Special Needs: When Does "Picky Eating" Cross the Line?

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Is your child an extremely picky eater? Are you concerned that your child resists trying new foods or eats a limited number of foods?

Having a child who doesn’t eat, or who seems to exist on the “beige food diet” (pasta, bread, French fries), can make mealtimes very stressful. Parents are often told to not worry about it, their child is “just going through a stage,” he will outgrow it, she will eat when she’s hungry, or that the situation will resolve itself.

It is not uncommon for children to demonstrate difficulties with eating. In fact, research shows that up to 25% of all children and 80% of children with developmental disabilities may experience a feeding disorder during infancy and/or early childhood that may persist if left untreated.  

For some kids, picky eating may be “a stage” but for others it may be a more serious problem.

A feeding disorder is diagnosed when a child demonstrates difficulties with eating or drinking that negatively affects his or her weight or overall nutrition. Feeding difficulties usually begin between the ages of six months and five years. Left untreated, these difficulties can persist into adolescence or adulthood.

Having a child with a feeding disorder can be frustrating and challenging. Children with feeding disorders often experience anxiety around food and mealtimes. This can impact relationships with peers because they avoid going to birthday parties or other events that involve eating. Children with a feeding disorder are also at risk for behavior problems, delays in physical development, delays in cognitive development, and for developing an eating disorder (e.g., anorexia or bulimia) later in life.

The causes of feeding difficulties are unique to each child. Sometimes there is an underlying medical issue that makes eating painful. Other times, a child may have missed the opportunity to learn to eat appropriately due to illness or developmental delays. Some children may not feel hungry, have oral sensitivities, or lack the overall skills involved in eating (e.g., difficulty chewing and/or swallowing), making mealtimes unpleasant. Even when the underlying causes of the initial food refusal have resolved, children often continue to engage in problem behavior during mealtimes because eating was unpleasant in the past.

So, how do you know if it’s “just a stage” or a concern that warrants further attention? Here are some warning signs that may indicate a pediatric feeding disorder:

  • Food refusal (e.g., not accepting any or only small quantities of food).
  • Food selectivity (e.g., eating few foods; only eating specific brands, textures, or colors of food; only eating specific food groups, etc.)
  • Extreme reactions to the presentation of foods (e.g., tantrums, gagging, vomiting)
  • Gagging, vomiting, difficulty swallowing, and/or choking during meals
  • Continuously spitting out food or holding food in the mouth
  • Failure to eat age-appropriate textures (e.g., still consuming baby food as opposed to advancing toward bite-sized table food)
  • Concern about aversive consequences of eating (e.g., getting sick, choking, etc.)
  • Failure to meet nutritional/energy needs (e.g., significant weight loss, failure to achieve expected weight gain)
  • Feeding tube dependency

If your child has any of these symptoms, if you’re worried that your child isn’t getting the nutrition he needs, or if you’re tired of fighting about food, your child may be a candidate for feeding intervention.

There are many different treatments available. Before considering any form of treatment, ask the following questions:

  • Is there scientific evidence that indicates the intervention is effective?
  • Does the treatment include parent involvement in terms of planning and training to tackle difficulties in the home setting?
  • Does my insurance cover this service?
  • How much will this treatment cost?

As a parent or caregiver, it’s important to gather information, consult with your child’s pediatrician to rule out underlying medical conditions, and evaluate treatment options.  Ultimately, your decision should be based on which intervention method will work best to address your child’s specific needs.

Dr. Jennifer Felber, a licensed psychologist at The Summit Center’s Pediatric Feeding Clinic, specializes in behavioral treatment for children with feeding disorders. She has a passion for working with parents and their children who experience difficulties surrounding mealtimes.