Picky eating is something that most parents are familiar with. If you’ve ever sat at the dinner table trying to coax their toddler to eat just one piece of broccoli, or trying to blackmail their teenager to eat their vegetables before they escape to play video games, you’ll know the problem all-too-well.

Many children go through phases where they refuse certain foods. They decide that they won’t try anything new and even reject meals and tastes that they used to love. It’s no wonder that parents can be driven crazy! But luckily, in most children, the picky eating phase is just that, a phase, and they’ll eventually grow out of it. For some children, though, the problem persists and gets out of control. It can turn into an eating disorder that can persist for the rest of their life.

If your child is showing the signs of picky eating, how do you know whether there’s anything to worry about? Is your little one completely normal or could it be an indicator of an issue that’s just beginning?

Disordered Eating And Picky Eating – Where Are The Boundaries?

It isn’t always easy to see where picky eating ends and disordered patterns of eating start, however knowing the differences between eating disorders and disordered eating can be the best starting point for parents who are concerned.

The term “disordered eating” is used to refer to a broad spectrum of irregular behaviors surrounding food and eating that can’t be diagnosed as any specific eating disorder. In most cases picky eating in children will fall under the category of mild or moderate disordered eating. It will usually resolve with time, although sometimes help from a paediatrician, therapist or dietician may be needed to achieve this.

The term “eating disorder” is used to refer to a mental health problem that is characterized by abnormal patterns of eating that often involve purging, bingeing or restriction. These have a negative impact on the sufferer’s health and results in an unhealthy obsession surrounding food, body image, shape or weight. Eating disorders like bulimia, anorexia, binge eating disorder and EDNOS (eating disorder not otherwise specified) all have their own specific diagnostic criteria.

While most eating disorders will develop in young people between the age of 12 and the age of 25 years, after the majority of normal picky eating will have resolved itself, it’s possible for younger children to be affected by eating disorders too. Specialized treatment can be found for young children as well as their families when they’re suffering from one of these mental illnesses

Surely Picky Eating Is Normal?

Lots of children are naturally picky eaters, so it isn’t too surprising that many parents think that this behavior is completely normal. Around a fifth of all pre-schoolers display some kind of picky eating behavior. However, just because picky eating is common doesn’t necessarily mean that it won’t cause any harm.

One of the biggest problems is that parents are usually more concerned about their child’s nutritional intake than their psychological well-being when they are raising a picky eater. They may, therefore, consult their child’s paediatrician who may tell them that such behavior is normal. Yet, when it comes to psychological harm, this can be far more wide-ranging and can impact on the parents as well as the child themselves. Anxiety and depression symptoms are not only more prevalent in picky eaters than in the rest of the population, but those symptoms are also more common in their parents. Picky eating in children leads to parental stress as moms and dads worry that they’re failing in their parental duties. This elevated stress, in turn, increases the child’s own anxiety surrounding food and eating and so the cycle continues.

If your child is a picky eater, it’s best to avoid turning mealtimes into a battleground. It’s often best to try to persuade young children to try new foods outside meal times rather than during them, and to make the experience of experimentation fun. But, in some cases, no amount of persuasion or experimentation will persuade a child to eat more than a very limited range of foods. In such cases, the child may have a psychological long-term problem and therefore it’s wise to seek medical advice from an expert.

Does Picky Eating Indicate Psychological Distress?

Even “normal” picky eating isn’t something to be taken lightly. It can turn mealtimes into a warzone and cause serious friction in family relationships. However, when picky eating gets out of hand, this can cause major issues for the child’s long-term well-being. Not only can it lead to issues regarding malnourishment, it can also lead to co-existing mental health disorders such as anxiety and depression.

There are some other psychological issues that may also be related to picky eating. For example, sensory problems can be linked to food aversions. Children who have a particular aversion to a smell, a texture or even visual flaws perceived in the food often have a hypersensitivity issue that isn’t actually about the food itself but about how they perceive the world around them. Children who have these types of sensory issues will have problems that extend far beyond food. For example, levels may need to be removed from their clothing because of the way they feel on their skin, or the TV may need to be muted for a specific show because they simply cannot tolerate the theme tune. Yet, when it comes to food these sensitivities can be more serious and disruptive to the sufferer’s life as well as the lives of their family members. Selective eating that is associated with any type of functional impairment is therefore diagnosed as ARFID or avoidant restrictive food intake disorder.

What Is The Impact OF ARFID?

ARFID may be about food on the surface but it’s also about anxiety and stress surrounding food. This can lead to the sufferer becoming socially anxious and increasingly isolated. They may not be able to stay at a friend’s house or go to social functions because they worry they won’t be able to find anything suitable for them to eat.

A typical ARFID sufferer will only eat around 20 or 30 different foods. Their diet is very repetitive and they are afraid of trying new things. Even more worryingly, ARFID sufferers often start to drop foods from their already limited diet over time. If they started out with 20 foods they would eat, they may reduce that number eventually to 15, 10 or less.

With less and less foods in their diet, medical problems will almost indefinitely arise. Depending on what the foods are that the sufferer will eat the resulting issues include obesity, malnutrition and osteoporosis, not to mention a host of mental health problems.

ARFID isn’t about wanting to lose weight or having a poor body image. Unlike most other eating disorders it’s more about trauma and a reaction to some incident in the sufferer’s life that triggered a phobia of eating those foods. In some cases, that incident involves choking – especially in children who were born prematurely and who had to spend months with tubes in their nose and mouth. ARFID sufferers, whether adults or children, feel that if they eat the foods that they are afraid of they could actually die.

Without treatment, the sufferer’s safe foods list will shrink further and further and a host of unwanted physical symptoms may begin to manifest. Headaches, dizziness, temperature sensitivities, aches and pains and numbness in the feet and hands are all signs that the sufferer is becoming malnourished due to their problem. It’s therefore essential for parents of picky eaters to take the problem seriously and to seek a referral if they believe their child could be suffering from ARFID.

Can ARFID Be Treated?

Although ARFID is a serious condition, it can be treated by experts with an in-depth understanding of the condition. The issues aren’t mechanical so there’s no need for any physical therapies. Instead, the treatment requires understanding about the trauma that occurred to cause this disorder to arise.

It’s important to use the correct forms of treatment for ARFID. If food exposure is used as a treatment, for example, this can actually increase and worsen the symptoms that the sufferer is experiencing. Treatments that are effective in binge eating disorder, bulimia or anorexia sufferers don’t work for ARFID sufferers.

With the right therapy and counseling, it’s possible for a sufferer to make a complete recovery from ARFID. There is particular success amongst teenagers who are often exceptionally motivated to get better since ARFID severely curtails their social life. With support from a psychiatrist, nutritionist and therapist, it’s possible to obtain an official diagnosis and begin effective treatment that will help to boost the sufferer’s confidence and help them to overcome their food aversions to live a more normal life.

What Action Should Parents Take?

It can be very difficult for parents to know how to handle their picky eater. If you’re worried that your child has a more severe problem than just picky eating, it can be even more challenging to know what course of action to take.

Rather than trying to shame or guilt a child into trying new foods, it might be helpful to highlight how they’re missing out when they won’t experiment with new things and how frustrated they must feel to not be able to eat the same as other people. It’s important to be aware, though, that this course of action may not work. If so, and you suspect that there’s something abnormal going on, you need to seek out a practitioner who is willing to listen and help. Familiarize yourself with all the eating disorder diagnostic criteria so you are armed with the facts and if the first doctor that you try is unwilling or unable to help, feel free to go elsewhere until you can find a professional who can give you the advice and support that you and your child are looking for.

Exploring Attitudes And Thoughts With Your Child

If your child is struggling with picky eating, you should try to discuss your child’s food preferences with them. This will help to determine if there is a cause for concern regarding their attitude to their shape, weight or body image. Even the youngest children become exposed to today’s obsession with slimness. The media, parental behaviors and attitudes and even school health programs which weigh children can cause anxieties surrounding food and eating in children. If your child expresses their rationale for their picky eating in terms of “vegetables are disgusting” or “I don’t like food that’s yellow” this is less worrying than a rationale like “white food is bad for you” or “meat will make me fat”. If your child is expressing thoughts like this, you should report it to their pediatrician as seeking treatment for any type of eating disorder should be done sooner rather than later.

Trusting Your Own Judgment

Sometimes, your pediatrican will tell you that there’s no cause for concern about your child’s picky eating, but it’s still important to listen to your own instincts. Sometimes, parents really do know best. If you suspect your child is suffering from a more serious issue that is more than a childhood fad you should make sure to seek help as quickly as possible.

Therapy - Picky Eating - Hillcrest

Talking To Your Pediatrician

A medical expert can help you to evaluate your child’s picky eating behavior to determine whether or not they are compromising their nutrition and whether or not they are suffering from an eating disorder. It’s best to seek out a doctor or dietician with specific experience in eating disorders as they will have the in-depth understanding of the eating disorder diagnostic criteria and will be able to make a treatment referral if necessary to the appropriate authorities. It’s important not to delay seeking advice as early intervention in the event of an eating disorder is vital to your child’s recovery or prevention of any worsening problems.