Picky Eater? Things to watch for, and how to help.

April 6, 2022 by Dr. Morgenstern

 Last weekend, I was at my niece’s birthday party, when I overheard a parent expressing his frustration about his five-year-old son’s eating preferences and the challenges surrounding mealtime.  “He never eats ANYTHING other than chicken nuggets,” the parent exclaimed. While meals of solely chicken nuggets, apple sauce, and peanut butter crackers certainly sound delicious, I found myself wondering whether this is a case of age-appropriate picky eating or whether there could be more behind this boy’s eating behavior.

         Avoidant/Restrictive Food Intake Disorder (ARFID) was introduced as an official eating disorder in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) in 2013.  However, ARFID is quite different from how we typically conceptualize eating disorders.  Individuals with ARFID engage in severe food restriction, yet are not concerned with body appearance and weight gain.  Rather, those diagnosed with ARFID refrain from eating due to anxiety from early negative associations with eating (e.g., choking, vomiting) or dislike of specific textures or smells. This restriction leads to low weight, nutritional deficiencies, a reliance on supplements, as well as impairment across areas of one’s life (e.g., family arguments around food, anxiety around eating with peers).

Here are five signs that your child’s limited palate is not just picky eating: 

  1. Your child experiences anxiety before entering specific situations when he or she will be expected to eat anything other than preferred foods.  Some situations that may provoke anxiety are eating at a friend’s house, a restaurant, school, or a birthday party.
  2. Your child is unable to obtain sufficient nutrition through selected foods.  Your child’s pediatrician may have expressed concern about weight and growth trajectory. 
  3. Your child is disinterested in food and reports rarely feeling hungry. 
  4. Your child has a fear of something bad happening after eating. The feared consequences may be vomiting, choking, or stomach pain.
  5. Your child will only eat foods of specific smells, textures, or colors. texture, smell.

If your child does exhibit some of these symptoms, do not fret.  These are some strategies you can try to increase eating flexibility: 

  1. In stressful eating situations, validate your child’s feelings while also conveying confidence in their ability to handle the anxiety-provoking situation.  For example, “I see that eating dinner makes you uncomfortable, and I know you can sit at the dinner table with us.”
  2. Reduce pressure around eating! Try to limit any comments about your child’s eating (e.g., “Why aren’t you eating?” “We are not going to leave the table until you try this new food”)  You can convey confidence in your child’s ability to handle these challenging meals by modeling your own ability to cope with anxiety. 
  3. As long as your child’s doctor approves, try and reduce any accommodations around eating behavior.  An accommodation is any parental behavior to reduce a child’s distress. This includes excluding non-preferred food from the dinner table, not going out to dinner due to your child’s anxiety, and offering multiple foods until your child approves.  As a warning, your child may become distressed when you change your eating routine! Give them both validation and confidence, and the space to figure out how to cope with the new situation.