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 two year old 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 (AFRID) 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:
- 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:
- 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
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.