How to Handle "Picky Eating"

Note to My Readers

I am not fond of labeling children as “picky eaters,” but as a former preschool teacher I have seen many parents struggle with introducing new foods to young children. Maintaining a healthy diet for little ones that are learning independence in food choices can cause stress for well-intentioned moms and dads. Rather than dub these children as picky, today’s post is designed to give you some background as to why children begin turning down foods, how to increase their willingness to try new things, and the effects parents have on a relationship with food. Read on for tips and thank you for your interest in the “Food Philosophers” blog, please leave a comment at the end of the post!

Controversy

ARFID may sound like the noise a seal makes at the beach, but it is in fact an acronym for a new eating disorder classification, Avoidant/Restrictive Food Intake Disorder (Zimmerman, Fisher, 2017). Previously known as selective eating disorder, ARFID is found in the most current Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the tool used by psychology professionals to diagnose and treat patients. It is a distinctly different diagnosis than anorexia nervosa or bulimia nervosa because there is no body image disturbance associated with the disorder (Zimmerman, 2017). According to the DSM-5, one or more of the following four features must be present for the diagnosis of ARFID (Kohn, 2016):

-Significant weight loss (or failure to achieve expected weight gain or faltering growth in children)

-Significant nutritional deficiency

-Dependence on enteral feeding or oral nutritional supplements

-Marked interference with psychosocial functioning

The popular community website, Reddit, has a sub thread for adults and teenagers to express their experiences, fears, and support as people with ARFID. One post is by a 15-year-old American girl describing her extreme aversion to vegetables in which she “gags at the smell or sight” of vegetables and feels the need to leave the room when her parents are eating them due to the “disgusting smell.” Other redditors describe their strict meal plans referencing “safe foods” and a shared feeling of being ostracized for their abnormal eating habits. One eighteen-year-old says his younger cousins want to be a “pizza vegetarian” like him and a young woman admits to feeling attacked by her well-intentioned boyfriend about her food choices (Reddit, 2017).

A 2013 study in the journal of Pediatrics, found out of 917 children, ages 24 months to 71 months, 20% had selective eating (SE), 17% had moderate SE, and 3% had severe SE (Zucker, Copeland, Franz, Carpenter, Keeling, Angold, Egger, 2015). The children with severe selective eating disorders, now termed ARFID, were 7 times more likely to have social anxiety and twice as likely to be diagnosed with depression, moderate SE was not associated with psychiatric diagnoses (Zucker, 2015).

The treatment for a child with an avoidance eating disorder is to utilize the expertise of a multidisciplinary team including pediatrician, psychiatric professional, registered dietitian, and involvement of the family and caregivers (Kohn, 2016). As a new diagnosis, more research is being conducted to determine the most effective treatment for ARFID (Zucker, 2015).

Facts

Picky eating is not synonymous with ARFID. Instead, it is a normal behavior that may begin to emerge around the age of one year and is associated with increased independence as children develop autonomy (zerotothree, 2010). Nearly 25-35% of parents have toddlers or preschoolers that are described as poor or picky eaters (Leung, Merchand, Sauve, 2012).

The MyPlate website details a few common signs of picky eating: refusal of foods based on color or texture, accepting only certain types of foods or individual foods, spending time distracted at the table instead of eating, and unwillingness to try new foods especially fruits and vegetables (MyPlate, 2017).

Parental expectations can also be unrealistic as children leave the infancy time of rapid growth and their physical development and eating habits begin to slow down in toddlerhood (Hayes, 2014). In the first months of life, the infant is constantly feeding and this growth is extremely apparent. As the baby ages, the appetite and physical growth will slow down. Parents should not worry as this is normal in development, children are naturally less interested in eating into toddlerhood (MyPlate, 2017).

Between ages one to five, there may be increasing hesitance to try new things and repeated exposure in a relaxed environment is a key to success with new foods (Savage, Fisher, Birch, 2007). It is important that meal times be friendly and not overly controlling as pressure to eat and food restriction can have negative impacts on the child’s developing eating behavior (Savage, 2007).

A 2013 study of 2,231 adolescents and their parents found that controlling feeding practices had a negative impact on a child’s ability to self-regulate energy intake (Loth, MacLehose, Fulkerson, Crow, Neumark-Sztainer, 2013). Instead, a more appropriate method is for caregivers to encourage moderation and emphasize healthy food choices in the home. Pressuring children to eat certain foods can increase negative feelings and it can take between 8-15 exposures of a new food for acceptance (Lam, 2015).

Take Home

Picky eating is a common behavior seen in many toddler and preschool aged young ones. It can be difficult for parents to cope with, but it is normally outgrown with time (MyPlate, 2017). Some strategies can be used to encourage healthy eating patterns.

Children that are choosy when it comes to taste, smell, and texture should be offered new items along with old favorites to encourage a sense of familiarity. Offer new foods frequently as it can take as much as 8-15 times for your child to accept a new food item.

Meal time should be relaxed and enjoyable, offer foods but do not coerce or force the child to eat. Over-controlling parenting can interfere with a child’s own ability to self-regulate feelings of hunger. Encourage a sense of wonder and exploration with new foods and allow playfulness at meal times, empower the independent eater with healthy choices.

Involve your child in preparation of the meals and snacks as this gives them a sense of purpose and desire to try the foods they helped prepare. If your child is having issues with wanting to feed themselves, choose foods that are easy to eat, grasp, and safe for self-feeding.

It is the responsibility of the parent to offer healthful meals and snacks. The children should choose how much of the foods they would like to eat, encouraging a lifelong knowledge of when they are full.

If you find that your child has extreme anxiety around meal times and is beginning to lose weight talk to your pediatrician about these emerging patterns.

Tips for Parents of Picky Eaters

References

Hayes, Dayle. 2014. Coping with Picky Eating Phases. Academy of Nutrition and Dietetics. Accessed October 4, 2017 http://www.eatright.org/resource/food/planning-and-prep/cooking-tips-and-trends/coping-with-picky-eating-phases.

Kohn, Jill. 2016. What is ARFID? From the Academy: Question of the Month. Academy of Nutrition and Dietetics. Accessed October 4, 2017 via http://jandonline.org/article/S2212-2672(16)31064-4/pdf

Lam, Jason. 2015. Picky Eating in Children. Frontiers in Pediatrics. https://www.frontiersin.org/articles/10.3389/fped.2015.00041/full

Leung, Merchand, Sauve, 2012. The Picky Eater: The Toddler or Preschool Who Does Not Eat. Pediatrics & Child Health. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3474391/

Loth, MacLehose, Fulkerson, Crow, Neumark-Sztainer. 2013. Food-Related Parenting Practices and Adolescent Weight Status: A Population-Based Study. PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275. Accessed October 4, 2017. http://pediatrics.aappublications.org/content/pediatrics/early/2013/04/16/peds.2012-3073.full.pdf.

MyPlate. 2017. Picky Eating. https://www.choosemyplate.gov/preschoolers-picky-eating

Reddit. 2017. ARFID. Back from A Meal with Family Members. https://www.reddit.com/r/ARFID/comments/71m3fu/back_from_a_meal_with_family_members/

http://pediatrics.aappublications.org/content/136/3/e582

Savage, Fisher, Birch. 2007. Parental Influence on Eating Behavior: Conception to Adolescence. J Law Med Ethics. 2007; 35(1): 22–34. Accessed October 4, 2017 via https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2531152/.

Zerotothree. 2010. How to Handle Picky Eaters Accessed October 4, 2017 via https://www.zerotothree.org/resources/1072-how-to-handle-picky-eaters

Zimmerman, Fisher. 2017. Avoidant/Restrictive Food Intake Disorder. Division of Adolescent Medicine, Northwell Health, Hofstra Northwell School of Medicine, Cohen Children’s Medical Center, Hempstead, NY. Accessed via http://www.cppah.com/article/S1538-5442(17)30049-4/fulltext,

Zucker, Copeland, Franz, Carpenter, Keeling, Angold, Egger. 2015. Psychological and Psychosocial Impairment in Preschoolers with Selective Eating. Pediatrics. http://pediatrics.aappublications.org/content/pediatrics/136/3/e582.full.pdf