Picky Eating

Symptoms

There are many types of behaviors that can be considered picky eating. Examples include:

• Refusing to eat specific foods (pears, ham, strawberries, peas, beans, etc.)
• Refusing to eat entire food groups, like vegetables or fruits
• Refusing to eat foods that aren’t a certain color or texture (only eating foods that are white or soft, etc.)
• Unwillingness to try new foods

When to worry

Picky eaters may not get enough of key nutrients. For example, prolonged and extreme picky eating can lead to nutrient deficiencies, like vitamin C or vitamin B12 deficiency. You can give your child a multivitamin to help prevent a deficiency.

Parents of a picky eater are often concerned that their child may be too thin. But according to a recent study in the European Journal of Clinical Nutrition, picky eaters are usually not underweight. They may be thinner than their peers, but not in an unhealthy way.

If a picky eater is starting to lose weight, it is cause for concern. Falling off a pediatric growth chart or having a body mass index (BMI) that’s too low is a sign that picky eating may be affecting a child’s growth and development.

Picky eating can also be a sign of underlying stress or anxiety. Children may have anxiety or a sensory sensitivity about certain aspects of a food, such as the smell, texture, or even the color. Others may have fear or stress related to the eating process, such as being scared of pain, choking, or vomiting when they eat. Sometimes, stressors at school or home can affect the way a child eats.

Picky eating may be a sign of an eating disorder if it starts to affect growth, development, good nutrition, and mental health. Eating disorders are serious conditions that should be treated by a mental health professional.

Picky eating in adults

Picky eating is often a childhood issue that many kids outgrow. But sometimes kids who are picky eaters continue to restrict what they eat as adults.

Unfortunately, not much is known about picky eating in adults because many adults keep their extreme food preferences a secret. It can be a source of deep embarrassment and stress that can cause personal and professional problems.

Picky eating that lasts into adulthood or starts as an adult may be a sign of an eating disorder. If your eating habits are starting to restrict your life and affect your physical and mental health, contact your doctor or mental health provider.

Causes

1. Normal development

Picky eating in children is most often just a sign of normal development. Picky eating often develops during the toddler years for two main reasons:

1. After the rapid growth of infancy, a toddler’s growth rate and appetite starts to slow down, so they’re less interested in eating than before.
2. Toddlers are trying to establish a sense of independence, so refusing to eat certain foods is an easy way to have a sense of control.

Extremely common: In a study of more than 3,000 infants and toddlers, the percentage of children identified as picky eaters by their caregivers increased from 12% to 50% as children aged from 4 to 24 months old [Source: Journal of the American Dietetic Association].

Other symptoms:

• Greater independence
• Temper tantrums and defiant behavior
• Imitating others’ behavior

Treatment and urgency: Picky eating is not a concern unless it starts to affect a child’s growth and development. Some ways to encourage your child to eat a greater variety of foods include:

• Make food fun. Cutting fruits or vegetables into eye-catching, fun shapes and presenting them in interesting ways will instantly appeal to any young child.
• Keep trying. Continue to offer your child new foods and ones they’ve refused before. It can take as many as 10 times being given a new food before a young child’s taste buds accept it.
• Offer choices. Appeal to your picky eater’s growing sense of independence by allowing them to choose different aspects of the meal, such as what vegetable you’ll serve.

2. Eating disorder

Eating disorders are dysfunctional eating behaviors that harm a person’s health and ability to function. There are different types of eating disorders, and picky eating is a sign of some of them.

Sometimes picky eating can be an early sign of an eating disorder. For example, avoidant/restrictive food intake disorder (ARFID) is an eating disorder in childhood that can seem like picky eating because kids who have it also have specific food preferences. The difference is that in ARFID, a child’s growth, development, and mental health are affected. Children with ARFID are often underweight, have nutritional deficits, and severe social anxiety around gatherings and situations where food is involved.

Picky eating that begins in early adulthood can also be a sign of the eating disorder called orthorexia nervosa. These individuals will avoid and refuse to eat any foods that are deemed “unhealthy” and develop very rigid dietary restrictions. Orthorexia can lead to serious health problems like malnutrition and other mental health disorders.

Common: In the U.S., 28.8 million Americans (9% of the U.S. population) will have an eating disorder in their lifetime. But these numbers may actually be higher since many people with eating disorders feel ashamed of their condition and don’t see a doctor [Source: National Association of Anorexia Nervosa and Associated Disorders].

Other symptoms:

• Avoiding foods with certain textures or colors
• Picky eating that worsens over time
• Anxiety with eating
• Lack of appetite or interest in food
• Liking very few foods
• Weight loss
• Low body weight
• Abdominal pain or other gastrointestinal issues
• Skipping meals or making excuses to not eat
• Withdrawal from social activities
• Eating in secret
• Shame, guilt, or disgust about eating habits
• Complaints of feeling sick after eating

Treatment and urgency: If you’re concerned that someone you know has an eating disorder, tell a doctor or medical professional right away. Some people with eating disorders may need to be hospitalized and monitored depending on how severe their eating disorder is.

3. Autism and other mental health disorders

Some mental health conditions such as autism, obsessive compulsive disorder (OCD), and attention deficit hyperactivity disorder (ADHD) can cause picky eating. For example, children with autism often have sensory issues, so they may react badly to certain food textures (such as crunchy items) and avoid eating them.

It’s important to recognize when picky eating may be a sign of a mental health condition. In these cases, a child usually has other symptoms related to the disorder.

Other symptoms:

• Delayed social skills
• Avoiding or difficulty maintaining eye contact
• Restricted or repetitive behaviors
• Developmental delays
• Hyperactive, impulsive, or inattentive behavior
• Unusual eating and sleeping habits
• Gastrointestinal issues (for example, constipation)
• Unusual mood or emotional reactions
• Has obsessive interests
• Insists on following certain routines

Treatment and urgency: Mental health disorders need to be diagnosed and treated by a multidisciplinary team of doctors and behavioral specialists. If you’re concerned someone you know has a mental health condition, contact a healthcare provider.

4. Anxiety

Anxiety can suppress a person’s appetite. In addition, having a bad experience, such as vomiting, that happened while eating a certain type of food can lead to avoidance of that food or more general picky eating.

Common: Anxiety is extremely common.

Other symptoms:

• Anxiety at mealtimes
• Fear of choking or vomiting
• Fear of  allergic reaction with eating

Treatment and urgency: Anxiety can range in severity from mild to severe. It’s important to see a mental health provider. There are many treatment options available, such as medications, therapies, or a combination of both.

Treatment

As a parent, it’s more important to help guide your child in making healthy choices rather than trying to stop them from having food preferences altogether. Pressuring kids to eat or getting frustrated by their picky eating often makes the situation worse. Also, calling them a “picky eater” can make them feel ashamed. Finding positive ways to expand what your child eats is the best treatment for picky eating.

If a disorder like anxiety or a phobia is related to picky eating, it’s important to identify and treat it. These conditions often need to be treated by several types of professionals, including doctors, nurses, therapists, and other behavioral specialists.

Individuals with picky eating habits related to stress and anxiety also benefit from a combination of treatments. These may include:

• Exposure therapy. Exposure therapy is one of the most common and effective treatments for phobias. The person is exposed to the source of the fear in a controlled setting, which allows the effect of the fear to lessen over time.
• Cognitive behavioral therapy (CBT). This form of therapy focuses on identifying negative thoughts, dysfunctional beliefs, and harmful reactions and changing them into positive views and feelings. It helps control symptoms and helps patients manage their anxiety.
• Dieticians and Nutritionists. Specialized dieticians and nutritionists can offer alternative food suggestions and feeding techniques to make sure a person with picky eating gets a balanced diet. They can also offer strategies to work around various sensory sensitivities and anxieties.
• Multivitamins: To ensure nutritional balance, especially if food variety is limited.

Frequently asked questions

Is picky eating a sign of autism?

Many children with autism do have some difficulties with eating, including picky eating behaviors. Picky eating is often related to sensory issues that cause them to refuse certain food textures, colors, or smells.

But picky eating behaviors may also be related to other aspects of autism like hypersensitivities to other stimuli or developmental delays. The autism spectrum is quite broad with early signs being noticed around 2 years of age, the same time period when picky eating behaviors are developmentally appropriate.

If you're concerned that your child has autism, contact your pediatrician to discuss further testing and diagnosis.