Case Challenges

Picky Eating and Food Aversion, From Typical to Extreme

Katja J. Rowell, MD; Jenny H. McGlothlin, MS, CCC/SLP


April 04, 2016

Editor's Note:
This is the second part of a two-part series discussing the frequently encountered issue of picky eating in young children. This article emphasizes management strategies for families with picky eaters. Read part 1, on recognition and assessment of children who might be picky eaters, here.

The Picky Preschooler

Andrew, a two-and-a-half-year old, comes in for a well-child visit. His mother is concerned that he is "picky" and "too small." This is the second time you have seen him; his last visit was 6 months ago, for a mild upper respiratory infection.

Andrew was born at 37-38 weeks, weighing 6 lb 8 oz. His medical history is unremarkable. As a newborn, Andrew struggled with breastfeeding initially, but improved with support. Past growth data are missing from the record. His mother states that he has "always been underweight." His previous provider advised his mother to feed him whenever she could, to try to get him to the 50th percentile for weight.

Andrew drinks about a half-cup of PediaSure® supplement spread throughout the day. He whines and cries in his high chair, eating little at meals. He eats pouches of organic pureed food while watching TV, and eats a few other foods on the go. He does not vomit or gag, and his only sensitivity is to tags in his clothes. No red flags for significant sensory concerns are evident.

Andrew sleeps well and attends preschool, where he is social and happy. He had some separation anxiety initially, but that has resolved. He is described as "strong-willed" and resists help with such tasks as putting his shoes on, preferring to struggle on his own. There are no developmental delays.

He has one bowel movement daily, no gastrointestinal symptoms, and no signs indicative of allergy or atopy. His immunizations are up to date. The family history is negative for celiac disease or allergies, and is otherwise unremarkable. He is the youngest of two children and lives with both parents.

On examination, Andrew is found to be at the 25th percentile for weight and 50th percentile for height. The physical exam is unremarkable. He is socially appropriate and engaging. Andrew's mother is lean and tall, as is his older brother. Andrew lets you listen to his heart and lungs only after he has his turn with your stethoscope. Throughout the visit, he nibbles from a bag of crackers. His mother repeatedly holds a cup of PediaSure to his mouth, which he pushes away.


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