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"They’ll grow out of it.”
“It’s just a phase.”
“Don’t worry, they’ll eat when they’re truly hungry.”
Sound familiar?
As a parent of a child who struggles to eat, these phrases might be ones you’ve heard before. Picky eating is a common part of childhood. So much so that over 50 percent of parents identify their child as picky at some point in their youth. Therefore, when a child’s diet starts to narrow or their intake dwindles, many can be quick to dismiss concerns about what or how much a child eats.
Yet not all picky eating is created equal. Traditional picky eating is a developmental phase that coincides with the change in children’s appetite, growth, and increasing maturity. It’s fairly common and, importantly, it’s usually temporary.
Extreme picky eating, on the other hand, tends not to spontaneously resolve and it’s often not a result of natural development. Instead, more severe picky eating is usually associated with underlying developmental delays or challenges.
This article will help you distinguish severe or extreme picky eating from traditional picky eating behaviors so you can determine how to best help your child learn to eat with ease and enjoyment.
Picky eating, traditional or otherwise, isn’t a diagnosable condition with concrete symptoms. Like autism, it exists on a spectrum of severity and there can be many presentations and etiologies.
Research shows that children with spectrum disorders are at a higher risk of feeding challenges and are more likely to experience extreme picky behaviors than kids who are not on the spectrum. Estimates suggest that about 50 to 75% of children on the autism spectrum have eating challenges that are more severe than those that the majority of kids experience.[1]-[2] Autistic kids are more likely to overly restrict their diets and have a harder time learning to accept new foods. Additionally, while most picky eating is transient, autism picky eating is persistent and often worsens over time.
It’s not surprising that kids with spectrum disorders might struggle to eat. Eating is one of the most complex activities that our bodies do. It involves the simultaneous coordination of our entire sensory system, muscular system, oral motor controls, and more.
While there is no definitive definition of extreme picky eating behavior, the following traits are more common in extreme picky eaters. See how many your child displays. The more they have, the more severe their eating behaviors may be.
As you read through the following list, you will also want to consider the duration of the symptoms you see and their evolution. For example, consider if a behavior is new, short-lived, or already well-established. Additionally, examine if symptoms seem to be resolving or are becoming more extreme.
Think about the number of foods that you eat. There are probably too many to count. Now think about the number of foods that your child eats. Can you fit them all on two hands? There is no idea or normal when it comes to diet diversity, yet an extremely limited diet can be a sign of eating challenges.
Dr. Kay Toomey, a pediatric psychologist who developed the Sequential Oral Sensory approach to feeding, proposes that most children - even picky ones - eat over 30 unique foods. Extreme or problem feeders, on the other hand, eat under 20 foods.
Having a limited range of safe foods puts kids at a higher risk of nutritional deficiencies and growth issues. Additionally, it makes everyday life, like visiting a restaurant or going to a friend’s house, challenging.
In my experience as a dietitian who works with extreme picky eaters, a very limited diet is a trait that almost all of the children I meet share. Most eat under 10 different foods.
Take notice of what your child eats over the course of a day or two. Are they consuming fruits, vegetables, dairy, protein, and grains? Barring food intolerances or allergies, a balanced diet ideally includes foods from all food groups, yet many super picky eaters eat from only two or three food groups. Vegetables are tend to be the least preferred. They are often the trickiest to manage from a sensory perspective and some kids dislike their bright colors and potentially bitter taste. Protein foods are also notoriously challenging for kids who struggle to eat.
Restricting an entire food group is a trait that can distinguish extreme picky eaters from typical picky eaters.
Do you notice any patterns when you take a look at your child’s diet? Extreme picky eaters often prefer foods that share similar sensory qualities, such as color, texture, and/or temperature. It’s not unusual to have a preferred texture or to enjoy savory foods over sweet, but excluding foods that do not fit within these parameters can be a sign that your picky eater’s behavior is on the severe end of the spectrum.
Extreme picky eaters are more likely to eat alone than traditional picky eaters. This can be because they cannot tolerate being around non-preferred foods or because they have trouble experiencing other people eating. The sounds and smells that come with shared mealtimes are sometimes just too much. Rather than endure an uncomfortable mealtime that could further impede intake, many extreme picky eaters become accustomed to eating on their own.
There’s no need to worry about a child who sometimes eats on their own. It’s when a child is unable to eat with others that you might want to consider seeking treatment. Eating with others is an important experience with tremendous social benefits. Plus, eating with friends and family can also help children to expand their diets.
Because of their myriad of restrictions and sensitivities, extreme picky eaters tend to eat different foods than the rest of their family. Parents often report cooking more than one family meal, which leads to stress and additional time in the kitchen preparing and cleaning. As most picky eaters can find at least something to enjoy in most situations, this can be a sign of extreme behavior.
Food flexibility is something that many autistic extreme picky eaters struggle to embrace. Most traditional picky eaters can handle a variety and variability in their food. They don’t stress about inconsistencies. For example, many picky eaters may not love potatoes but willingly eat any type of french fry. This is often not the case for more extreme picky eaters.
Many extreme picky eaters struggle to welcome new brands or different preparations of food. This makes eating out at restaurants or traveling extremely difficult. Additionally, many with spectrum disorders and eating challenges require specific rituals, such as a certain environment or particular plate, when eating. This sort of rigidity puts them at higher risk for food burn out and nutrient deficiencies and just makes the everyday act of eating even more challenging.
If you’ve gotten to this point and alarm bells are going off...
Don't worry!
The first thing to remember is that eating habits are always evolving, especially for kids who go in and out of growth spurts and experience changing taste buds.
Second, keep in mind that there is no one specific definition for extreme picky eating. You’re not receiving another diagnosis. Instead, this article is simply providing information that will allow you to better understand how to help your child.
1.) Continue to serve formerly preferred foods
Formerly preferred foods are any foods your child used to eat and has since started rejecting. Think of anything all the way back to first foods up to the foods they most recently started rejecting. You can serve these in small portions the same way they were used to eating them or change up the presentation a little.
2.) Offer tiny portions of new foods
Small portions are key. You might want to start as small as a penny or even tinier - the size of a grain of rice!
Additionally, you can give your child a choice about the foods you’ll serve: which food do you want to work on? Which size bite do you want? Try to only offer two options for them to choose between.
3.) Expose your child to non-preferred foods, even if it’s just the ones that you’re eating
Don’t isolate your child from non-preferred foods even if they’re uncomfortable being around them. Exposureis crucial for learning to like new foods. If they can’t tolerate a non-preferred food on their plate yet, you can always place them on the table or ensure that they witness you or other family members eating a variety of foods.
4.) Involve them in food-related activities such as gardening, grocery shopping, and cooking
This goes right there with exposure. The more a child experiences new foods - especially in a way that engages all of their senses - the more comfortable they will be ultimately eating new foods. Cooking with kids, grocery shopping, and gardening are all effective for creating new food exposures and positive experiences with new foods.
If you suspect your child is experiencing extreme picky eating behaviors, it is best to bring your concerns to your pediatrician or other medical professional. You can also consult with a feeding therapist, usually a speech or occupational therapist, or a registered dietitian. Look for someone who you feel comfortable with and who understands your child’s unique struggles and needs.
References
[1] Ledford, Jennifer R., and David L. Gast. "Feeding problems in children with autism spectrum disorders: A review." Focus on Autism and Other Developmental Disabilities 21.3 (2006): 153-166.
[2] Schreck, Kimberly A., Keith Williams, and Angela F. Smith. "A comparison of eating behaviors between children with and without autism." Journal of autism and developmental disorders 34.4 (2004): 433-438.
Jennifer Friedman, MS, RD, is a registered dietitian who specializes in extreme picky eating.
Known for her playful and approachable style, Jennifer has become a leading resource for parents and professionals working with children who struggle at mealtimes. Jennifer works directly with families to improve and expand the diets of young picky eaters. She shares her insight on her website and blog, and on social media @autism.nutritionist
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