanced diet.

I share this anecdote with you because I want to stress that, in addition to being considered an expert in the diagnosis and treatment of eating disorders, I'm also a parent that has struggled with a picky eater. There's nothing more frustrating than being told not to worry about something that feels fundamentally worrisome, particularly when it pertains to your children. That being said, the good news for parents is that, in most cases, selective eating in children, or the restriction of diet to the point that it is a daily struggle to fulfill nutritional needs, is fairly common and generally resolves with age, maturity or any other variety of factors. However, as the prevalence of eating disorders in children continues to increase, it's prudent to evaluate the context surrounding your child's picky eating to determine whether these eating issues are merely a temporary phase or whether they could be early symptoms of more troublesome eating disordered thinking and behaviors.

Look at the Bigger Picture

Eating disorders are complex illnesses with biological, psychological and sociological implications. Given the diverse causes of eating disorders, behaviors around food and eating are only a part of the puzzle. Has your child recently lost weight, or has he or she not gained weight expected at his or her developmental stage? Has your child increased his or her activity or begun exercising excessively? Is your child dissatisfied with his or her body, evidenced by negative comments or excessive time looking in the mirror? If you have observed any, or all, of these eating disorder warning signs in your child, his or her picky eating may be indicative of the beginnings of an eating disorder, and early intervention may be necessary.

Examine Your Family Tree

Eating disorders are highly genetic in nature and have been shown to be as inheritable as bipolar disorder and schizophrenia. Many children with eating disorders have already had a latent genetic predisposition for developing the illness and a precipitating event, like a nasty bout of the flu or a mean comment from a family member or peer, triggered their bulimia, anorexia or related disorder. If there's a chance your child might have a genetic predisposition toward developing an eating disorder, parents should pay heightened attention to picky eating and other disordered eating behaviors, like cutting food up into tiny pieces, pushing food around his or her plate or chewing food and spitting it out.

Use Your Child's Pediatrician as an Ally

If picky eating is prolonged or feels worrisome to you, talk to your child's doctor about his or her food intake, thoughts and behaviors around eating, exercise and body image. While most pediatricians don't have extensive eating disorders training, they can generally help you determine if your child's relationship with food is affecting his or her development in an unhealthy way. If the situation warrants the examination of an eating disorders expert, your pediatrician can generally refer your family to a specialist. Eating disorders treatment resources for children abound online as well, with some (like this one) offering parents the opportunity to discuss their child's case with highly trained clinicians in real time via live online chat or phone.

Parenting lore tells us picky eating phases are common among children and that they generally resolve as your child develops. From a clinical perspective, this sentiment generally rings true, although it's important to remember that because eating disorders in young children are emerging more frequently, severe selective eating can be an early indicator that a very serious illness is developing in some cases. Parents should be diligent observers and trust their instincts. If your gut tells you that your child's picky eating may be an eating disorder, do your research, talk to professionals and intervene early.

 

Follow Kenneth L. Weiner, M.D., FAED, CEDS on Twitter: www.twitter.com/EatingRecovery

Comments

[robert horwitz]

05:32 AM on 09/20/2011

Having once been a kid myself I have a few of tips for kids who are picky eaters. Your pet dog standing next to you under your dinner table doesn't like vegetables either. Yes your parents do know that you are burying them under your mashed potatoes. If your parents threaten to send you to your room without any desert for not eating the darn things first ask what is for desert before you start whining about it. If your parents tell you that you need to eat them so that you will grow up big and strong. Tell them that that's not important as you plan to be a Jockey for a living.

[Todd G Chavey]

11:18 PM on 09/09/2011

Eat only when you are hungry. If you or your child does not eat at dinnertime, I guess it means that they are not hungry. There are too many obese children and adults. Get it together, people.

[fallenarches]

08:16 PM on 09/06/2011

Hold it, hold it, what's this?

"However, as the prevalence of eating disorders in children continues to increase..."

Really? Can we go back and discuss that one? I have certainly *thought* that I noticed an increase in picky eating among U.S. children since sometime in the 1980s, and I would love to see some discussion about the cultural/historical roots of that. I am not talking about "diagnoses" here. Rather, I think we need to be talking about changing cultural patterns that have resulted in more tolerance of pickiness, consequently resulting in more children and adults with debilitating eating problems -- the man who can only eat peanut butter sandwiches, the woman who can't have anything on her plate touch another food item on her plate, the children who grew up being allowed to refuse all food but plain cheese pizza (or dinosaur-shaped, chicken-like food substance... I mean Doc, how did your child ever get the option of that in the first place...?), and who subsequently grow up with health and *social* problems because of their food limitations. Let's see something concerning this apparent increase in food problems among children that examines what might be some messed up changes in our cultural patterns re. food.

[Chaton de Malheur]

06:17 AM on 09/06/2011

As a child, I had severe allergies, and was a very picky eater. The flavors of different foods were distorted by having a permanently stuffy nose. I loved salad, every kind of fruit, and most vegetables, but I hated uncooked tomatoes and pungent condiments. I had thrown up when forced to eat a regular hamburger from McDonald's.

My father resented the extra 5 minutes it usually took to order a plain hamburger, and made mealtime a nightmare for me. During one dinner, he decided to force me to eat a tomato. I just could not make myself do it. I was seven, very shy and slight. Enraged, my hulking 6'5" father slammed his fist on the table and began to walk around to my side to do God knows what. My grandfather jumped up and stood between us, and I ran outside in tears. I will NEVER forgive my parents for putting me through this daily nightmare.

The bottom line- as long as they are getting basic nutrition, don't push the issue, and don't you DARE make it a battle of wills. This issue is NOT about discipline. It’s about YOUR PATIENCE, and the child’s trust. Attempting to break a child's spirit over broccoli is abuse, period. You're the grownup- act like one. You have resources today that previous generations didn't have, such as nutritional supplement drinks. It's better to give them a fortified shake than a complex.

[fallenarches]

08:29 PM on 09/06/2011

I should say that your father had every right to not appreciate the extra five minutes it took to order a plain hamburger. And he should have said, "A hamburger is a hamburger. If you don't want a tomato on it, pick it off, but we are not going to allow you to make everyone in the known universe jump though convoluted hoops just so you can see them wiggle under your thumb."

The substitutes we have that make it easy for us as parents to avoid the work of exposure-based training and intervention are part of the problem. Giving your child the happy option to not try things or refuse food, because it's so easy for you to open a can or a bag or a box of frozen, processed garbage does not teach your child anything about what is considered edible, real food.

It's far better to keep serving up the broccoli with calm words: "Yes, this is edible, and it's what we're having for dinner." Eventually the kid will get the picture, but yes, there probably does need to be a bit of pushing, just like there needs to be a bit of pushing when teaching your kid how to tie his own shoes or do his homework or do his chores. Claiming that any amount of "pushing" is abuse is, in my book, tantamount to parental neglect.

[Chaton de Malheur]

01:14 AM on 09/09/2011

Certain items made me physically sick, as I mentioned, and they still do. Should my parents have forced me to eat foods that made me vomit? I was CRYSTAL clear that my father pushed the issue to the point of abuse, where other adults had to physically intervene. I hope your parenting skills are better than your reading comprehension.

[annie mac]

01:36 AM on 09/06/2011

People give their children far too many choices on too many fronts. Giving children too many choices makes meal times "an issue" because children expect to have the same freedom to choose what they eat too. Or, being denied this choice, meal times (and ultimately food in general) become entangled with concepts of power and control - an association that can become problematic later.

[crom14]

09:06 PM on 09/05/2011

My daughter as a baby did not like food. As a adult she is a gourmet chef. Eats every fruit, vegetable and herb. Our son hated every vegetable except corn, he now eats everything, every vegetable and fruit with a passion.

[thinkingwomanmillstone]

08:00 PM on 09/05/2011

Many children with autism have difficulty with eating. Malnutrition can be a real issue with some children with autism. It can be due to a need for routine or an obsessive behavior but it can also be due to sensory issues....or all three. My son could not eat anything that was smooth (applesauce, mashed potatoes, oatmeal, ice cream, etc) or anything that had combined textures (casseroles, sandwiches, soups,etc). He ate a bar of staples with no problem however. As a toddler he had a very limited list of foods. We discovered that highly spiced foods helped him overcome some of his sensory issues (tobasco is big in our house). Now at 22, he has a varied enough palate that nutrition is not a problem...though casseroles, potatoes and non spicy soups still make him gag. He has developed what we call company manners and will attempt to eat anything when a guest in someone's home.

[blondebeblonde]

05:21 PM on 09/05/2011

My parents used to make me stay at the table until I finished my dinner. An hour later, I was still there. Then I discovered I could sneak over to the garbage can and "empty my plate" just as they wanted.

I was terribly skinny and that was before it was fashionable to be so. I have no idea why I was such a picky eater, and I think my parents ignored it enough so that it didn't become a real issue to them or to me.

This was before anorexia was a household word, and I'm glad that was so, because my picky eating resolved itself. If we had been aware of this term, it might have changed the dynamics and I may well have developed an eating disorder based on my parents' anxiety.

[Milrepa]

11:11 AM on 09/05/2011

Many years ago, before I'd ever heard of eating disorders, I read about a study that was done relative to children and picky eating (they've always been picky eaters). Rats which were offered both "healthy" and "unhealthy" food selections over a five day period would select the "unhealthy" only to a point, and finally would make up the nutrient deficit by eating the "healthy" selection. UNLESS they were offered either sugar or salt, which they would eat relentlessly, even if they died of malnutrition.

[Shirley Fisk]

12:24 PM on 09/05/2011

9/5/11
12:25pm
NYC

A similar study was with children, not rats. Similar results, though.

[Shirley Fisk]

10:20 AM on 09/05/2011

9/5/11
10:21am
NYC

My youngest child was diagnosed autistic at the age of 2. He gagged on almost all meat, most veggies, and even some "unhealthy" junk food when he was little. Poor kid.
Parents have to recognize that some children are not being picky and have a problem with the texture, taste, or whatever. So don't nag them incessantly or try to force food on them. This would make the problem worse.
I remember when my little son was sitting in a high chair at TACO BELL with me and his siblings when he expressed an interest in the tacos. Great, I thought, he can eat something besides the avocado. But one bite caused projectile vomiting.
Good opportunity to explain to his siblings that he was NOT a picky eater.

[Chaton de Malheur]

11:14 PM on 09/17/2011

Your compassion and patience will allow your child to grow up to be secure and happy, and he will always love and cherish you for the gentle way in which you handled his problem.

[Chiprang]

08:54 AM on 09/05/2011

We should rephrase it as Piggy eaters. LOLzz. These days people hardly cared whether the food they eat are healthy or not. They go by their taste buds which is human nature. Except for the celebs who are under constant media scrutiny most people don't give a damn whether they be picky or piggy.

[traveling1]

08:45 AM on 09/05/2011

I know so many picky eater adults I find it hard to believe this issue is resolved "as the child develops". So then what, what do you do with these grown-ups who won't eat anything healthy?

[Kenneth L. Weiner, M.D., FAED, CEDS]

11:55 AM on 09/12/2011

Thanks for reading, and for your comment. You’re absolutely right. Some children don’t grow out of their picky eating and will carry those behaviors into adulthood, particularly as consumers have ever-more food choices and are constantly exposed to messages about “good" and "bad” foods. However, it’s important to understand that eating disorders in children and adults alike are a complex mental illness with biological, psychological and sociological underpinnings, and that the disease is much more complicated than a refusal to eat healthy foods or other categories of foods.

If an adult’s thoughts and behaviors around food consumption begin to interfere with their physical and emotional well being, or their relationship with others, their picky eating could be a warning sign of an eating disorder and they should seek help from a trained eating disorders professional.

[lisalulu]

08:18 AM on 09/05/2011

My younger son has sensory issues - taste, texture and smells turn him on or off. I struggle constantly with him - and walk a thin line. He likes the same foods and does not like to try new things which is so frustrating. I don't want to make him mental: I am teaching him the connection between food and mood - and exercise. I want both my sons to get the mental health connection with sweating and eating good. I have resources and its still hard. One day he will eat eggs, vegetables, rice, fish but until then- I will keep trying.

[Enock Zamora]

08:12 AM on 09/05/2011

I am no expert on eating disorders but I do know that a child craves that which its mother ate after it is born, i.e. ice-cream etc. Since my mother was a vegetarian, my family ate only local fruits & veges. When my mother cooked meat, which was seldom, she used local herbs & spices and generally dried the meat and never cooked it. Our mother read many books to us, like 'The Essene Gospel of Peace', which a book all about what we should eat and what not to eat and why. The link is below. It may take a generation of 'thinking' women to put our children back on the right diet to stop the plague of our children's health issues so that they can teach their children what to eat and not eat and why.

http://reluctant-messenger.com/essene/gospel_of_peace.htm

[karenemt]

09:44 PM on 09/04/2011

Picky eaters aren't necessarily starving themselves or thin either, my son has not grown out of the pickiness and is obese. I see symptoms of binge eating with my picky eater already and am seeking professional help. His dad was a binge eater as well and just had gastric bypass surgery. Thank you for this article!