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.
What should I do when my husband is a picky eater as well?? He won’t eat any fruits or vegetables (does mashed potatoes count)?? When I serve my 2 children and husband vegetables for dinner, my husband makes a face and gags, so I believe that my children are following his lead. With my children, I have served sweet potatoes (for example) different ways – as fries, little squares, mashed, etc., yet they won’t even try 1 bite. I’ve even referred to sweet potato fries as “suntan fries” but that doesn’t work either. Got any advice? My husband also won’t eat rice, tacos, or salads too.
Hey Mary,
This is a common issue that we do hear about! I’d read over this article on parent picky eaters and have your husband read it as well. There are some tips, so maybe he can get on board or at least meet you in the middle so he’s not making faces in front of your kids 🙂 You can read about it HERE
Best,
Desiree
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Hi There, My son is 3 and a half years old. He eats around less than 5 foods, no fruit, no meat, no chicken, no veggies… although he used to eat chicken. I’m based in South Africa, please advise what I should do and who I should take him too? I have a suspicion it has to do with his tonsils… although I’m not positive. I know his tonsils is a problem though. Do I take him to a dietician?
A dietitian may be able to help, just make sure that they also are able to advise with feeding, not just nutrition. I’d also look into an occupational therapist, like myself, or speech therapist – as they can specialize in feeding.
However, tonsils can play a big role as well, and having a GI doctor look at him would also be helpful! I hope that helps!!
Hi Alisha, I have an 18month old. He hasn’t taken a morcel of food in the last four and a half months. He used to like his purees and transitioned to table foods. Me being an Indian, rice and vegetables are our staples. He would eat them too until one fine day when just said no and that was it. No amount of coaxing, distracting, pleading, luring has helped. He just wants milk all day. Have tried all varieties of foods that people generally offer to toddlers. Nothing has helped. Eats biscuits, plain cornflakes (no milk) and chips. Cucumber occasionally. Needs everything to be crispy. Doesn’t even touch any other food. His growth has slowed down. Height and weight much below average. Me and my husband end up fighting almost every other day. Pediatrician agrees that it is a form of extreme picky eating but unfortunately we get no help with that. Therapies for such issues is almost nonexistent here in India. Badly in need of help.
Falls sick so often. Hospitalization is becoming the order of the day. Please help
Hi Ashwini,
First off you are doing great!! You are reaching out for help and recognize there is something going on!! Let’s start off by having you complete our quiz on What kind of picky eater that you have!! This will help you put into a category and provide with some suggestions!
Best,
Desiree
My son is 10 and his eating habits seem to fall under extreme. He is a adhd, odd, mood and anxiety disorders. He naturally loves sugar and i have cut most of that back but he refuses to try new foods only likes things made a certain way. I have a hard time having a relationship because I get told my son is spoiled or picky or out of control. I really want the best but have no clue how to change him.
Oh Ashley, I’m sure this is so hard, and I’m sure you’re doing a great job. Any of those diagnoses are challenging and yet he’s facing so many of them. Most people don’t understand:( If you feel like picky eating is a major concern right now, one resource I have is the free picky eating workshop. You can watch it here.
We also have a sensory workshop, that is going to be bigger picture for all of his challenges. The link for that is here:
I hope that helps!
I’ve also heard my son is spoiled, I do get desperate and will give my child sugar foods just to get him to eat. But then I also think, I have 2 boys, completely different from each other… I’m the same mom to both. Kids are different, it’s not always just about the mom/ parent. I can completely feel your frustration, pain and anger… know it very very well. Good luck and a hug
My son is 7 and reading several articles from your website has confirmed to me he is not than “just a picky eater”. He only eats a handful of foods and discriminates againsy those (1 brand of nuggets, milk has to be from a sippy cup not open mouth, etc) and it’s only getting worse. Is he too old to see an earring therapist? Every day I stress that he isn’t getting enough nutrition
Absolutely not Amy! He’s absolutely old enough to go to feeding therapy. I’d look into that, but also check out my free workshop, I teach you three critical strategies that every picky eater needs to start eating new foods. You can sign up here.
What about a 9 year old problem eater? She has only recently come into my life, no one has ever worked with her on this and recognized it as a problem. Her list of foods is easily under 10 items and she is painfully thin. What are the chances of teaching her how to have a health relationship with food at age 9?
Yes, definitely! It may take a little bit longer, but it can definitely be done. I’d start here with my free picky eater workshop!
My daughter is 15 and I despair of her ever eating like a normal person. She still eats like she did when she was 5. Her pediatrician kept saying her taste buds would change when she hit puberty, but they never did. I’m at the end of my rope.
It’s not too late to look into feeding therapy, but you’ll have to look for someone that specializes in teenagers. I’d check out this post on feeding therapy, as well as my favorite book for extreme picky eaters.
I registered for the Alisha Grogan’s 2:00 pm webinar, but never received an email with the link.
Oh no Karen, sorry I’m just seeing this. Did you end up getting through?
Link to basic strategies to eating isn’t working. Would love to check it out if still available.
Fixed it Andrea, thank you!
My four-year-old son that has Asperger’s only eats cheese sandwiches with ketchup and a slice of cheese it has to be cut into tiny little strips with no crust. Not sure how to help him get to where he eats food again. He stopped eating all the foods that he seem to love after he gag or they tasted different.
Hey Sherece,
We totally understand where you are coming from and know how hard it can be! I’d work on trying to get him interacting and touching of foods to get him more comfortable around them, this can be very beneficial. We just recently opened up sign ups for our free picky eating video series, where we will be walking through where to start with picky eaters. I think it’ll be full of some great information for you! Sign up HERE
Best,
Desiree
Thank you so much for this post!!! I see it’s a few years old and I wish I had found it back then. My daughter got really sick on me when she was 11 months old with stomach issues for 3 1/2 weeks. I was told that it was probably a stomach virus that lingered in her because she was so young. She refused to eat baby food, or table food. All she wanted was her formula that lucky was soy based. She was not a picky baby before that and after that it was like she was tramatized, if we offered food she would go for it then before she grabbed it she would reacted with a sick look in her face and shake her head no, sometimes even have a phycial reaction like the shivers. Dr kept telling me it was her being picky and to just let her be that she will eat when she was hungry. I would try and after 1-2 days I would couldn’t stand doing it to her. As she got older she got worse, they told me to do the same thing and to be tough. I would try it and it was heart breaking having my 2 year old tell me “mommy I’m hungry” but not be able to eat what I laid out for her. I tried different shapes, sizes, bribes, treats, tough love, nice and compassionate and nothing worked. She only at 5-6 foods and at times would get sick of them herself from eating them so much. She was sent to get evaluated last year with a problem called birth to 3 that does therapy including feeding and they said she was to advance in everything else and didn’t qualify under the eating spectrum. They said I was doing great and to keep doing everything I was doing. That it was probably one of those times that I would have to wait for her to grow out of it. They felt so bad for me, they said because they felt like there was nothing else they could tell me to try that I had not done already. Since then my daughter started to have bowel issues. She couldn’t go for Day the most a week and a half and then would scream bloody murder then she would finally go these monster size movements. They finally sent her to a GI specialist in December of 2016 (she’s 3 now) and he’s telling me the same thing the pediatrician was. They have her on miralax and laxative to help her be regular and want her eating more. He told me to go “old school” and take everything she eats away and she “won’t starve herself” she will eat. I feel like a bad parent either way, because if I don’t do it I’m enabling her bad habits and it’s harming her system and if I do it she’s starving herself. For the past two weeks I have been trying the “tough love” and my daughter won’t eat. She cries constantly, I have tried everything from bribes with toys and food, being nice and loving to being tough and taking things away. Every fiber in my body is telling me this is doing more harm then good and after reading your article I was right. I’ve tried to force my daughter to taste food and she will cry for 20-30-40 mins and when she finally takes a bit she gags and throws up. She is literally starving her self and I’m scared to death she’s going to end up in the hospital. I’m so lost and glad I found your article! She’s has an evaluation with eating therapist the 22 of march and it could not come fast enough at this point. Thank yo again for this article, and the work you do with children and families!
Hi Darleen, I’m so sorry for the struggle you’ve been though. Its one I’ve heard so many times! I’m so glad she’s getting an evaluation, that should be really helpful.
Also, I’m getting ready to be offering 2 free workshops (they will be live) all about picky eating. I think it will be really helpful for you, you can sign up here
I highly recommend that you DO NOT take her foods away, as you’re now seeing. Its so hard when professionals tell you otherwise! I have a ton of info on here that I think will be really helpful, you can click start here to find more! Let me know if you have more questions or need more direction
Thank you so much I will definitely looking into both link. I gave her back the food the next morning and she’s been so much happier and has actually had a crazy appetite.. she’s trying to eat everything she can from what she eats. I am doing all the research I can do I can go in prepared and with information also to present to her pediatrician and her GI specialist. Thank you again for sharing all this information! I finally feel like I have answers and I was right that my daughter had something else going on then just a typical picky eater.
That’s wonderful Darleen! I’m so glad to here that, truly!!! I’d be cautious with serving the same food again, just so it doesn’t seem like punishment, but if its working then great! Let me know how everything progresses!
Reading through this made me realize we have gone beyond picky to problem with my 2.5 yr old autistic son. He will not eat any kind of dip or sauce, he will not eat rice or noodles or veggies… let’s list what he will eat, American cheese cut inton6 pieces, mini pancakes, peanut butter jelly sandwich but only if he makes it and no jelly ever leaks out whole, chocolate cake donut holes but will hold in his mouth for an hr at least, gummy fruit snacks, banana bit must be whole, clear liquids in sippy cup only, his special formula milk, cookies, crackers unless it breaks then it gets crushed, on occasion a bite of a dino nugget, randomly hashbrowns and scrambled eggs maybe 1x a month. That’s it folks.
Background lip tie, oral phase dysphagia, overactive gag reflex, acid reflux, allergies galore. All sorted by 18m. Ate normal and everything from 18M to 24m than stopped gradually accepting food to where we are now. Ot said not sensory based, speech said not mechanically based, aba said not just behavioral so now we’re lost:(
Oh my Kimberly, I totally hear you, I’ve worked with so many kids in similar instances, truly! To be honest, I’d get a second opinion and take a look at this post: 5 Reasons Kids Don’t Eat– you are familiar with a lot of these, but it may give you some new insights. I also have a comprehensive picky eating online course, that I cover everything you just mentioned. You can look at that here. Let me know if you have any questions!
Yes! This is what I hear all of the time when I tell someone about Liam only eating PediaSmart via bottle. They say, “I know how it feels to have a picky eater.” Well, yes he is picky but he also has other stuff going on sensory related and possibly behavioral related. He will be 2 next month and has JUST now started to put toys in his mouth. He will take pureed foods on a very rare occasion and sometimes a strawberry banana smoothie via bottle. We’ve been in OT since he was 13 months old and are trying to do more feeding therapy. He is being assessed for Autism as well. Any input on an inpatient feeding program like at Kennedy Krieger? I’ve heard good and bad and am wondering if this would potentially help my son. He has other developmental delays like speech and oral-motor for sure.
Hi Olivia, yes, you have your hands full. I have had treated kids like your little one. I think an inpatient can be really helpful, I’m not particularly familar with KK’s program. But, I know it isn’t for everyone. I know this is going to sound cliche, but it is true- what is your gut telling you? Get more info, a lot actually, take a tour if you’re able. If you don’t go that route, go to outpatient feeding therapy 2x a week, if you’re able to and have in-home 1-2x a week. These therapists need to be solely working on feeding. It’s fantastic that hes putting stuff in his mouth, encourage that often!
Thank you! Our OT that we have private is 100% focused on feeding. She went to a great training class and learned a lot of techniques to encourage him to do things with food. He will play with any texture and doesn’t seem bothered but it NEVER makes it to his mouth. On the occasion that he does put it at his mouth, we can’t see him do it or he will stop. We are working with the county program to see about getting some behavioral motivations for him but we shall see. He doesn’t talk either so that makes it hard. We’ve been tested for EOE and other things and all have come back okay. We are on the waiting list for KKI and shall see how that goes. Thanks for your input.
Hey, I have a just turned 3yr old preemie (3lb 9oz) at birth NICU 2 MONTHS.She has been hospitalized many times with respiratory issues,RSV and pnuemonias many times,with RSV, a NG tube feeding was a must bc she was starving n not eating or drinking.The last 6 months she has evolved into a problem feeder.She is on Zantac for Acud Refux meds but WILL NOT EAT AND STARVES,IM LOST AND SO SCARED THEY WILL RESORT TO A G OR PEG OR JG TUBE AND THAT WILL BE AWFUL,SHE ALSO SLEEPS SOOOO MUCH…..WHAT COULD THEY OR I BE MISSING…PLEASE HELP,ITS BECOME SERIOUS AS TO LIFE ALTERING/THREATENING.
Hi Melissa, I can only imagine how overwhelming this all must be, and I totally get it. Do you like the GI doctor? Do you feel comfortable with the plan in place? It sounds like you are covering all your bases from a medical standpoint. Here’s the thing though, once a child has had some very negative food experiences they get stuck in that rut and operate out of a place of fear. Is your child in feeding therapy? I would recommend that. I also have a program that might be helpful for you, you can check it out here: http://www.yourkidstable.com/join
Let me know if you have any more questions!
Hi Alisha, thanks for this informative article.
For further clarification, I’d like to understand what these numbers of food that kids eat mean.
Are these numbers based on a certain food or a dish prepared with it?
For example, my kids eat potato salad, baked potatoes and french fries, does that count as 1 food or 3 foods?
Or for example they love tuna pasta with pesto sauce, does that count as 1 food, or does it count as 3 foods (pasta, pesto sauce and tuna)?
My other questions is: what is then the definition of normal eater in terms of the number of items which I know is not the only criteria but still curious.
Thanks so much
Ahu
Hi Ahu, that counts as 3 foods! ANything that is different, no potatoes in general. I would try to expand on the pasta and maybe to the same pasta but with salmon or chicken or another type of fish.
You know I don’t have an exact number for “normal eaters”. My guess is, it would be over 40 foods. Don’t caught up there though. If you are over 20-25, your kids are doing great. Keep exposing them, keep it positive, encourage experimentation and messy play. Have them help you prepare food.
Sounds like you’re doing great!
I just found this site and I want to say thank you. My autistic son is definitely a problem feeder, but my youngest child, who is not autistic, is trying to follow suit. He constantly only eats the same food because we have to cook my autistic son a different meal from the rest of us. My youngest son ends up eating what my autistic son eats. It’s almost like youngest is learning from my oldest, and we are doing everything we can to combat this, but it’s really turning mealtimes into battles. I’m lost on what to do, but this advice really helps. Thanks so much
I understand that this is correct in some instances, but each circumstance is different. My 8 year old daughter is a problem feeder, but it is also self induced. She knows she don’t get away with it with me, however if mom is home she don’t eat anything she don’t want and she knows it. I can cook something for lunch when mom is gone and she will eat it with little to no complaining. I could make the exact same thing when my wife is there and she will gag before she even gets it into her mouth. If there are any people around she will make a complete spectacle of it. Yes I’m sure there are mental problems but just remember there is just the spoiled child also.
Hello, I just found this website and I would love to hear some type of advice. I have a 9-year-old daughter, she’s always been a problem eater but for the last two months it just got worst. She only eats French fries and soup (Mexican style). I am taking her t two doctor her regular pediatrician and another doctor in Mexicali. So far all the testing they’ve done comes out negative, telling me that is more mentally. Decided to take her for a psychological examination and is receiving therapy but she continues the same. She can last up to three days without eating telling me and crying over saying that even what she liked before grosses her out. I don’t know what to do, I am in a moment in which I am so concerned that I keep Reding articles trying to get more advice and haven’t been successful. I’ve been told that it might be something seasonal but this is moving on to three months, she only weighs 50lbs and its justo si overwhelming not knowing what to do. Whatever advice i can get will be great. Thanks!!!
Hi Maria, I totally understand how stressful this! I would highly recommend reading the book, “Help for Extreme Picky Eaters.” If you look in my menu bar you will see the article index. Click through there and look for a full review of the book.
Also, take a look at the eating basics tab, and start making those changes. Take a look at some of those resources and let me know if you have more questions!