I know that I use the phrases “picky eating” and “picky eaters” a lot. I find that it is an easy way to define the topic and something many people can easily relate to.
But the truth is, I am not in love with this term. I do not like how negative it sounds. I also think it is too simplistic for describing a whole range of eating problems.
At the milder end of this continuum, we have the developmentally appropriate picky eating phase. At the more extreme side, we have a clinically significant feeding disorder.
In this post, I wanted to clear the confusion and use the research literature to classify feeding problems. I hope it will help you better understand your child eating and also give you the vocabulary and talking points to use in your conversations with doctors and other health professionals.
I hope you do not mind so many links to research articles and other feeding blogs I love. I think it helps to have a lot of references on your hands, especially since we are so lucky to have more science on this important topic than ever.
Two popular picky eating myths, busted
Before I go deeper into the types of feeding problems, let’s do some myth-busting, shall we? If you are parenting a picky eater, I am sure you have heard at least one of these.
- It is just normal, you do not have to do anything. Not true. Even if your child’s feeding issues are on the milder side of the spectrum, it is fundamentally important to use correct feeding strategies. Your reactions and your actions will play a big role in how your child’s eating will develop with time.It is amazing how your child’s eating and mealtime atmosphere can change if you switch your parenting style around food.
- He will outgrow it. I agree with this only partially. Kids on the milder spectrum of feeding problems have a chance to naturally improve their eating, but only IF they do not have severe underlying issues and IF the parents use the correct approach to feeding.I have seen a lot of cases in my practice when a typical picky eating phase was turned into a more extreme feeding problem down the road. Research confirms my suspicion – about one-third of picky eaters never outgrow it.
Types of feeding problems in children
OK, now that we got the myths out of the way, let’s talk about the classification of feeding problems.
1. Food Neophobia:
Food neophobia is a fear of foods that are new to a child. Some experts believe it is a primal mechanism that helped the babies of our ancestors stay safe and avoid poisoning after they were becoming mobile and crawling around.
The typical age for neophobia is 1-3 years. Most kids become neophobic at this age, at least to some degree. It is interesting that neophobia is different from picky eating because once kids have tried the food, they start accepting it. Picky eaters, on the other hand, are more likely to start refusing previously accepted foods.
Neophobia often goes hand in hand with picky eating. That’s why it may be tricky to figure out why your 18-month-old suddenly started turning down all dinner options. He may be neophobic to the new sauce you served, but rejecting the familiar sweet potato may be a picky eating trait.
2. Mild feeding problems (a.k.a. picky eating):
Mild feeding problems are often referred to as a very general term “picky eating”. Picky eating is not a formal definition and does not have any strict criteria.
Some researchers call it fussy or faddy eating. It generally means having a low appetite and/or eating a smaller variety of food but it’s not classified as a medical condition.
Picky eating is usually a developmentally appropriate phase. But in some cases, it can also be a symptom of underlying issues like sensory challenges, oral motor delays or history of reflux, among many others.
Most kids go through a picky eating phase at some point between 1 and 5 years of age. But if a feeding problem has an underlying sensory, oral-motor or another component, your child may start struggling with mealtimes as soon as solids are started, or even earlier.
If you are wondering what makes kids picky, you may want to know that it is usually a combination of reasons. Here are the most common of them:
1. Toddlers go through a prominent phase of testing limits and establishing their independence.
2. Their appetite goes down as their growth slows.
3. They may still be catching up on their chewing skills.
4. Their sensory systems may be hyper-attuned to food properties, especially texture. This may be due to innate difficulties or lack of exposure to a variety of textures when solids were started.
5. The memory of a trauma may play a role. Gagging or choking episodes and history of reflux may create negative associations with food and eating and trigger mealtime anxiety.
6. Their developing temperament plays a role. It looks like generally cautious kids may be less adventurous when it comes to eating, although we are still waiting for more research on this topic.
3. Severe feeding problems and ARFID
Severe feeding problems always have a significant underlying organic or behavioral component, and often, but not always, result in poor growth and inadequate nutritional status.
Research has determined a link between severe eating problems and anxiety in kids, so if your child has a lot of trouble at mealtimes, chances are his emotional health in other realms of life is also compromised.
Some kids, teens, and adults with severe feeding problems can be diagnosed with ARFID (Avoidant Restrictive Food Intake Disorder). ARFID is a clinical diagnosis that may be given to a child (or adult) only after a thorough examination by a team of medical specialists.
It is important to note that not all medical providers outside the US are familiar with ARFID. ARFID is included in DSM-V (Diagnostic and Statistical Manual of the American Psychiatric Association), so, depending on where you live, it may not be something your doctor knows about.
Some feeding experts are concerned that the parent-child feeding relationship is omitted from the definition and treatment of ARFID. But the positive side of having a diagnosis like this is the validity it gives to parents’ concerns and also, hopefully, an opportunity to get better care and support.
Read more about ARFID here.
What can you do to help your child?
Regardless of where on the continuum is your child’s eating, you can always start helping her at home by using positive feeding strategies. Positive feeding practices are about supporting the child by setting limits and giving certain freedom within them.
If it is not your first time here, you may know that I cover positive, or responsive feeding strategies in many articles on my blog, as well as in my online class.
In case you would like to read more about positive feeding strategies:
Why is your toddler refusing to eat?
How to end mealtime struggles with your picky eater
10-step plan to help a child who is anxious at mealtimes
3 valid reasons for screens at mealtimes
5 rookie mistakes that make picky eating worse
Why one-bite rule may not work for your child
Of course, depending on the severity of the feeding problem and the possible causes behind it, you may need deeper medical evaluations, and sometimes a whole team of medical professionals to help your child. The treatment may include a sensory integration program, oral motor exercises, optimizing feeding schedule, strategies to add more nutrition and reduce anxiety.
If you are convinced that your child’s eating is more severe than just picky, talk to your doctor.
If you need help figuring out just how picky your picky eater is, schedule a free chat with me, I would love to help.
But above all, stay on your child’s side and support him every step of the way. The best way to do that is by serving meals regularly, eating together, having fun at mealtimes and valuing your child for what he is right now, with all his quirky eating habits and all. This is the most important piece of advice I can leave you with today and I will dive deeper into this topic in the next post.
Until then, happy feeding!