Picky Eaters: Pathological or Just Particular?
Filed under: Nutrition: Health, Behavior, Nutrition: Toddlers & Preschoolers, Nutrition: Big Kids, Nutrition: Tweens
For picky eaters, there can be no food substitutions. Illustration by Dori Hartley
Harrison Bloom, age 5, will eat macaroni and cheese only if it's Kraft brand. A friend's mom once resorted to pulling the iconic blue and orange box out of the garbage as proof. Relieved, he tucked into the day-glow orange heap with gusto.
"Harrison's a typical picky eater in that the foods he will eat are starch foods [and dairy]," says his mother, Californian Toni Bloom, a registered dietitian (and no, the irony is not lost on her). "So we do lots of grilled cheese, cheese toast, bagels and cream cheese, cheese quesadillas," she says in a phone interview with ParentDish. She also has 3-and-a-half-year-old twin boys.
The morning of the interview Bloom served a new food to her sons: mini bagels from Trader Joe's. This was a departure from the regular-sized bagels she usually serves. Harrison refused to eat one, "because it was a differently shaped bagel," says Bloom.
She admits she bought the mini bagels knowing he'd have an issue with them. Through her own research, she came upon a treatment philosophy that made sense: offer variations of foods the child already eats. "One small tweak," she explains. "A slightly different colored cheese than the Havarti white cheese. It's this painful, thoughtful [process]. You have to think this through. 'Let's see. What's one degree different than that?' And who likes to do this? I'd rather short-order cook."
Bloom is on to something. According to Dr. Brad Riemann, Clinical Director of the Obsessive Compulsive Disorder Center and Cognitive Behavioral Therapy Services at Rogers Hospital in Wisconsin, one of his center's most successful treatments, mirrors Bloom's approach. "We apply strict, graduated exposure therapy to this problem. We spend a lot of time with the child and sometimes their family developing a food hierarchy. We get an idea of what they can eat and then we develop these hypothetical challenges -- exposures -- to try to spread their wings a little bit."
There's no official diagnosis called "picky eating," as it's often a symptom of a larger problem, says Riemann in a phone interview with ParentDish. "Some picky eaters we see in our facility have Obsessive Compulsive Disorder (OCD), meaning they may be concerned for example, about contamination -- who touched my food, who prepared it, what germs might be in it ... Another child may significantly reduce his or her food intake and what they eat, just like this person with OCD, but they don't care about germs at all. They're concerned, say, about the fear of choking. Their fear is so intense they only drink soup broth and malts."
Another cause is Sensory Processing Disorder, which involves sensitivities to texture, smell and sight.
When dealing with a finicky eater, "It's a matter of being flexible," says Long Island mom Cristina O'Keeffe in a phone interview with ParentDish, although she admits to having good days and bad days when dealing with her elder daughter, age 4-and-a-half: "I have times when I'm open and creative ... and there are days when I'm rushing and I'm frustrated and I'm chasing her around and I'm like, 'I'm only asking you to eat three pieces of an apple.'"
How can a parent tell the difference between generic picky eating and something more serious? According to Riemann, "When it interferes with the child's life: Children going over to other people's houses, friends' houses, sleepovers, and they can't eat anything."
"There seems to be a sincere, true, anxiety fear-based problem about how parents" try to address picky eating in the child's early years, says Riemann. "I'm clearly not saying it's the parents' fault by any stretch, but when [picky eating behaviors] start popping up they don't seem to be very significant [so] parents say, 'Well, OK, if Johnny doesn't like that food let's not go there. We'll pick and choose our battles.' So they give up a little bit of ground ... Johnny pushes back a little bit further and they give up a little bit more ground and the next thing you know, you may have a problem on your hand."
Riemann explains why this happens: "Part of it is because we care about our kids, we want our kids to be happy. Part of it is, do we really want to be going to war again at the dinner table? And part of it is that preparing food these days is so much easier."
Yes, convenience foods have made things a lot harder -- for parents of picky eaters that is. Once upon a time parents told their children to eat what's being served or else go to bed hungry. This was before microwaves and two-minute enchiladas made it easy to cater to individual tastes.
O'Keeffe tries not to fall into the trap of preparing separate meals for her two daughters, but does take advantage of prepackaged foods: "I will offer them an easy thing I can grab out of the pantry," she says, listing items like fruit, yogurt, cereal and cheese sticks. "But I won't make them another meal. That's not going to happen."
Riemann's suggestion to parents who suspect their child is a picky eater but without pathology is to be firm but reasonable. He also recommends using rewards when necessary. And no, he doesn't consider that a bribe. "There's a big difference between bribes and reinforcement," he says. "Reinforcing your children and providing rewards can be a key role in this. For example, you can tell your son if he tries a little bit of this cutlet he can have extra time playing video games or an extra book at bedtime. Those kinds of things can be powerful for children and can sway their decision."
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ReaderComments (Page 1 of 3)
1-06-2011 @ 2:18PM
charlotte7224 said...Sorry, but waaay off base!!! DO NOT offer rewards.....kids aren't stupid, & will manipulate you til you want to jump out the nearest window, & they'll win the battle anyway. Yes, it is a battle, & one you won't win! Speaking as a former very picky eater, & the parent of a picky eater,( I could count on 1 hand the food items he'd eat) I will tell you this....leave them alone! They will not starve themselves, & they will be OK. Make as little fuss as possible, treat them normally, & treat them no differently than you would the other family members. Yes, its a pain, but worth it. Whatever they do eat, in my son's case, as stated, starchy foods,White bread, pasta, rice, certain cereals, (although no potatos) certain fruit, bananas, certain type of apples, grapes, yoghurt, certain brand & flavor, & certain cheese. & milk, (Vit D only) No meat, no veg, no butter, just the items mentioned, so I made sure they were the healthiest options possible, & made sure he had a good multi vitamin. He ws born 2 mths premature, he is mildly OCD, (with other issues) I DID NOT keep cookies, candy, chips etc in the house!!! Junk food was definitely out!!!
Today, he is a healthy 21yr old, 6'6'' successfully graduated HS, & living alone, & doing well.& to all the "doom & gloom" brigade who urged this & that, (from spankings to withholding, force feeding etc) he now eats a wider variety, including some meat. And does his own shopping, pretty healthy.
In my quest to help him, as a child I did a lot of research, one thing I noticed, he didn't taste things the way we did, & although not proven, I do believe that it is possible that certain disorders, & disabilities affect the senses, sight, smell, taste etc. My gut feeling was to leave well enough alone, as long as he was healthy & thriving why create more of a problem? He was sick less often than the rest of us, had just as much, if not more energy, & in all other respects, normal.
Enjoy the positive, & let them grow out of it at their own pace, be assured, eventually, they will!
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1-14-2011 @ 1:35PM
Jessica said...Thank you for your comment it was very encouraging. My son is 6 years old and eats the exact same things as you described. We have added a multivitamin with iron to his diet (in the evening)because it is beyond me how anyone can survive on what he has limited himself to. I feel trapped between encouraging him to try something new and pushing him too hard and turning him further away from the food. We eat at the dinner table and eat family style so it's not like the food is not offered and readily available. His 10 year old sister eats just fine.
1-06-2011 @ 2:27PM
Alicia said...I understand that parents don't want t fight every night at the dinner table, but my grandmother did dinner the old fashioned way. You ate everything on your plate or you sat at the table all night. If you were hungry later, you went hungry because you didn't finish dinner. She babysat my neighbor with me and he was the pickiest eater I ever met. Trust me, that didn't last long. It's probably not the right way of going about breaking a picky eater, but it sure as hell works.
Though probably not with a phobia or OCD. Compulsions are general stronger than even hunger.
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1-06-2011 @ 8:29PM
dougalcandy said...My daughter is a picky eater. From the time she was about 4, she ate only macaroni and cheese from a box, soup from a box, ramen noodles, scrambled eggs, pizza, spaghetti, and in later years, penne a la vodka. Chinese food, only plain Lo Mein. She is now 19, and still eats only the foods I listed above. Oh wait, she's added Rice a Roni. We tried to work on this for years, I always made a healthy dinner, she refused to eat any of it. When she was 7 I told her I was not running a restaurant and if she didn't want what the rest of us were having, she would have to make it herself. Didn't faze her, to this day, if she is eatiing with us, she makes her own plate of mac and cheese. She has missed out on sleepovers and school trips, can never find anything to eat at a BBQ except for hot dog rolls, and still refuses to try anything new. She's always been healthy, and growing up the pediatrician never thought it was a huge issue, but now she is finding out that her friends aren't willing to accomodate her eating habits, and many times she doesn't go out with them if they are going someplace she can't eat. Was hoping peer pressure would work, but so far it hasn't.
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1-08-2011 @ 10:35PM
Jane said...Unfortuantely, you created your daughter's problem by allowing her to get away with it. As you stated, she's learning that her friends aren't going to put up with her behavior and she's 19. Guess what? The older she gets, collegues aren't going to be toleratent either and god forbid she had to particpate in a business dinner.
Your daughter needs to grow up and YOU have to acknowlege that YOU are the root of it cause you allowed it to happen.
1-06-2011 @ 9:13PM
Nancy Peske said...If a child has sensory processing issues, picky eating can be a huge problem. He might not notice how hungry he is and may avoid food for days. the anxiety over food that is perceived as repulsive in smell, taste, or texture can be unbelievably strong.
That said, many moms of sensory kids will tell you that self-limiting to dairy and wheat/gluten foods is a HUGE red flag for gluten-casein-intolerance. A GFCF diet is difficult to implement but can be incredibly helpful if a child is truly intolerant of these foods (and yes, they crave the very foods that mess up their bodies!).
See sensorysmartparent dot com if you want to know more about SPD.
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1-08-2011 @ 10:48AM
Heather said...I was a picky eater and so is my son. I do not cook special meals ( my ex does though grrrr). He eats what is cooked or he can wait til morning. He eats meat, breads, dairy, bannanas and carrots. He gets tomatoes from his spagetti sauce so i try to sneak a couple veggies in there but he notices the different taste. I think part of the issues with him is texture.
He does have to have a no thank you bite of veggies. Usually he ends up wrapping everything in a peice of bread so he doesn't have to taste it but I don't care how he eats it as long as it is eaten. Another tick I have tried is ketchup or honey. He will eat more veggies if he can have a bit of honey with them.
I have tried to get my son to take vitamins but he doesn't like candy so he won't eat those either.
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1-08-2011 @ 9:29PM
Laureen said...Just curious... did you ever outgrow this? I know I was fairly picky as a child but my daughter is far worse, and I grew out of it as a teen/adult. I'm at my wits end with her and suspect an aversion to various textures.
1-08-2011 @ 8:19PM
Jane said...Picky eaters are MADE, not born. The problem, quite frankly, boils down to one thing -PARENTS. Parents allowing the kids to get away with it.
If it's NOT tolerated from the beginning, it won't go on. Cook one meal. You eat it or you don't eat, PERIOD.
Sorry, I have NO SYMPATHY for any parent that gives in to these kids and fyi, I have a 20 year old who was NEVER EVER allowed to get away that the picky crap and because she was never allowed to get away with it, she learned to appreciate a wide variety of foods from many cultures.
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1-08-2011 @ 8:59PM
Raejean French said...I completely agree. Unless there is some legitimate issue like an actual food allergy or digestive sensitivity, the rest of it is something the child is acting out and attempting to manipulate adults with.
Don't even believe in the "tasters vs. non-tasters" hogwash. Kids are ALL sensitive tasters. This is why you don't give them the strong stuff like Hunan Chinese or sauerkraut, and you might have to forego even well-prepared brussels sprouts, but otherwise, it's all malarkey. Put it on their plate. They eat or they go hungry. Don't indulge them for a minute.
1-08-2011 @ 9:08PM
Lee said...Well said! I agree 100%!
1-23-2011 @ 8:00PM
sil said...Unbelievable. My child has sensory issues and is now 10 years old, and, yes, he is a picky eater. We've been dealing with this since he was an infant. Still think it's behavioral? Don't judge unless you've been there. Sometimes it's not about options.
1-08-2011 @ 10:37PM
Liz said...I grew up thinking the same thing - they eat what they get or they don't eat....but when my daughter was born 7 weeks premature we had to watch everything we fed her and even though we had her try everything and anything under the sun she is an extremely picky eater - What's the weirdest is that she will like something and few months later she can't stand it....Doctors say it's her tastebuds - they may not be working properly due to her being premature and MAYBE as she gets older they will develope more - So it's not always about "letting them get away with it" it's about making sure there is something in that stomach to avoid other medical problems - so there are 2 sides to the debate.....it's very frustrating for us as parents - we offer many things in hopes that 1 day she'll like it and add another item she is willing to eat....She is now 6 years old - eats Ramen Noodles, White Bread, Milk, Butter, Chicken, Oscar Meyer Turkey Hot Dogs and french fries - she is at least getting her dairy and protein and we give her a multi vitamin as well as Pedisure - so far her health has not become compromised by this.
1-08-2011 @ 11:17PM
Jennib said...My son has SPD and is extremely particular about what he will eat. Before his diagnosis I tried the approach of you'll eat what I make or you don't eat. I served him pb&j, three meals a day, for three days - the boy did not eat! At 2 1/2 years old, this just wasn't healthy. It's been that way since he was born. I have to say that I am also an extremely picky eater. I have been since I was an infant as well and I've tried and tried to eat the food that I can't. I even tried hypnosis. I simply cannot get the stuff down, I gag, sweat, and just can't do it! I'm sure for some this is a learned behavior, I have two other kids without SPD and they will eventually eat what I make. Please don't judge if you haven't experienced this firsthand.
1-09-2011 @ 1:59AM
Cazbotch said...To the people whose children have allergies, obviously nobody would suggest you make them eat foods they're allergic to, but nobody is allergic to all foods except Kraft brand Mac & Cheese. Some of the most common childhood allergies are to wheat (and/or gluten) and milk products. I know people CAN be allergic to certain fruits and vegetables (generally raw), but those allergies are quite rare, and usually cooking the food takes care of the allergy problem.
I realize these are generalizations, but nobody is allergic to everything except ramen noodles and cheese sandwiches.
1-08-2011 @ 9:03PM
scotmortimer said...I was labeled a 'picky eater' as a child and spent my fair share of nights at the dinner table until my plate was cleaned.
It wasn't until high school that we found out about my food allergies.
Now I can't go out to eat for fear of what may be hidden in the menu.
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1-09-2011 @ 3:57PM
Kay said...I've had severe (anaphalaxis generating) food allergies; it is indeed scary and frustrating, but (for your own sake) don't make yourself paranoid by blowing the situation totally out of propotion!
You certainly CAN go out without "fearing" a menu... just COMMIT to focusing on all the things you CAN eat! Think of it like a treasure hunt, (not a potential death march)!
Hints:
*Know your allergic triggers AND know all the Hypoallergenic Foods (listed provided below)
* When eating out, review the list of "side dishes" first, (I often end up chosing several "side dishes" to avoid hidden ingredients in "recipies").
*Dont be afraid to ask the server/manager/cook if they can "just grill my lamb, and steam my veggies" (or whatever), plain and simple!
*Consider calling ahead and asking the manager/cook/chef about convenient options for BOTH of you. (As a last resort, are they willing to reheat a "home cooked meal" that you bring along, so you can enjoy a no-risk lunch out with friends/coworkers?).
*Nowdays restaurants are very aware of food allergy issues, and most will happily accomodate requests for "plain food".
*If they are rude about it, just say... OK, would it help if I mention that I'm in chemotherapy, and just trying to make sure that I dont stat throwing up in your dining room? (This one works every time LOL)
HYPO-ALLERGENIC FOODS: (food that are unlikely to cause allergic reactions):
*GRAINS: millet, quinoa, amaranth.
SWEETNERS: maple syrup, brown rice syrup.
BEVERAGES: rice milk, pear nectar, chamomile tea, sparkling water (without any added sweeteners).
VEGETABLES:The majority of vegetables are considered hypoallergenic; especially lettuce, cucumbers, peppers, broccoli, cauliflower, spinach, kale, celery, carrots and Brussels sprouts. (AVOID eggplant, corn, tomatoes, broccoli, olives, spinach, mushrooms and avocado)
BEANS & LEGUMES: lentils, black beans, kidney beans, garbanzo beans, peas, navy beans, black beans, lima beans and pinto beans. (AVOID peanuts)
FRUITS: apples and pears (AVOID all types of dried fruits, which may contain amines or salicylates)
MEAT: Lamb (AVOID chicken, beef since they eat wheat and dairy products. Avoid canned meat and smoked cheeses as well.)
I hope this helps!
1-08-2011 @ 9:04PM
mezl said...i was a picky eater, but only when it came to vegetables like peas, asparagus, broccoli, liver and egg plant. i liked corn, some types of beans and never really had a problem with much else. oh, pea soup -yuck! - to this day i hate it. and artichokes. and beets i'm not too crazy about. but pretty much any thing else i like. in other words, i hated the stuff kids are SUPPOSED to hate. i don't get the kids who only eat a few things. and what kid hates butter?! i LOVE butter.... i dunno. kids to day are weird.
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1-09-2011 @ 4:19AM
juli said...I agree 100%! I have a stepson, who is the same age as my son, who was allowed by his mother to "pick and choose" what he wanted to eat. When he met me he had a HUGE, HUGE HUGE!!!, paradime shift. His mother tried to tell my husbad and myself that he had 'food alergies" but she had never had him tested. So my husband and I had him tested.... no alergies to anything other than hay fever. no celiacs, no lactose intolerance not a thing. So I would let one boy choose breakfast and one choose lunch I chose dinner. Even if he chose it he would still not eat it. I told him "You chose it, you wanted it, every one else is eating it, so will you to period. Funny thing after 4 days of not eating his "food alergies" were gone! He tried to tell his mother that "I was not feeding him" and I told her, in front of a judge "I will not tolerate a "picky eater" who has no "alergies to foods" but has been "created." The judge agreed. To this day when he is here he eats what is on his plate and says "thank you!" He tried to tell me that I am a "picky eater" also becasue I am an ovo lacto vegetarian... I told him "I eat everything else but meat. That is not a picky eater it is a lifestyle choice."
1-08-2011 @ 9:11PM
Pat said...I have a quick cure for picky eaters. Not harmful or dangerous. It's worked in my family for the last 3 generations at least, now working on my grandchildren. Keep in mind, this must be used at first sign of picky eating.
If they don't eat what you put in front of them. They don't eat...period.
No offering any substitutes or treats, not even fruit. Do this at EVERY meal.
I GUARANTEE a few days of going hungry and they WILL eat what you put in front of them, they WILL survive.
When they get to the age you can talk to them, very calmly tell him or her;
"I decide what's for dinner, I buy the food, I cook it and serve it to you, you eat it or go hungry".
I have NEVER had a child go more than a week without this working.
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