Case Challenges

Picky Eating and Food Aversion, From Typical to Extreme

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


April 04, 2016

Feeding-Related Phobias

Courtney's case describes phagophobia (fear of swallowing), and qualifies for a diagnosis of avoidant/restrictive food intake disorder with an aversive event. Rarely, children develop a similar picture after a vomiting episode. Rapid referral to qualified mental health professionals who can work with Courtney and her parents, is critical.

Harriet Kohen, LICSW, past president of the Minnesota Society for Clinical Social Work, specializes in the treatment of children with anxiety and phobias. She summarizes her approach as follows: "Begin with a complete history, including talking with the girl, getting a sense of the event as well as general mental health and anxiety levels. We would identify what she could eat and begin small exposures to those foods, with parents' cooperation. We would also address energy and sleep. Cognitive-behavioral therapies (CBT) around thoughts and feelings can also be very helpful. Most important is creating positive expectations while building on therapeutic rapport with the client and the family."

As with other feeding and eating challenges, the evidence base for a "gold standard" approach is missing.[15] With this in mind, referral to a mental health provider with experience in treating children with anxiety and phobia is the first step.

Follow-up: Courtney

Courtney was able to see an experienced psychologist. She and her parents identified safe foods that she is able to eat. Her sleep rapidly improved, and her weight loss stabilized. After three weekly sessions, including CBT exercises at home and relaxation techniques, she was gaining weight and able to eat increasingly challenging foods.


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