Picky Eating (Part 1): How to Tell if Your Picky Eater Needs Help

by Maryann Tomovich Jacobsen, MS, RD on May 18, 2010

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Expert Profile: Diane Keddy, MS, RD, FAED is a Nutrition Therapist and a Fellow of the Academy for Eating Disorders. She has treated men, women and children with eating disorders, including selective eating, for the past 25 years. Currently she is in private practice in Newport Beach, CA.

If all children accepted the food parents gave them, feeding kids would be easy. In fact, this is usually what happens the first 18 months to 2 years of a child’s life.

But then one day the same child who ate almost everything starts to say “no” and reject foods. In the eyes of a child, new foods can be scary and intimidating. And parents are left unsure what to do, afraid their little one will become deficient in key nutrients.

Welcome to Raise Healthy Eaters’ picky eating series. Here we’ll talk about why kids eat the way they do and what parents can do about it. I believe what happens during this lengthy stage of development can have a big impact on a child’s future eating.

But before we get into what is normal for most kids in terms of food choice and eating habits, it’s vital to discuss what isn’t normal. There are times when kids may require professional help if they are to become normal eaters.

Selective eating
Selective eating is picky eating that persists into middle childhood and beyond with an extreme reluctance to try new foods. Unlike eating disorders, there are no body shape issues and weight of the child can vary, with many children being underweight.

“Most pediatricians are missing it,” says Diane Keddy, MS, RD , FAED, a nutrition therapist who has worked with selective eaters for 10 years. “The longer parents wait to get help, the harder it is to treat.”

Now this doesn’t mean that any 10-year old picky eater has selective eating. Keddy says these kids only accept a very narrow range of (usually white) food. The typical list includes pasta, macaroni and cheese and gold fish and some will drink milk.

Selective eaters tend to only eat their accepted foods at home even if someone else is making it the exact same way. When they try a new food it’s common for them to choke, gag or even vomit which leads to their anxiety about eating. Keddy explains that this is neurological because the part of their brain that recognizes food as pleasure is underdeveloped.

Typically by age 6 kids really start expanding their palate but with selective eating this doesn’t happen, making social activities anxiety-ridden for the child. They often fall off the growth charts and can experience slow bone growth if left untreated.

Who gets it?
“Children with a family history of autism, eating disorders, OCD and severe picky eating are at greater risk for developing selective eating,” says Keddy. “With autism spectrum disorders (ASD) on the rise, selective eating is becoming more common.”

A recent study published in the Journal of Pediatrics, showed that while both ASD and non ASD children had picky eating, the ASD group refused more foods and had a smaller repertoire of foods they would eat. As a result, these children had insufficient intakes of vitamins A, C, D, zinc and calcium.

This doesn’t mean non ASD children can’t become selective eaters, but it appears to be more common in children with ASD.

The treatment
Keddy says that the treatment for selective eating is very different than what she recommends for normal picky-eating kids. The division of responsibility of feeding does not work with selective eaters. She utilizes a treatment called “systematic desensitization.”

Children are first put on medication to treat their anxiety. Once their anxiety is reduced and they are better able to relax, she works with them on trying different foods. For each new food they try, the parents give them some kind of non-food reward.

She describes it as a negotiation, where kids are allowed so many “pass” foods. She says the treatment takes a lot of energy and commitment from parents, but it’s worth it. Based on her own experience, she estimates that about 80% of selective eaters eventually become normal eaters.

What worried parents should do
“Parents know their kids best,” Keddy says. “If they sense something is wrong, they should seek professional help.”

Keddy says to start with the pediatrician and if they can’t refer you to anyone, find a dietitian that works with eating disorders. She says that even if the pediatrician says your child’s eating behavior is not worrisome, it’s worth it to get them evaluated. “It can’t hurt,” she adds.

The sooner kids get treated for selective eating, the better off they’ll be. Keddy says the average age she sees kids are 10. But children often display signs at much younger ages, typically starting around ages 3 to 4.

And if left untreated, kids who are selective eaters will grow into adults who can only eat a short list of foods. This not only negatively impacts health but hampers social activities where food is often the central part of gatherings.

So when in doubt, get your child evaluated. If this isn’t an issue for you, stay tuned for our next post in this series about the kind of little eater you have at home (and why it matters!).

Next: How to Pinpoint Your Child’s Eating Personality (and Why it Helps)

References

Bandini LG, Anderson SE, Curtin C, Cermak S, Evans EW, Scampini R, Maslin M, Must A. Food Selectivity in Children with Autism Spectrum Disorders and Typically Developing Children. J Pediatr. 2010 Mar 31.

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{ 39 comments… read them below or add one }

June May 23, 2010 at 12:11 pm

OMG! I am in tears! My 7 yr old has this and the doctor says she’s ok and her therapist says it’s normal, but I know it’s not!! There are only 6 or 7 things that she will eat and only if I prepare them! What really struck me about this article is that my daughter also has mild Asperger’s. So why doesn’t anybody find her eating habits odd?? Thanks again!

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Maryann Tomovich Jacobsen, MS, RD May 23, 2010 at 2:20 pm

June,

I’m glad you found your way to this article. Let me know if you need any help!

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Theresa July 6, 2010 at 9:47 am

My daughter, now five, was very slow to self-feed, rejected “lumpy/chunky” baby food and all table food, and between age 1 and 2.5 lived mostly on crackers, applesauce and the occassional chicken nugget. She had other issues that raised red flags with us, so we had her evaluated first by a developmental pediatrician then by an occupational therapist. The pediatrician thought she was on the ASD spectrum and referred us to OT. The OT worked with her on a broad range of issues including oral motor skills – I had to struggle to get her to use a straw – we’d gotten lazy about letting her use a sippy cup all the time – and now, 3 years later, her range of foods has broadened significantly, including Chinese pork buns, spaghetti and meatballs, and raw carrots and celery (if they have peanut butter on them.) I’m intrigued by the anti-anxiety drugs thing, as she clearly has high levels of anxiety about trying new foods, but this angle has never come up for us before. Thanks for posting.

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Maryann Tomovich Jacobsen, MS, RD July 6, 2010 at 2:53 pm

Theresa,

Thanks for the comment. If you have questions about selective eating you can always send it to Diane Keddy (expert I interviewed). Just click through to her site and you’ll find her contact information. Thanks again for reading!

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Adrienne November 30, 2010 at 4:29 pm

My oldest son was diagnosed with Sensory Processing Disorder this spring. He’s almost 6, and eats maybe 4-5 things. I’ve begun making just the one meal, and I control what goes on the plate but he controls what he eats. My best results are at no-pressure meals. He’s tasting things but it’s early days. I worry that he may never eat meat because of texture (he doesn’t eat it now, except in highly processed form like chicken nuggets and corned beef hash). How can I broach the texture issue?

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Janine February 7, 2011 at 8:10 am

Thank you for this portion of the article. It is good to finally see some information becoming available about selective or resistant eaters. There was very little information about it available (on the internet) when my daughter was diagnosed with ASD 4 years ago.

To address the question about texture, I’ve found the best approach is to make your own foods with that texture. My daughter will eat McD’s nuggets, so I found a recipe to simulate at home that is healthier. Grinding chicken breasts in a food processor will give that weird re-constituted chicken look and texture.

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Kathryn November 3, 2011 at 9:47 am

My son is 7 and has been diagnosed with Aspberger’s. His is more the social disorders and he does tend to eat “white foods”. The point I don’t agree with is putting them on medication to treat anxiety. I don’t think my son needs that. As he’s gotten older he has been more willing to try new things and has found out that he even likes some! I sneak things into food he likes, such as golden flaxseed meal into peanut butter.

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Julia S. June 29, 2012 at 11:02 am

I am a therapist who just started working with a 10 year old picky eater. I know it was not “normal” when he parents sat down and told me the info at the assessment. I’ve only seen him a few times and little progress has been made but I am slowly trying to work towards the systematic desentization approach.

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Natasha August 29, 2012 at 5:24 am

How would I go about finding someone knowledgable about selective eating to evaluate my child? He is nearly 9 years old, and I am not absolutely convinced that this is his problem, but I have great concern about his eating in general. I want to get to the problem, so that we can work on the solution…without damaging his perception of meal time and eating.

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Maryann Tomovich Jacobsen, MS, RD August 30, 2012 at 8:14 am

Natasha,

The dietitian I interviewed recommended finding a dietitian who specializes in eating disorders and works with selective eating. You can also find a good feeding therapist who deals with sensory issues such as an OT or ST. They may be able to help rule out oral/motor issues. If you need more help, contact me directly at raisehealthyeaters@gmail.com

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Foodforthoughtlinds September 10, 2012 at 8:19 pm

I find it very disturbing that the first course of action is meds. I’m not at all someone who is opposed to medication when it is needed. But often, these picky and resistant eaters can benefit enormously from Occupational Therapy, to help them with their foods issues. Personally, as both a Speech-Language Pathologist and a mom of two little ones who are resistant eaters (and have a sensory processing disorder), this would be my first course of action. My little guys have made enormous progress with textures of foods since starting with their OT.

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Maryann Tomovich Jacobsen, MS, RD September 10, 2012 at 9:16 pm

Thanks for your comment. I do plan write another post on this as this was written when I first started this blog — and I have learned a lot since then. Much of the advice comes from an RD who works with selective eaters who are older — and were likely never treated for sensory issues early on (with an OT/ST).

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Foodforthoughtlinds September 11, 2012 at 8:21 pm

That’s great to hear! I just wanted to be sure that that people were also aware of this option for therapy. I realize in reading this that I’m terribly lucky that my kids were identified young (one at 21 months and the other at 7 months). Hopefully, we won’t have to pursue the route of medication that we might otherwise have had to.

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Maryann Tomovich Jacobsen, MS, RD September 12, 2012 at 6:59 am

Maybe I can interview you about your experience as I love ot share real-life stories. Will be in touch!!

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Foodforthoughtlinds September 12, 2012 at 7:15 am

By all means, I would be happy to share my story. I’d be happy to do whatever I can to help other families struggling with feeding issues find solutions. We continue to search and know that we continue to learn a lot from other similar families. The internet is great for this these days!!

I’ve also decided that I’m going to start practicing in this field professionally and am going to attend the SOS Feeding conference in November. So I look forward to becoming even more knowledgeable in the field.

You can also see bits and pieces of our story on my own blog: http://foodforthoughtlinds.blogspot.ca/ clicking on the tabs picky eaters, Logan’s/Chloé’s journey and sensory processing disorder.

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Glenna Williams September 12, 2012 at 1:45 pm

I am (as a few others) crying as I read this. I have a 12 year old daughter who since the age of 3 has only eaten: orange Yoplait Yoguart, Chicken Nuggets, Plain Pasta, Top Ramen, Mac and Cheese, Bacon & Chocolate Milk. She is now to the point that she is telling me she is “sick” of her usual food, but is too afraid to try something new. This terrifies me. I have spoken with a few counselers (over the phone) and they tell me to take her to an eating disorder clinic, but what I’ve found is they only treat the anorexia or bulemia (sorry for the spelling) – No where in Oregon can I find anyone to help us with this. She is now begining to lie (saying she ate breakfast) when I do an “inventory of food” – I know she didn’t eat. And this is a huge red flag.. ANY Help or pointing in the right direction would be so appreciated.

Warm Regards,
Glenna

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Foodforthoughtlinds September 12, 2012 at 3:15 pm

Glenna,

I can’t even imagine how challenging of an issue feeding has been with your daughter. I’ve had more than a few days of complete frustration, and my eldest is not even two and a half yet. *Hugs*

I don’t know what area you are in. But if you’re anywhere near Portland, you might want to try here: http://www.ohsu.edu/cdrc/clinical/portland/nutrition.html If you’re not near the Portland area, you can perhaps contact them for suggestions of who might be able to provide services in your area.

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Glenna Williams September 12, 2012 at 3:23 pm

Thank you for the *hugs* – I went to their website before, and that is more of an audism program/or ausbergers (ugh, I’m not good at spelling) – they said they didn’t have much help on this topic – great place to go though, as they’re right down the street from us!

Thank you!
Glenna

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Foodforthoughtlinds September 12, 2012 at 5:56 pm

Oh… sorry to hear that. It sounded from their website that they might have relevant services for your daughter. I guess that means they weren’t able to refer you anywhere either. That must be so frustrating…

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Foodforthoughtlinds September 13, 2012 at 5:51 am

Glenna, I just posted a blog post on tips for picky eaters who have more sensory issues. It was working on this that brought me onto this website in the first place. I thought this might be of interest to you, in case there is anything that might be helpful for you with your daughter. I’m dealing with toddlers, so I suspect not all of the strategies will be helpful for you. But maybe you’ll be able to pick up a tip or two?

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Foodforthoughtlinds September 13, 2012 at 5:52 am
Glenna Williams September 13, 2012 at 8:58 am

Thank you! That is a great blog – even though it’s toddler oriented, there are still some similarities…. thank you – and for your kind words… I am not giving up and will continue to educate myself and help my daughter :)
Glenna

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Foodforthoughtlinds September 13, 2012 at 7:48 pm

Thanks Glenna :) I wish you the best of luck with your daughter. It sounds like you’re on the right path, searching for solutions.

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FB March 30, 2013 at 11:46 pm

The article is very informative but I don’t know what the matter is with my elder daughter. She is 15 years old with Down Syndrome. Recently she is refusing to eat harder foods like fried chicken, any kind of roti (Indian flatbread similar to tortillas), even chicken nuggets that she used to love. She is crazy about pizza but she has a hard time eating it and sometimes leaves it half-eaten. Her OT (at school) checked her and says its a behavioural problem and told me to offer only hard foods. But I am not convinced. We have an appointment with the dentist tomorrow. If she doesn’t find anything out of place, then I may have to think about other things.

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acne.org May 14, 2013 at 11:56 am

Very descriptive article, I loved that a lot.
Will there be a part 2?

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Maryann Tomovich Jacobsen, MS, RD May 14, 2013 at 3:32 pm

Thanks! Actually this is the first article in the series http://www.raisehealthyeaters.com/category/picky-eating-series/ I do plan on running another article on picky eating soon though.

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Kim May 14, 2013 at 2:39 pm

Hello,
I just read this article and am having a hard time finding someone in the NY area (Long Island) who has experience treating selective eating disorder. My daughter is 14 and has had this problem since she started solids. She has adhd and I believe she has anxiety but she will never admit it.She also doesn’t want to deal with her issue. I have brought her to a therapist and a nutritionist and an adolescent nutrition program but nothing has helped. How do I get her to see this is an issue and needs to be addressed? She eats Perdue chicken nuggets, pizza, bagels, ice cream popcorn and Nutella on a soft tortilla. The only veg she eats is a rawcarrot which is not enough. Can you recommend someone in the Long Island area who could help?

Thank you

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Maryann Tomovich Jacobsen, MS, RD May 14, 2013 at 3:28 pm

Let me check with my nutrition colleagues. Hang in there!

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Kim May 15, 2013 at 7:58 am

Have you heard anything about Sondra Kronberg? She is a reg dietician and has a very good website but I don’t know of anyone who has gone to her.

Thanks,
Kim

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BusyMOM June 22, 2013 at 1:19 am

It was great to read the above posts and comments! I am a dietitian mom myself who is struggling with my toddler (3 years) selective eating. I have tried strategies that I have read from journal articles, and I have seen a difference! My child usually does regress to only consuming 2 foods when she is sick, but after a week she gets to eating her selected foods. This is usually when I can try to expose her to trying new foods step by step (touching, holding, touching to face and so on!) Luckily as a dietitian I know which food groups I need to work from! After reading the above comments, I think I better find an OT to help her out soon! She has just been diagnosed 6 months ago so I am still learning! Maryann I love your informative blogs, thanks so much for sharing. Your blogs help keep me updated!

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Maryann Tomovich Jacobsen, MS, RD June 23, 2013 at 8:34 pm

Thanks so much! stayed tuned for an update to this post soon. It’s been a while since I wrote it and have a lot of new stuff to add (and stories).

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BusyMOM June 23, 2013 at 8:51 pm

Ill be waiting for your updates! I forgot to mention my toddlers diagnosis of autism. Your blogs on this topic would really help another dietitian mom!

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Ashley October 3, 2013 at 2:16 pm

Hi I know this article is mainly about children, but I am 23 years old and I have been living with this my whole life! I don’t know what to do anymore because it has completely taken over. I want to be healthy and I am trying so hard to loose weight but because I am such a very picky water probably eat less than 15 different things I am worried I am susceptible to becoming malnutrioned. I only eat 3 fruits and absolutely no vegetables I can’t get them anywhere near my mouth or I gag I gag from the smell alone. I don’t know what to do anymore! Please help! I want to loose weight but I want to be healthy about it!

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Samira October 15, 2013 at 3:21 am

I’m having similar issues with my sons eating habits, he is 2 years 4 months, he has always been picky and will never try new foods we have tried and tried, he used to eat a good vegetable, tomato meat type dinners every day and suddenly stopped. He now eats only cheese, cerilac (seems to be his main meal 3 times a day with milk), yoghurts, Pringles, French fries, bread, organix crisps, bananas, omlette and rice sometimes. basically all white/cream colored foods. I’m really worried. We have tried everything possible.:-( any advice is most appreciated. Going out to eat is sad as I see him not eating and I want him to enjoy foods, nursery he will only eat slices of cheese and bread.

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Maryann Tomovich Jacobsen, MS, RD October 15, 2013 at 4:32 pm

Samira — this article should help you decide whether or not to seek help. Kids do typically get picky around 2pm but ther eare some red flags to be aware of. If you have any more questions feel free to email me at raisehealthyeaters@gmail.com

http://www.raisehealthyeaters.com/2013/08/the-nagging-question-every-parent-of-a-picky-eater-asks-part-2/

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Stephanie November 10, 2013 at 11:54 pm

The issue of being a picky eater never bothered me until now, I am 25 y.o., and trying to conceive. My husband and myself are concerned that first of all I will not be able to provide enough nourishment during a pregnancy…and although he believes its just a matter of trying new foods, I know that it is much more difficult than that. Instead of broadening my range of foods that I eat…it is getting smaller as I get older. This Thanksgiving my plate will consist of the same foods it has for the past 20 Thanksgivings…bread w/butter, mashed potatoes (if there aren’t any lumps), green olives (if they’re soft), and cranberry sauce (if it’s the jelly kind, from the can..not actual cranberries).

In my head I know this is not normal…I’m also a nurse. I mentioned to my PCP a few years ago about this issue, but his reply was that everyone has there little quirks. I just need to know if there is anyway to go about treating this…I don’t want my future children to pick up on this horrible fear of trying new foods.

Any advice/help would be greatly appreciated.

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Maryann Tomovich Jacobsen, MS, RD November 13, 2013 at 8:15 am

Stephanie,

I suggest you see a registered dietitian that specializes in eating disorders and has worked with selective eating. She/he can may be able to help you eat more foods and develop a plan to meet your needs during pregnancy. I also suggest you visit this website as Duke is studying adult picky eating http://www.dukehealth.org/clinicaltrials/the_food_fad_study_finicky_eating_in_adults Some one there might be able to help you too.

Good luck and don’t stop until you get the help you need!

Maryann

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Samantha May 11, 2014 at 3:56 am

Wow thank you for this. I have a just turned 2 year old who i believe is a selective eater. As you say he only eats white foods. Basically bread, yogurt, chicken nuggets and potato. He has been this way since the introduction of solids slthough now refuses anything new or slightly different in appearance for instance if his nuggets are deep fryed and therefore slightly crunchier he wont eat them, his bread always has to be the same brand, cut, colour etc. if its not the way he has it he just wont touch it. He doesnt maje a big deal he just wont eat. I have often thought about seeking help but here is the catch, my partner, his father is exactly the same and suffered alot of anxiety as a child through ‘people forcing him’ so he does not support the idea of seeking help. I dont know what to do. I offer new foods at every meal but he wont even touch them.

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Maryann Tomovich Jacobsen, MS, RD May 14, 2014 at 5:32 pm

This article should be of more help in terms of help etc. Let me know if you have any questions http://www.raisehealthyeaters.com/2013/08/the-nagging-question-every-parent-of-a-picky-eater-asks-part-2/

As for your partner, let him know that help is not about forcing a child — and if it is it is bad therapy! Let him know an evaluation will just let you know if he has any issues like sensory or even medical.

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