Picky Eaters: Pathological or Just Particular?

by Julie Z. Rosenberg (Subscribe to Julie Z. Rosenberg's posts)
Jan 6th 2011 12:00PM

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."

ReaderComments (Page 2 of 3)

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1-08-2011 @ 10:34PM

Jane said...

I totally and absolutely agree with you. Picky eaters are MADE not born because they're allowed to get away with this behavior. Parents who tolerate it create their own problems.

1-09-2011 @ 4:01AM

QueenLaese said...

Wanna bet? My mother tried this with me. I didn't eat. Passed out at school one day, so guess who won? My mother did, actually, when she wished me a child as stubborn as myself. My daughter is an extremely picky eater, but I have the Sneaky Chef book. For us, it isn't about sneaking vegetables in -- she doesn't mind eating them if she doesn't have to taste them, so she'll help add the purees to the recipes. She likes blueberry and spinach smoothies, "pizza" with carrot puree instead of tomato sauce, and Pediasure and multivitamins are also part of her diet so I know she's getting what she needs. She is absolutely healthy and I have had pediatricians tell me stop worrying about what she won't eat and how nice it is to see a child who is not obese.

1-08-2011 @ 9:22PM

weezieb said...

My rule when my daughter was little was that she had to try what was on her plate. If she didn't like it after she tried it, she didn't have to eat it. That allowed me to keep a running track of what she liked, and gave her the opportunity to enjoy new foods. Her children are both very good eaters, and she follows the same "rule".I do not believe in forcing a person to eat something they don't want, and allowing a person to eat when they are hungry. Everyone in my family is a normal weight, and we all have a healthy appreciation for different foods.

1-08-2011 @ 10:23PM

lo said...

I agree the rule I use is you have two choices you can try one bite or you can go to bed. If you don't like it you don't have to eat it, but you have to try it.

1-08-2011 @ 9:35PM

Belle said...

My kids could have been picky eaters but I never gave them an option, I don't cook box meals and the only can products I use is tomato sauce and beans. Which I actually just recently got a pressure cooker and will soon be making fresh black, red and so on beans. There have been many times my son has not wanted to eat something I put before him. But I have made him take a bite and he starts to smile and realize's its not bad after all. (He usually tries to hide his smile.) I also no longer allow him and his sister to have a drink until after they have eaten the majority of their food, liquids will fill up the tummy. When he doesn't want to eat like the other night, I give him two options: One, go to bed hungry and with no juice; Two, eat whats on your plate and you will have your juice. I also don't allow them to drink anything but water unless they are eating a meal, then they may have a juice. To introduce them to other fruits, I make fruit pops. I put blueberries, raspberries, blackberries, orange slices, banana slices, strawberries, grapes cut in half and fill it with a capri fruit punch. (They hadn't tried the blue, black or red berries until a few months ago.) My son told me, "mommy I love the black circles!". I recently left out the left overs and both of my kids were busy eating all of it up and not in a fruit pop form. Don't ever start to cater to your kids just to make your life easier at that moment because in the long run your going to end up doing double the work with two meals being prepared and your setting up a bad behavior for that one moment of I didn't feel like arguing. Cook one meal for the family and everyone par takes. There have also been times that he will tell me I'm full mommy I can't eat anymore but yet he wants his fruit pop for dessert. Well, if you have room for a fruit pop you have room to finish your dinner too! Sometimes he won't finish and he doesn't want dessert afterwards and an hour later he's hungry and he want's cereal or a breakfast bar. I tell him if your hungry still you can have some more dinner. Sometimes he says sure other times he tells me I'm not hungry. They are sneaky but thats why your the parent. By the way today my kids had tofu in their Mongolian and had no idea and ate almost all their food! >^.^

1-08-2011 @ 9:32PM

dianna bradley said...

how about: you're the parent and you tell the kids what they're eating for dinner, starting from when they begin to eat solid food. cut off the OCD at the pass. you dont ask kids what they want, you serve healthy meals and if they don't care for what they're served they don't have to eat it. when they're hungry enough they'll eat what the family is eating. barring food allergies, what is the puzzle here? i'm tired of hearing about and seeing our children running the show. they need firm direct parenting to prepare them for life in a world where there is not much coddling.

1-10-2011 @ 2:51PM

Alicia said...

You've apparently never met anyone with OCD. They don't have control over their compulsions and I've never met someone with it who didn't wish they could control them. Trust me, it's as likely someone with obsessive compulsions will go hungry rather than eat something that clashes with their compulsions. Same goes with sensitivity. These are not a child being too stubborn to try something new, they are legitimate medical issues that the child has no control over.

1-08-2011 @ 9:33PM

sueellen33 said...

I have 3 kids that sometimes would be picky eaters. After trying all kinds of things, including bribery, I hit on a solution that worked out great for us. I included them in making snacks at first. Fun things like celery stuffed with peanutbutter and raisins on top became "ants on a log" a fine icing tube in red supplied the "eyes" on it. I got this from kids cookbook. There is inexpensive ones (10 bucks at wwwbluebearcreekhome.com). Once we made it an "art project" it was entertaining and they learned skills in the process. Such as how to handle tools, under adult supervision. And it was bonding, they put down the video games and worked with me!! Of course we bought them their own aprons, and planned from the books what to make. I also took photos and posted them on the fridge at first, as they got older, we turned it into a competition. Today, as grown adults they remember time with me in the kitchen and I don't have to worry about them starving.

hypatia said...

Neither of my children are picky eaters. They have no choice and never did. My daughter once refused to eat beef ribs and salad which was the family evening meal. Fine, we put clear plastic wrap on her plate and put it in the fridge. It looked a lot worse when it was put in front of her for breakfast. She refused to eat it. The salad looked pretty nasty by lunch. By dinner the next evening she was ready to eat - still the same food offering. No picky eaters in our house. Go ahead, spoil and cater to those kids but don't complain to the rest of us.

1-09-2011 @ 9:26PM

Wasn't that a scene from "Mommy Dearest"?

1-08-2011 @ 9:34PM

Samantha said...

My picky eater is now 19 and still a picky eater although he has branched out a bit. People have to realize the difference between a whiny or manipulative toddler/child and a child that has a true issue. My son did not turn picky at 4 or 5 but from day one in the hospital! This was not an issue of nature vs. nuture although I do believe it is the case for many kids. He never ate junk (other than some sweets) until he started eatting potatoe chips at 11 - and it was astonishing to see! He still rarely eats them... There was no going for fast food or any restaurants, no fun at birthday parties (including his own) where the main dish is pizza, no sleepovers without going hungry. He is still managing through it and really trying to branch but its very hard for him. He isn't malnourished but his 28 inch waist is the envy of many! Keep your kids on vitamins and make sure they drink milk assuming that is something they like.

1-08-2011 @ 9:36PM

Kenzie said...

I'm a teen that was diagnosed with Sensory Processing Disorder as a small child. So, yes, I was and still am a very picky eater. I know that for me, it was the way the food was prepared. For example, I absolutely HATE red meat (steak, hamburgers, other beefs), but I love tacos, weinersnitzel, and knockwurst. With texture, I can't eat baked potatoes unless they're mashed. Corn on the cob: yes. microwavable corn: no. etc. My tip is, if a kid won't eat something, give it to him/her in a different way

1-08-2011 @ 9:43PM

Lee said...

My youngest grandson, hardly eats anything! Even eating what he likes, which is not much, he appears to eat an inacceptable small amount. The parents seem to feel , because he is still active, that this is OK, but I am worried. He appears pale but is always active and does not tire easy. He does get sick often. When everyone is eating dinner he does not eat a thing. Sometimes skips breakfast lunch and/or dinner.

1-08-2011 @ 9:46PM

sondbr said...

I'm 68 yrs. old and I would only eat Kraft mac and cheese and when they changed it a bit during my childhood I hated it at first, but finally gave in and ate it. There is a difference between Kraft and the off brands. My kids were the same way - would only eat Kraft. I had one VERY picky eater and one that would eat anything in sight, so I'm a firm believer kids eating habits/tastes are inborn. You can't stuff food down their throats if they don't want to eat it. The picky one ended up being a vegetarian. Now that picky eater has children, one is just an infant, but the other two - one is VERY picky, the other will eat anything. I don't believe in forcing kids to eat what they don't like. It could taste different to them than it does to you.

1-08-2011 @ 9:52PM

sue ellen said...

I forgot to add that cheese sauce did work miracles over unpopular veggies such as brussel sprouts and califlower. My cheese sauce was american cheese slices melted over the veggie for 1 minute in microwave and stir to coat. Also, no dessert for those who don't finish. Non-negotible on that one.

1-08-2011 @ 10:10PM

Denise said...

My "picky eater" is 55 years old. My husband has been extremely difficult to cook for for the past 30 years. My kids loved just about everything I put in front of them, but many, many times I had to cook a separate different meal for him. He does have some allergies, but if "it doesn't look right, forget it! (I blame his mother!)

tawnya25 said...

my one son has pdd and he only ate waffles pizza ( the cheap pizza for 1.25) and mc donalds..but i worked with him and he eats alot of different foods. now my 4 yr old only eats cottage cheese and croutons all day everyday and maybe a bite of what i made ..is hat healthy

1-08-2011 @ 10:35PM

Tom said...

Being a finicky eater is not a big problem. When I was a kid all I ever ate was peanut butter and jelly. My family would go out to eat and that's what I had to have. Today I'm 6' - 215 lbs. and I love all kinds of foods. I'll eat foods that my friends won't even try.
It's a phase. The kid will survive and later they'll eventually try foods and see what they've been missing. When I think about all the great foods I misse out on. Italian, Mexican, Chinese...

1-08-2011 @ 11:06PM

Pixie said...

I was a picky eater. When I was 3-4 years old, I ate very little and was quite thin. I don't remember anybody catering to my likes or dislikes; I ate what I wanted to eat and left what I didn't want. Nor did anybody make me clean my plate. We ate dinner together every night and all ate the same thing.

I did start eating more after I had my tonsils and adenoids removed, but I was fairly picky throughout childhood. SInce then, I have eaten normally and have no food allergies or phobias.

Unless the child has a health or psychological issue, leave them alone. Let them eat what they want and don't make a big deal out of it. They won't starve. The more attention you pay to this, the more attention the child will want (even negative attention), and you've started a vicious cycle. Battles of will are never a good idea. Let them grow up and they will find more food to their liking.

1-09-2011 @ 12:07AM

Lucy Burger said...

I was and still am a picky eater.I can't tell you how many times I sat at the breakfast table or dinner table all day because I wouldn't eat something. I became enemic and anorexic by the time I was three years old. I was always very under weight. When I was a teen I started putting on weight for no reason. The Dr told my mother I was eating when she wasn't looking. I married a controlling man much like my mother. We were only allowed to serve the foods he liked. It wasn't until I was in my 30's that they found out the only reason I was alive was because I had an under active thyroid gland and I didn't need very much food to keep me alive. After I started to taking thyroid hormone i became hungry and wanted to eat what I wanted to eat. I devoriced the husband and married a non controlling husband and now I am fat and love food. So you see sometimes It is the controling parents who don't know how to nurture that can sometimes be the problem. Love is not always the parents always getting their way.

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