Feel like you’re banging your head against the wall trying to figure out why your child won’t eat anything or refuses to eat at all? There are real reasons and ways you can help picky eater kids. Learn how from a feeding expert and mom.
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As an occupational therapist, parents ask me all the time “Why does my child refuse to eat anything?”
It’s frustrating when you try to serve new foods, or worse, when you serve something they’ve eaten before like their beloved chicken nuggets or peanut butter crackers and they refuse to eat!
Most kids will do this occasionally, but some kids are refusing to eat on a regular basis.
What’s going on with kids that almost never seem to eat?
Or, will only eat if you feed them?
Or, the child that won’t eat and is losing weight?
As a parent, it’s scary, confusing, and stressful. You may wonder if you’re just dealing with a picky eater’s preferences that are like shifting sands.
It’s often much more than picky eating – more on that in a minute.
“My 2/3/4+ year old won’t eat anything” – Where to Start
To help kids that are refusing food, we have to start with figuring out WHY they aren’t eating, because consistent food refusal is not a typical part of development.
In fact, when a kid is repeatedly not eating with or without weight loss, it’s a BIG red flag that something more is going on.
It’s time to put on your detective hat and get to the root of the problem so that you have the tools to help your child eat more food, and avoid power struggles at family meals.
5 Reasons Why a Child Refuses to Eat Anything
The truth is that there are A LOT of reasons why kids refuse to eat food. In my experience, as a occupational therapist with a specialized feeding background, I believe that most can be organized into 5 different reasons.
However, we have to be clear that when a child is regularly refusing to eat very little of any food or has only a few favorite foods that they are willing to eat, they may qualify for a diagnosis of Pediatric Feeding Disorder (PFD), which was just added as a diagnosable code in October of 2021.
Another option is Avoidant Restrictive Food Intake Disorder, however this is closely linked to anxiety. See more in number 5 below for more info!
This is a good thing because children that are struggling to eat have often been described as picky eaters, which isn’t an adequate definition and leaves kids not getting the help they need.
As you read through the list below, look for signs you’ve seen in your child as a possible explanation. It’s very possible that several of the the underlying difficulties below are present in a child that often won’t eat.
Keeping that in mind, let me explain in some more detail.
#1. Physical or Medical Issues
Although this may seem like the most obvious reason kids don’t eat, it is often the most overlooked, or isn’t explored thoroughly. When kids have a well documented medical condition or are visibly sick, it is obvious that their eating is affected.
But, sometimes there are more subtle signs that are incredibly easy to miss. Two of the biggest culprits are silent acid reflux and constipation. Both of these very common problems for kids can put a halt to eating.
Although acid reflux is common in babies, it can also have an impact on kids much older, even if they weren’t diagnosed as an infant.
Unfortunately, many times it’s because kids don’t complain that their stomach is hurting. Many of them don’t even realize it because they have felt that way for so long OR they are too young to put into words how they are feeling.
Read more about acid reflux in children and to find a few natural remedies.
My older son has struggled with constipation since he was about one year old. I have to carefully watch his fiber intake and when he starts to get a little backed up, his eating is greatly affected.
Every time he doesn’t eat well, I have to ask myself, “Does he need to go to the bathroom?” The answer is usually, yes! Managing your child’s constipation can be a huge game changer in helping them eat new foods.
Read more about severe constipation in children and natural remedies to fix it.
If your child’s refusal to eat is more of a phase, you may want to consider teething, not feeling well, or fatigue as possible reasons for not eating.
And sometimes, if your child is chronically sick or tired, then food refusal or picky eating may become a way of life for them.
I strongly encourage you to see a pediatric GI if your child has any physical symptoms, or if you’ve ruled out the other causes listed here because there could be other possible digestive difficulties. There are many other, although less common possibilities such as:
- Food allergies (3-5% of kids)
- Food sensitivities
- Eosinophilic esophagitis (EoE)
- Delayed stomach emptying
- Physical abnormalities in the throat, mouth, or gut
- Tongue, lip, or cheek ties
Some signs that your child may have any of the above medical issues are:
- Eating only small portions
- Difficulty swallowing dry or rough textures
- Dropping a food they used to like such as milk, yogurt, or eggs
- Only wanting liquids and not solid food
- Holding chewed food in their cheeks (pocketing food)
However, each of those signs can have multiple explanations! That’s why that detective hat is important!
It’s a good idea to discuss it further with your doc!
#2. Sensory Processing Causing Food Refusal
For many picky eaters, sensory processing plays a big role in their refusal to eat foods. Simply put, if something feels gross in their mouth or on their hands, they aren’t going to eat it.
The fancy therapeutic term we give for when a child doesn’t want to touch different textures is tactile defensive. And, when they don’t like certain textures in their mouth, or chew/bite/lick everything else but food, it is a sign that their oral sensory system needs some help.
Clues that your child may be refusing foods because of sensory input are: gagging, squirming, or seeming frightened by the sight, smell, touch, or taste of a particular food.
Often, the first signs appear when parents try to feed babies baby or table foods. Sometimes, these reactions start as the taste buds become more developed between 1-2 years old.
And, other times, older kids can develop texture and taste sensitivities that weren’t there when they were younger!
Extreme Sensitivity and Fear of Anything in or Near the Mouth: Oral Aversion
Oral aversion also fits into this category.
If your child has had medical testing, feeding tubes, severe vomiting, or a physical incident in or around their mouth/throat (even from a infancy), they may be scared to have anything come toward their mouth and be overly sensitive in the area.
On the other end of the sensory spectrum, a child may not be able to discriminate food in their mouth well and they will unsafely stuff a large amount of food into their cheeks like a chipmunk.
This helps give them some feedback as to where the food actually is. These kids lose track of the food easily and can’t chew it well. Soft foods that aren’t easily discriminated (think mashed potatoes, cheese, etc.) are usually refused because they can’t manipulate them well in their mouth.
Sensory is often the hidden link in picky eating and food refusal, and while a lot of parents haven’t heard of it before, it’s critical to address it so that your child can learn to eat a variety of nutritious foods at meal times with the rest of the family.
If you can understand why your child is refusing food from a sensory perspective, well, it changes everything. To understand the connection better, read sensory processing and picky eating.
What May Be Causing Chronic Poor Appetite: Interoception
While frequent snack times and drinking milk throughout the day can spoil a child’s appetite for the next meal, some kids never seem to feel hungry or understand what fullness is.
This is related to one of the hidden senses called interoception. Basically, a child with poor interoception isn’t recognizing signs from their stomach that it’s time to eat or to keep eating until they feel full.
It’s like they’re lost in transmission. The good news is there’s a way to improve this appetite awareness! Learn more in our interoception article.
If you want to dive into a whole plan for sensory kids, then get into the free workshop I teach specifically for parents that are trying to help kids that refuse to eat. You can start using the steps today!
3. Oral-Motor Skills
We take it for granted, but chewing is a coordinated skill just like walking, talking, and learning to read. It doesn’t come easy for all kids. Therapists call the ability to bite chew, and swallow, oral-motor skills.
Signs that your child may not be chewing well are:
- Choking/gagging after the food is already in their mouth for a few seconds/minutes
- Pocketing food (holding it in their mouth)
- Wants to eat soft or pureed foods
- Spitting out half chewed food
- Food falls out of mouth accidentally
- Can’t remove food or crumbs from lips or corners of mouth with their tongue or lips
- Throwing up food that looks like it has hardly been chewed
- History of difficulty breastfeeding
Often, these signs are apparent in young children because they have a hard time learning to eat table foods or even pureed foods. While kids with any of the underlying causes listed could have a difficult time with weight, kids with poor oral motor skills get tired and frustrated.
They give up on eating quickly and may not get on a growth curve.
Some kids will start refusing to eat foods because they don’t know how to chew it or they are scared they are going to gag/choke/throw up again on the food they literally don’t know how to eat.
This can continue into the teen years, although when left untreated, kids may figure out some workarounds.
But, it’s not uncommon for a 12 year old’s refusal to eat to be linked in some way to oral motor skills. Head over to Oral Motor Exercises to learn more about how to help your child improve their oral motor skills.
Sometimes, oral motor difficulties snowball to include sensory defensiveness too, because when a child hasn’t eaten any other textures in a really long time or ever, they become very sensitive to them.
These other textures may seem strange and even uncomfortable when they touch or feel them.
If your child never transitioned well to crunchy table foods, then you’ll want to check out How to Transition to Finger Foods
4. Routine, the Typical Picky Eating Phase, and the Snowball Effect
I strongly believe that structure and routine around food and meal time is critical to kids eating well.
Because for some kids with average picky eating, changes to the meal time routine can help your child reduce “junk food”, come to the dinner table easily, and eat more of what we often consider “healthy” meals.
There are some kids that will manage to eat well with a lack of routine, but by and large, most kids’ eating habits will suffer greatly without a regular routine.
Without a routine, kids can slide into eating a separate meal away from the rest of the family and may not eat much food when they eat alone.
If you don’t have regular meal times, pay attention to how frequently your child is eating. Do you eat in front of the TV often, and/or mostly let your kids pick what they want to eat?
If they don’t have a wide variety of foods, only want snack foods, or aren’t willing to try foods, lack of routine may be the reason for it… or at least part of it.
I commonly see this compounded on top of one of the other 4 reasons kids don’t eat. When there is a problem with eating, we get overwhelmed and start grasping at straws just to get them to eat.
This is another way the bad habits can begin and then play a role in food refusal.
That’s not to say that you’re to blame, I mean our kids have to eat, right? And, we do the best we can with what we know. Don’t feel guilty about choices you’ve made in desperate situations.
I promise you that even with the pickiest eaters, there is a way out of eating in front of an iPad or them having their own separate meals. It is one step at a time and I’ll show you how in my tips below.
Although many kids that rely on a screen to eat often get to that point because eating is difficult because of oral motor, sensory, or medical issues.
The Typical Picky Eating Phase
One other common factor is that some children start off as good eaters, and then between 1-2 years of age, eating starts to go awry. Annoying, upsetting.. yes!
Like it or not though, it is NORMAL for toddlers to go through a picky eating stage as their taste buds mature and they begin to want to exert some control into their lives. Parents, sometimes, get scared when their child that had healthy eating habits is now not eating as well, and will begin to throw routine and structure out the window.
The Snowball Effect
With parents just wanting their kids to eat anything or at least some healthy snacks, short order cooking is ushered in, among numerous and otherwise well-meaning, but sabotaging techniques, and parents are left with a bona fide picky eater months or years later.
Although the intention was in the right place, the lack of routine can lead to long term eating refusal and difficulties.
I call it the snowball effect because the eating difficulties started off small and grew with momentum over time, just like a snowball rolling down a big hill!
Most parents I talk to with kids over 5 think that anxiety is the main factor for kids that refuse to eat, and it is often a component. Kids that have a hard time chewing, get stomach aches or worse when eating, or can’t stand the texture of so many foods are scared to put new or different foods in their mouth.
Eating has often not been enjoyable and filled with negative experiences, so yes they are scared. They are anxious.
But, I don’t consider anxiety the main underlying cause unless it goes into clinical psychological anxiety. In which case, kids will often make the following types of statements:
- I’m scared to eat the spaghetti I might choke
- I really want to eat that, but it might be contaminated with germs
- What if there’s poison in the pizza? I just can’t eat it
With clinical food related anxiety, kids often become irrational. And, they often have clinical anxiety in other areas of their life.
This is different than a child saying, “I’m scared that food is going to feel slimy like the avocado”. That is a sensory based fear and is treated differently.
If a child has clinical anxiety and NO OTHER underlying causes that have impacted their eating and are typically over 5 years old, they may qualify for an Avoidant Restrictive Food Intake Disorder diagnosis (ARFID), however I see this diagnosis frequently mis-diagnosed when PFD is more appropriate.
If you aren’t sure, get a few opinions and please feel free to leave us a comment below, we answer every one!
What if My Child is Refusing to Eat Because They’re Being Bad?
A lot of people advise parents that kids are being “bad” or that the reason they are refusing to eat is behavior-based. Although behavior plays a role, it is actually a small percentage of kids that actually refuse to eat based solely on behavior.
In fact, with the hundreds of families I’ve treated and the thousands I’ve taught in our online picky programs, I’ve never seen one kid’s picky eating that can be solely explained by behavior.
Now, please don’t mistake me, even the youngest of tykes will learn quickly what they need to say or cry or throw to get what food they want.
All kids go through different stages of development when they are testing boundaries and you can bet they will test it at meal times, too. After all, this is one of the few areas where they actually have some control. But, these kinds of little phases are short lived and aren’t severe.
For kids that have a history of being picky eaters, behavior is a piece of the puzzle, but typically, it has evolved from one of the legitimate reasons listed above.
And, when you address the underlying cause, the behaviors around meals decrease!
What to Do When Your Child Won’t Eat
If you can’ tell yet, here at Your Kid’s Table, picky eating is our thing. We have a lot of resources for parents and therapists working with picky kids.
No matter what combination of reasons are causing your child to be a picky eater, you’ll want to start with not pressuring them during meals while putting a consistent routine in place for them like having regularly scheduled meals with no snacking in between to help them start eating.
Then, focus on specifically addressing the underlying cause, whether that is sensory processing, medical, or oral motor skills.
Once you have a solid routine (grab this free printable to help develop one) and are addressing the underlying cause, you can also use some of my favorite picky eating tips. I love to use dips (even if you think your child hates them, I show you how), fun tools like toothpicks (trust me) and divided plates.
Plus, there are lots of novel ideas like making food fun, and I’m not talking about elaborate food scenes that you spend an hour cutting out.
And, my favorite tip that can make a huge difference is cooking with your kids! I know everyone says that and parents think, “Not my kid”. But, hear me out. I show you how to do it, tell you why it’s important, and give you these recipes designed for picky eaters:
- Pumpkin waffles (added nutrition)
- Bruschetta bar (this seriously is the best dinner for ANY picky eater that likes bread)
- High calorie smoothie
- Homemade chicken nuggets your kid will eat! (my special recipe)
- Not-spicy homemade tacos (check out the very motivating taco truck that can come to the table!)
- Banana sweet potato bread
- Roasted Cauliflower (2 of my kids tried cauliflower for the first time with this recipe)
- Crispy Potato Skins (basic recipe that’s perfect for picky eaters, got one of my kids to eat potatoes with this recipe)
If you’ve tried a lot of these tips before and want to dig a little deeper (only use these after you have a routine and positive environment), then you can move on to my heavy hitting picky eating tips. These require a little more thought, but can have a huge impact.
I know you may be tempted to feel overwhelmed at this point, but resist! This page is here (pin it so you can come back). Remember, one step at a time!
Getting More Help for the Child that Refuses to Eat Anything
Having a picky eater, let alone an extreme picky eater or child with PFD, can be extremely overwhelming and paralyzing. I’ve experienced it myself and the worry can take over your life. But, there are a few ways to get help from a professional:
- Come to the FREE 3 Keys to Turning Picky Eating Workshop with me! Yes, you can save your seat and listen as I talk in a lot more detail about how to help kids that refuse to eat.
- Learn more about feeding therapy and if it would be a good fit for your child!
- Join our Mega-Edition of Mealtime Works – our picky eating go-at-your-own-pace course filled with tons of printables, resources, and even a private facebook support group. (Doors close on 5-25-2023, get in now!)
You might need the tips and link shared here again. Save it to Pinterest here!
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Alisha Grogan is a licensed occupational therapist and founder of Your Kid’s Table. She has over 19 years experience with expertise in sensory processing and feeding development in babies, toddlers, and children. Alisha also has 3 boys of her own at home. Learn more about her here.