Case Challenges

Picky Eating and Food Aversion, From Typical to Extreme

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

Disclosures

April 04, 2016

Typical vs Extreme Picky Eating

The following lists generalize the differences between typical and more severe picky eating, but remember that many characteristics exist on a continuum, making diagnosis challenging. Clinicians may find it helpful to ask parents to video a few minutes of a feeding or meal to provide a sense of how mealtimes are going.

Typical picky eating usually involves the following:

  • Often starts around age 15-18 months;

  • Usually resolves by about age 5 years;

  • The child has favorite foods, but can make do with other options;

  • The child is upset if not given a favored food, and may whine or fuss briefly; and

  • The child has a preference for carbohydrates.

"Extreme" picky eating is more likely with these characteristics:

  • Begins with the introduction of solids, or earlier;

  • Often associated with medical, anatomical, or developmental challenges;

  • The child may be inordinately fearful or anxious around new foods;

  • The child prefers carbohydrates and may avoid entire food groups, most often vegetables and meats;

  • Associated with sensory processing diagnoses, anxiety, obsessive-compulsive disorder, or autism spectrum disorders;

  • More likely to involve nutrient deficiencies (such as iron);

  • More likely to involve falling off of the growth curve, or even losing weight;

  • Growth may be normal;

  • Associated with marked mealtime conflict, behavior challenges, or parental anxiety; and

  • May involve psychosocial impairment related to eating.

Don't be fooled! Even typical eating in young children appears erratic. It is normal for young children to have strong food preferences, prefer carbohydrates, and cry or try to get a parent to serve a favorite food. Help parents understand that after 12 months of age, as growth slows, intake and appetite can diminish. Young children may eat little for a given meal or snack, but intake tends to even out over the course of a day or a few days. Anticipatory guidance helps parents avoid unnecessary worry and inappropriate intervention.

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