Picky eating or feeding disorder?

Most parents know the struggle of trying to get their kids to eat new foods or finish their broccoli. Some might turn spoons into helicopters or cook side dishes of chicken nuggets. Picky eating strikes many children during their toddler years, but are there times when it’s more than just a childhood phase?

Why are some kids picky eaters?

There are a number of reasons children don't eat what we want them to or could be considered "picky eaters," according to Emily Donoghue, MS, CCC, speech-language pathologist with Wolfson Children's Rehabilitation.

Limited diet variety can be a typical stage of development, but it can also be considered a pediatric feeding disorder when pickiness is accompanied by other symptoms like difficult mealtime behaviors, issues with chewing and swallowing, or frequently dropping previously preferred foods from their diet.

Young children often don't have the ability to make many choices for themselves during the day; what they wear, what's for lunch, where they go and what they do each day is usually directed by the adults in their life.

“Eating, or choosing to not eat, is one avenue children can use to find a sense of control, so picky eating is often a secondary result of something more complex going on,” said Donoghue.

When is picky eating a concern?

Picky eating is often seen alongside immature oral-motor skills, leading children to prefer only purees and soft foods. Food aversion is commonly associated with sensory regulation difficulties, which might look like a child avoiding all wet, mushy foods or only wanting to eat a specific brand of chicken nuggets.

A history of certain medical conditions like gastrointestinal illnesses, respiratory or cardiac disorders can also reinforce a belief that eating is difficult and causes discomfort.

Feeding therapists are trained to work alongside a child's medical team to discover the root cause of a food aversion, which can be multifaceted.

Typical, developmental picky eating can look like a child "burning out" on a highly favored food for a short period of time, having a slightly limited diet variety that consists of at least 30 foods, having the ability to tolerate new foods on their plate even if they don't eat them or eating just one food from most food texture or nutritional groups.

Signs your child may have a feeding disorder

Still, parents worry when little ones don’t eat, and they may want to know when picky eating is more than just behavior. Talk to your pediatrician if your young child:

• Eats fewer than 20 different foods.
• Has frequent bouts of vomiting or constipation.
• Is not progressing from a bottle or pureed foods after 12 months.
• Has a physical reaction to food, like gagging or holding food at the front of the mouth rather than chewing.
• Is outside the recommended weight for his or her age, not simply at the low end.
• Stops growing for six months to a year.
• Has behaviors that make the majority of mealtimes distressing to him or herself or other family members.

An otolaryngologist, gastroenterologist, speech therapist, occupational therapist, or other specialist may be able to help.

How parents can help with picky eating

Whether the cause is medical or emotional, there are many ways parents can help their child move past picky eating habits. Donoghue's tips are to:

• Establish regular mealtime routines where the child is eating alongside at least one familiar family member.
• Make mealtimes fun and a way of connecting with others so that children are more encouraged to participate when the focus isn't all directed towards what they are or aren't eating.
• Remove the pressure to eat and allow the child to get messy and learn about the sensory properties of new foods.
• Respond to the child's cues, respecting hunger and fullness cues, signs of distress or dysregulation, and a need for taking a break from engaging with less preferred foods.
• Involve your child in mealtime preparation, asking them to help stir ingredients in the bowl, set the table, safely cut foods and serve other family members.

It can be helpful, Donoghue said, to avoid "yes or no" questions. Instead, offer choices so the child feels a sense of control while the adult decides what foods are available. Ask questions like "Do you want to use the spoon to scoop the peas or poke them with a fork? Do you want to smell the berry or lick it?"

Finally, Donoghue recommended avoiding force feeding or pressuring a child to eat something when they're showing signs of distress.

“Remember that as the adult we can control when food is served and what food is offered, but it is the child's job to decide what they eat and how much of it they eat.”