Picking Apart Picky Eating, Part 1: Selective Eating in Children

“Try it–you’ll like it!” It’s something children and toddlers hear a lot. Most kids go through phases of picky eating, sometimes even fairly extreme. Mostly, this is part of normal development. From an evolutionary standpoint, where not all foods were safe to eat (especially combined with a young child’s desire to put everything they can possibly find into their mouths), it’s probably not always a bad thing for little kids to be cautious when it comes to eating. By the time they generally become more willing to try new foods, they have a little better sense of what’s safe and what’s not. This is combined with the general trait of being adventurous and open-minded.

In recent years, psychologists and researchers have begun paying attention to selective or picky eating. This increased awareness has been, in part, due to the recommendation that picky/selective eating be included in the Diagnostic and Statistical Manual when it persists for an unusually long period of time. Most of the time, children outgrow their picky eating phases. But for a small subset of this population, the selective eating or food neophobia persists, even into adulthood.

It’s not a disorder that’s discussed as much as anorexia and bulimia. But for those who have this disorder, it can put a tremendous damper on psychological, social, and occupational development. So I thought I would do two blog posts on selective eating: one in children, and one in adults. To start with, I’m going to discuss picky eating in children.

The young picky eater

To start with, I’m not going to be discussing the normal food fads of toddlerhood. For one, they’re not disorders (however frustrating they must be to parents). For another, that’s not really my area of expertise.

So what exactly is picky eating? And how do you distinguish “normal” picky eating from the more problematic type?

Researchers have developed three different sets of criteria, below. In terms of doing the best job of capturing problematic picky eating, I think the middle and right-hand criteria do the best job, although I’m not sure that there has been much in the way of validation, especially since selective eating isn’t well-defined.

picky eating children

Initial studies of picky eating in childhood found that patterns of inhibited or selective eating began shortly after birth, while the babies were still breast or bottle feeding. Female picky eaters generally ate fewer calories between ages 3.5 and 5.5 than their normal eating counterparts, and parents of picky eaters reported more overall negative moods in their children (Jacobi et al., 2003).

A 2008 follow-up study by some of the same researchers concluded, however, that picky eating wasn’t an eating disorder per se. Instead, it appeared to be associated with a broader range of problematic behaviors (Jacobi et al., 2008). A study of 426 children between ages 8 and 12, as well as their primary caregivers, found that approximately one in five children in this age group were considered picky eaters by their parents (rates were equal for boys and girls). Although measures of height and weight were similar between the different groups, other characteristics showed distinct differences. Mothers of picky eaters said that their children ate a more limited number of foods, required special preparation of foods more often, showed a lower acceptance of new foods, were more inhibited about food, had more parent-child struggles about food, and expressed special food preferences more often. Children who were classified as picky eaters also had higher levels of internalizing (turning anger inwards) and externalizing (turning anger outwards) behaviors. The authors concluded that picky eating seemed to be more of a symptom of a larger behavioral or psychological problem in these children rather than a problem in and of itself.

The genetics of childhood picky eating

Whether picky eating is one aspect of a larger problem or a stand-alone disorder

I got the idea for these blog posts by stumbling across a study on the genetic basis of food neophobia in children (aka selective eating). Besides sounding more highbrow, I think the name “food neophobia” is perhaps a little more descriptive of what is going on in children with these symptoms. These kids aren’t gourmands- they have a very limited range of foods that they will eat (usually highly processed, high fat, high carbohydrate foods) and a marked fear of expanding their range of foods.

Researchers recruited 66 families with same-sex twins to participate in a study about food neophobia in childhood (Faith et al., 2013). The parents completed a variety of questionnaires about their feeding style, food environment, their child’s eating habits, and other psychological factors. The parents and children also completed a lab study of a sample meal. By comparing how many twins both had picky eating, how many didn’t, and how many twin pairs had one picky eater and one regular eater, the researchers could determine the relative effects of genes and environment.

Basically, if picky eating were 100% genetic, then identical (monozygotic) twins would always be either both picky eaters or both not, since they share the same genes. Similarly, fraternal (dizygotic) twins would be both picky eaters or both not 50% of the time, since they only share half of their DNA like normal siblings. If picky eating were 100% environmental, then monozygotic and dizygotic twins would have the same proportion of both picky eater pairs and one picky eater and one normal eater pairs. Math helps the researchers figure out exactly how much genes and environment contribute to a particular condition.

For picky eating, the researchers found that, in this population, picky eating explained 72% of the variation in picky eating. What that means is that approximately 72% of the variability between normal and picky eating in these twins was due to genetics. Other factors were related to environmental factors, including the different ways parents tended to respond to each child.

Conclude the authors:

The present findings have implications for health professionals and parents. First, our results underscore the important role of ‘nature’ on young children’s tendency to avoid new foods. This information may be valuable to parents who believe that they alone ‘make’ their children food neophobic through ‘bad parenting.’ Pediatricians may be in a unique position to disabuse parents of such beliefs, which discussing strategies to encourage acceptance of new foods.

Julie O’Toole from the Kartini Clinic shares her thoughts on childhood selective eating here that are worth reading.

Without treatment, more severe forms of picky eating tend to persist into late childhood, adolescence, and beyond. Concludes one prospective study of children through age 11 (Mascola, Bryson, & Agras, 2010):

Parents of picky eaters were more likely to report that their children consumed a limited variety of foods, required food prepared in specific ways, expressed stronger likes and dislikes for food, and threw tantrums when denied foods. They were also more likely to report struggles over feeding, preparing special meals, and commenting on their child’s eating. Hence, picky eating is a prevalent concern of parents and may remain so through childhood. It appears to be a relatively stable trait reflecting an individual eating style.

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18 Responses to “Picking Apart Picky Eating, Part 1: Selective Eating in Children”

  1. Very interesting. I am blessed to have children who will try just about anything. However, my younger child has Asperger’s, and has recently (within the last year or so) developed sensory issues around food and his body- specifically, he gets anxious and uncomfortable when his belly feels “full.” I do not think this is the same thing, but it results in the same thing- losing weight, conflicts around food, stressed out parents- as we try to get him to keep eating.

  2. Carrie,thank you for this.I am the mom of a picky eater(9 years old)who was recently diagnosed(Sept.2012)with an ED after a choking incident.She developed a food phobia and her selective eating came on full force.She is being treated by an ED specialist and an OT.I am determined to find out more about her illness and have been finding pickiness in children more and more common.By the way I am bontoplen on ATDT and I follow you here and there.

  3. To treat or not to treat, that is the question–Dr. O’Toole at Kartini does not treat if the growth charts are normal.

    Would be interesting to hear how/when/why this is treated as a disorder, or accepted as normal human variation in eating behavior.

    • In response to Anne I think when it is interfearing with daily life then it should be treated.My daughter was never underweight and always in the 90-95 percentile but it affected her health,she was basically living on junk food, no meat,no veggies,could not go to friends houses for more than a few hours because she would not eat there,I would sometimes make her 3 different dinners so she would eat.Her dinner choices were spaghetti or frenc fries.

    • Bonnie’s response would be what I would use to treat picky eating: when it’s interfering with health or general functioning. It depends to some extend on the degree of selectivity, what foods are acceptable, and what other co-occurring conditions might exist. For instance, kids on the autism spectrum generally have a lot of sensory/textural issues, so those also need to be taken into consideration.

      But some people are just naturally going to be pickier, and I think it’s important not to over-pathologize people whose preferences aren’t really impacting their lives.

  4. A great read! I got so many information in one one article. Thanks for sharing this.

  5. Great that this issue is getting more attention. As a childhood feeding specialist, I think those working with EDs need to get ready for many more adults with SED. While the feeding challenge is helpful to understand, be it genetics, sensory, oral-motor, GI pain etc, I think that what is missing from this discussion is the role that the feeding relationship plays. I work with many clients who are “feeding clinic failures,” well to be clear, I work with the parents in a parent-centered approach. I am seeing more and more children with feeding challenges undergoing various therapies that may not help, and at the most extreme, I believe cause great harm. http://www.huffingtonpost.com/katja-rowell-md/when-feeding-therapy-becomes-aversion-therapy_b_2951294.html Parents often feel so tired of fighting, or trying to “get” the child to eat more volume or variety. They tell me they are tired of fighting and just give up and serve the few favored foods.(The responsive feeding literature and literature on feeding dynamics tells us that all the fighting and pressure is likely to stall progress and may perpetuate and worsen the initial feeding challenge.) There is a whole lot parents can do to support children with selective eating. Also interesting from the parent’s point of view is a blog called Mealtime Hostage where the mother is learning that reducing anxiety and restoring trust are key to helping children progress at their own pace. I’ve been doing a lot of outreach to ED professionals about some of the harmful ways parents are told to address this issue, and that there are better ways. Glad to see this discussion happening!

    • In response to Katja,I am the mom of a 9 year old extremely picky eater and I wanted to say thank you for understanding.I can’t tell you how many times her pediatrician told me to keep trying she will eventually eat,Ha!She is a little better now,we have been working with some pretty great professionals but I do worry about the future.I think this has unfortunately become more common.I have been in contact with 3 other families who have the same problem.People just don’t understand that this is real,not just a spoiled child,my daughter can’t eat new things,underlying anxiety issues prevent her from eating.I am commited to helping her to recover and to make sure the medical community and public know that this is a real problem!!

      • Bonnie, I’m so sorry this has been such a struggle and that you haven’t been well supported by your doc. This problem is increasingly common. I do believe there is hope for you daughter, and encourage you not to think that she “can’t” do these things, but that she isn’t doing it yet. I go into this in detail in my book Love Me, Feed Me, which I don’t want to just promote here, but there is hope. Mealtime Hostage online is also a great resource. Helping her feel trusted, and not pressured, and addressing her anxiety can help over time. Please don’t give up. Focusing on her anxiety and addressing the mealtime attitude is the first step. Good luck!

  6. Great post. When my son was 3 we tried the whole “he’ll eat when he gets hungry enough” approach. After 4 days of him eating absolutely NOTHING because he didn’t want what I was offering, I called my pediatrician in tears and told her I couldn’t go another day like that. For years I had been told that my child will grow out of it or that I am not a short order cook and he needs to eat it or go hungry I was so relieved the first time I read Julia’s article about SED. Her article described my son to a tee, like she wrote it while looking at his dinner plate. I actually sobbed while I read it because it gave me hope and let me know I wasn’t doing anything wrong with my son. I’ve recently read some other articles that suggest that many people who deal with SED also have mild Aspergers symptoms and/or mild OCD symptoms. My son definitely has some of those tendencies though not high enough on the scale for a diagnoses. It is just such a relief to start seeing more posts acknowledging that this is real. And selfishly, it is a relief to have research to back up that this is a real issue not a poor parenting issue.

    • My son is almost 15 and is still eating a handful of “kid foods” that he has been eating since 2 years old, I’ve tried everything to get him to expand his food selections. He absolutely refuses to try a new food. Social situations are difficult and also has mild aspergers characteristics. He also refuses to admit that his eating habits are different and he says it’s everyone else that has gross eating habits. How do you change what you don’t admit too?

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  8. I have a 20 month old who has been picky since he started solids. At first he liked only fruits, veggies and cracker type foods, along with milk.
    Over time he has stopped eating all veggies and now all fruits except bananas. He will still eat any variety or flavour of those puréed baby food squishee pouches.
    I honestly don’t remember the last time he willingly tried a new food. We offer him everything we eat. And yet he refuses it all and even his small list of food he will eat keeps getting smaller. I’ve also noticed he’s getting more aware and upset when his hands get ‘dirty’ with foods and it stops him from eating what he touched. I don’t know where to turn or what to do. My Pediatrician said to starve him out and he will eat eventually. My husband said we can’t afford a potential help I have found, so we should just starve him. I feel this is cruel, and not the answer to my sons problem. I’m worried for his long term health and development as well as for my marriage which is strained due to this issue.

  9. Claudia please first let me say I am not a doctor. the following is just my opinion. My daughter has selective eating disorder,she is now 11.She ate everything as a baby.When she started on regular food I noticed some pickiness,no biggie I thought,all kids go throught this.At 3 she announced she would no longer eat meat,yea at 3.Things got extremely bad for years.Please do not starve your child,In my expierence it wont work,My daughter went 2 weeks on only broth,she cried day and night,mommy please help me I am so hungry.I know others too that will tell you it wont work.Your child is not doing this for fun,as mine wasn’t.They cannot physically try new things.Your is so young so I would never presume to tell you what to do.I can say there is tons of help out there,my daughter now eats meat,veggies,all kinds of things.No child would ever willingly starve themselves.Please feel free to call me if you would like to talk 267 987 0100.I am in P.A.eastern time.

  10. hi bonnie,

    i just came upon your site and just read your last posting and i am extremely curious about how you got your daughter to eat. my son, also 11, has sed – he eats mostly carbs, certain cheeses, and definitely no veggies or fruit or meat of any kind. this also started around 3 years old – up until then, he ate everything. he is unwilling (unable) to try anything new. we have tried the ‘no pressure’ route, and of course, the ‘lots of pressure’ route but nothing seems to work. wondering how you got her to try new things. we live in new york city and i feel like there must be someone here who could help but i don’t know where to look. would appreciate any help!! thank you!!

  11. Jennifer, email me at bonnietoplenszky@yahoo.com and I will give you my number so we can chat!