What does it really mean for a child to be a picky eater? Find out when it becomes a food aversion disorder, extreme picky eating, or a food phobia and get tips to help turn it around.
Many parents consider one or more of their kids to be a so called “picky eater”. It’s a term we hear EVERYWHERE, spoken on the lips of parents around the globe. But, sometimes the picky eating seems to be more extreme. Like when your child has a sensitive gag reflex when tasting, touching, or even looking at new foods. Or, when they tantrum and even totally meltdown at the suggestion of eating something new. And, when they only have a handful of foods in their diet, that leaves the looming question, “When picky eating becomes more serious, does a child have a food phobia, selective eating, picky eating or food aversion disorder?”
Parents that are living in this extreme stress are often wondering what to do to help their child eat, and a solution seems unattainable. But, there is hope. I know because as a feeding therapist (and mom), I’ve seen many extreme picky eaters overcome it and grow to have a healthy relationship with food.
To understand why a child may be a selective eater, we’ve got to dive a bit deeper into the meaning of picky eating…
What Does Picky Eating Mean, Anyways?
What does it really mean to be a picky eater? If you scroll through the comments on various articles on this site, you will find a range of picky eaters from parents looking for advice for a child that is refusing several vegetables, to one that has a seemingly overactive gag reflex every time they even look at some foods. Surely, all of these kids can’t all just be picky eaters, or can they?
Hardly. It’s actually more accurate to think of picky eating as a spectrum. On one end of this spectrum is the average picky eater, that eats a decent variety of food, but can be particular at times. Most families don’t really notice a disruption to their lives with this mild version of picky eating, even though it can be annoying at times.
On the other end of the spectrum is extreme picky eaters or children with a “picky eating or food aversion disorder”. I’ve seen both in my own home! When my second son was born, as soon as foods were introduced, he gagged and didn’t show an interest. While that can be normal, it persisted. He seemed to have no interest in eating. He definitely fell on the more extreme end of picky eating. I had to use some more targeted strategies and a lot of consistency to turn him around. He had underlying sensory issues with food, and this picky eating thing just wasn’t going to go away on it’s own. You can read about how I got him to go from being a child that won’t eat to one that has a healthy relationship with food.
Totally on the other side of the picky eating spectrum, I’ve watched both of my other two kids go through what I like to call “normal” picky eating. In fact, my 2 year old picky eater is in it right now. This morning he came down for breakfast and hardly ate any oatmeal, his favorite breakfast. A few months ago, he stopped eating yogurt, but for the most part, he has a well rounded diet.
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When Does a Child Actually Have Some Type of Food Aversion Disorder?
There a lot of different terms coined by different researchers and practitioners to describe a child that eats very small variety of foods.
The SOS Approach to Feeding, by Kay A. Toomey, uses the term problem feeders. And, authors Rowell and McGlothlin, in one of my favorite picky eating books, Helping Your Child with Extreme Picky Eating, use the phrase extreme picky eaters to describe these kiddos. You’ll also hear, picky eating disorder, food aversion disorder, food phobia, neophobia, selective eating disorder, and well, the list goes on and on.
To be honest, whatever word you use, there isn’t consistency among professionals like pediatricians and feeding therapists using a diagnosis, even though Avoidant/Restrictive Food Intake Disorder (ARFID) was added to the DSM-V (that’s the guide doc’s use to give diagnoses).
Even though you may have never heard of any of these terms, the distinction between average picky eating and the more extreme food aversion is important. Generally speaking, picky eating can be a normal part of childhood, albeit annoying and frustrating. Selective eaters are beyond picky eating and usually need the help of a feeding therapist to make progress eating new foods. In these cases, eating is actually a serious problem for the child and can have a big impact on family life.
On top of that, general feeding advice often doesn’t apply to these kids! Besides parents feeling frustrated by that, they often have to deal with well-intentioned, but vastly incorrect, comments about how they just need to give their kids some tough love when it comes to eating. Have you heard the advice, “Just feed them what you’re eating and they’ll eat eventually, when they get hungry!”???
That may work for some kids that fall on the milder side of the picky eating spectrum, but for kids with food aversions, it could be disastrous, even leading to a feeding tube. That may sound dramatic, and although it’s unlikely, it is possible.
I want to get really clear about the definition of an average picky eater and one of a child with more extreme picky eating. My hope is that it gives you some peace of mind, and answers the ever nagging question of your child needing more help!
These are some of the characteristics of Average Picky Eaters:
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- Eats 20- 25 foods on a regular basis. Eats at least a few fruits/vegetables, carbs, and proteins
- Can be coaxed to occasionally try new foods
- Bribes, rewards, and punishment will often work
- Usually will eat foods similar to their favorites. For example, will eat a variety of chicken nuggets or pizza, they will typically not reject different brands or styles
- Sometimes eats foods different than the rest of the family
- Will suddenly refuse a food they have preferred, but will eat it again in the future (Just like my youngest son and the oatmeal)
These are some characteristics of Kids with Food Aversion Disorders/Selective Eating/Extreme Picky Eaters:
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- Eat less than 15 foods consistently, maybe as few as 1-3
- May gag, shudder, or vomit at the site or taste of foods (Just like my second son when he started eating)
- Common picky eating strategies like the “try a bite” rule and punishment often don’t help them to eat more or new foods
- May become emotionally upset when they are encouraged to interact with non-preferred foods
- Refuses large categories of foods (vegetables, meat, etc.)
- Might lose weight or have growth concerns
- Seems to have a sensory issues with the food (the way it smells, looks, feels, etc.)
- May insist on foods being preferred in specific ways or will only eat a specific brand/style of food
- Almost always eats food different than the rest of the family
- Will suddenly refuse a food they previously preferred and never eat it again
- May only eat with distractions like a tablet, TV, or toys
The SOS feeding approach has a great printable here of the differences between picky eaters and problem feeders, and it includes some of the characteristics on this list.
How to Help Children With Food Aversions or Extreme Picky Eating
Please keep in mind that the lists above are just guidelines and if you aren’t sure where your child falls or you feel confident they are an extreme picky eater, consider having a feeding evaluation (click that link for how to set it up in your area). Usually, that is completed by an occupational therapist, like myself, or a speech therapist. If your child is under 3 and in the states, you should qualify for a free evaluation.
I will say this, the one piece of advice that will not work with an extreme picky eater and that you will never see here on Your Kid’s Table is to serve your kid what you’re eating and they will eventually get hungry and eat. This is a huge myth and many well meaning people love to dispense this advice: Moms, Grandpa’s, neighbors, and friends that haven’t had a child with sensory food aversions or extreme picky eating. Many kids with picky eating disorders will NOT eventually eat, they will end up in the hospital because they are starving.
Fortunately, parental instincts tell moms and dads this and they usually don’t try or give up on this approach quickly. That isn’t to say that picky eaters should be allowed to rule the roost, either. In fact, I believe there’s a few keys to create a balance between parents setting up healthy boundaries and kids being treated respectfully, all while helping them to eat more foods!
Want to know what they are? Then, grab a free spot in my free picky eating workshop for parents right here!
It’s perfect for helping you with the average or extreme picky eater!
More for Kids with Food Aversion Disorders and Extreme Picky Eating
What You Need to Know About Sensory Issues with Food
10 Extreme Picky Eating Red Flags that You Need to Know
The Most Amazing Healthy Snacks for Picky Eaters
Alisha Grogan is a licensed occupational therapist and founder of Your Kid’s Table. She has over 15 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.
Hi, my son is 9 and plays too many sports. He’s a picky eater and notorious fir skipping lunch at school. He gets migraines if he doesn’t eat often yet he still continues to do it his way. I’ve tried the techniques you mentioned but where he gets migraines it changed everything. Any advice? Thank you
Hi Ari! Thanks for reaching out! Check out this blog post with lunch tips, which can hopefully get him to eat lunch at school, and therefore will hopefully prevent those migraines! For more help with picky eating, check out our picky eating workshop!
Best,
Kalyn
Wow I’m happy I found this page, the feeding tube situation sounds scary! I feel like im starving my child, I hope we won’t need a feeding tube! We are definitely in the Extreme category, my toddler will be 4 this December and he only he’s maybe 1-3 foods if that a day and although I may have a list longer of foods I know he likes, it could be months and months between some foods he’s likes, he may like it one week then doesn’t touch it for a long time. So he’s only literally eating 1-3 food items a day in total. He likes milk, I do replace with Pediasure sometimes, then he likes apples strawberries, go gurt in a tube, bacon, apple gate chicken sausages, tortilla land tortillas, chicken nuggets, pizza, mozzarella sticks, string cheese, gold fish, pancakes, cookies, bbq chips, popsicles- This list sounds like junk but that’s it. 15 foods, but only will he 1-3 foods from his fav food list a day. So I feel like I’m starving my child, he won’t even try other food, he won’t put it to his lips at all. I guess I need to do 3 Pediasures a day. Any advise? My child is also speech delayed, he’s speaking on a 2 year old level. Maybe his delay goes hand in hand. He really can’t communicate with me. His vocab is less than 15 words. I just want to pull my hair out. Help!!!
Hi Nicole! Thanks for reaching out! We totally understand how difficult it can be- you are not alone! Definitely consult your pediatrician to rule out any medical issues and to potentially get a referral for an Occupational Therapist, who can offer hands on support! Also, we highly recommend our FREE picky eating workshop that offers additional tips and information to help with extreme picky eating. Save your seat here!
Best,
Kalyn
Hi!
I am a SENCO and i have been reading a few of your articles. I have a child I’m working with who is 4 and will only eat blended food if they are spoon fed. They do not feed themselves and will not eat any finger foods even at home with parents. The child has picked up a potato wedge and licked it, but that is all. I am struggling to support the parents and unsure how to approach the idea of seeing a specialist to check for sensory issues or other concerns. Id appreciate any advice you can offer!
Thank you for the help!
Hey Danika,
I’d really start to try to work on getting touching a variety of textures, doing sensory bins to get used to touching and food play (with crafts outside of mealtimes). Starting with this, can help work their way up! If you are having trouble getting her to touch any of these things you can discuss the sensory side of it at that point, so they can see concretely. Hope that helps!
Best,
Desiree
Your Kids Table Team Member
I am very concerned about my grandson. He will be six in a few weeks and will only eat certain chicken nuggets, tacos, certain pizza without cheese, pbj but you have to put peanut butter on one slice and jelly on the other slice of white bread, and steak. He devours candy, cookies and Cheetos. He throws a tantrum and is rewarded by being allowed to eat cookies or candy. He did not start out this way. When he started eating he would eat a wide variety of foods. It has gotten progressivly worse as he has gotten older. He has behavioral problems and is now on medication for ADHD.
Hi Dona! Thanks for reaching out! Picky eating can definitely spiral from an inconsistent feeding routine. We have a free picky eating workshop that can help with this! Check it out and save your seat here!
Best,
Kalyn
I’m at a complete lost! My son was born and had a lip tie and tongue tie that was not found until he was 2! He ate baby food fine and then stopped and started to refuse it. When they released his ties he started to talk! But he will not chew, or use a straw cup. I mean he has a complete cow trying anything else. You can tell he’s trying to chew but it hasn’t been successful because he just wants to swallow the food. He was eating mashed potatoes and apple sauce. Now he’s eating puree toast sticks and completely stopped eating the mash potatoes and apple sauce. I tried to expanded it so he had more then 1 thing but he cuts the other foods out. His food therapist is only concerned on his talking but my son says his whole Alphabet and can talk just fine. We aren’t sure what else to do, we both went through every website and source possible. We are so stressed out by this. When he does take a bite of his french toast we all are eating at the table and all cheer him on so he has some positive.
Hi Jean! Thanks for reaching out! We know how stressful eating issues can be. We definitely recommend consulting with your pediatrician if possible, since they can refer you to a feeding therapist for some hands-on help. Since he’s stuck mainly on purées, he may need help with chewing/swallowing. In the meantime, practice with some sensory and oral motor exercises by using sensory bins, food play, and allowing him to touch/feel/play with his food. Try using a toothbrush to brush the insides of his mouth before mealtimes. Other oral motor exercises include making silly faces, blowing bubbles, sipping from straws, and licking lollipops/popsicles. These exercises will help strengthen his oral muscles, which are what he uses to chew/swallow his food. You may also try demonstrating eating/chewing by having him watch you make the over-exaggerated motions, or even use toys to demonstrate feeding and having him practice feeding the toy. We also have a free workshop that can help with eating table foods- save your seat here!
Best,
Kalyn
Hello, my 7 year old has always been a good eater. From Spice, curry, lots of different flavours. She loves lots of food and is willing to try things. However all of a sudden out of the blue she has become “picky”. Won’t eat meat because it’s chewy. Wants everything a certain way. Doesn’t like the yogurt I buy only wants a certain type. Pls help. Why all of a sudden? Should I be concerned? I will admit I’ve been going about it the wrong way. Nagging her to eat and hovering over her. She is on the slighter side and I worry about her weight.
My four year old will only eat noodles with butter, popcorn, cheese tortillas, sometimes sandwhiches (only if they are cut into stars), sometimes sliced carrots, donuts or candy. She seems to only like extremely bland foods with almost no flavor.
Most days I spend the ENTIRE day just making meal after meal, trying to find something that she will eat. I have tried putting her in time out, taking away her kindle, even literally begging her to eat. If I list foods to her, she will not answer ‘yes’ or ‘no’. I just have to make them and see if she will eat them. If the smallest element is not EXACTLY how she wants it, she will refuse to eat all together, even the things that she likes.
Sometimes she will go DAYS without eating anything more then a cheese tortilla. She throws up sometimes because of it and there have even been a few incidents where she has gone completely pale and lifeless and I could not keep her awake no matter what I did. We just moved from another state right before the pandemic started so she does not have a primary care physician and I am scared to take her to a clinic because of COVID being so rampant in out state. The last thing that she needs is to battle an illness on top of everything. What do I do? I am so scared and desperate and I just don’t know what to do. Please help.
Hi Tina! Thanks for reaching out. We understand how hard this can be! Because of what you described with her sometimes appearing pale and lifeless, we would definitely recommend consulting with a pediatrician once you’re able to do that! Plus, a pediatrician could potentially refer you to a feeding therapist for some hands on help if needed. In the meantime, focus on making meals a positive experience by making sure there is no pressure put on her at mealtimes to eat. I know this might sound difficult, but once they feel that pressure removed, it can have a huge impact. It can be helpful to provide a preferred food at all meals, in addition to whatever the family is eating. This will show her that the entire family eats the same foods, but will make her feel comfortable having a preferred food available. Try to work on getting her involved with helping in the kitchen, to get her touching and engaging with the foods. This can be a really helpful step in moving forward. We have a free picky eating workshop that covers all of this and more- save your seat here!
Best,
Kalyn