Picky Eaters: Pathological or Just Particular?

Filed under: Behavior, Nutrition: Toddlers & Preschoolers, Nutrition: Big Kids, Nutrition: Tweens, Nutrition: Health

picky eaters

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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AdviceMama Says:
Start by teaching him that it is safe to do so.