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06:17 PM

When picky eating becomes dangerous

How to know when your child needs help

Nearly all children dabble in picky eating. But, severely picky eaters take food selectivity to a different level. Severe selective eating is a disorder that prevents the consumption of certain foods or food groups and is associated with complete intolerance or the unwillingness to attempt new foods.

About 3 percent of kids suffer from severe selective eating, to the extent that they can't eat out at a restaurant, said lead researcher Nancy Zucker, an eating disorders specialist at Duke University Medical Center in Durham, N.C.

Severely selective eaters are more than twice as likely to be diagnosed with depression or social anxiety, when compared with kids who'll eat anything, according to findings published online Aug. 3 in the journal Pediatrics.

Alaina Everett, a Cook Children’s licensed psychologist in Denton, says severe picky eating can be treated from a psychological/behavioral perspective as well as through oral-motor and sensory therapies and trying new foods for children who have severe selective eating can be terrifying.

“The fear is only intensified when parents make threats or express anger and frustration,” Everett said. “In our psychology department we emphasize the belief that kids do well if they can. Likewise they will eat well if they can. But there are obstacles that get in the way. Whether the original issue is a sensory processing disorder, oral-motor weakness or a gastrointestinal problem, all these kids have one thing in common, anxiety.”

From a psychological standpoint, these kids have had unpleasant experiences with food and the lingering trauma may be real. This is especially true for well-meaning moms who hide veggies in their kids’ favorite foods. If you have a seriously picky eater, Everett says this strategy will back-fire big time.

So how much anxiety can meal time actually cause?

“It is not uncommon in my practice to see children cry, scream, hide under the table, and quite literally shake at the sight of a novel food or when asked to join me at the table,” said Amanda Fyfe, a speech-language pathologist at Cook Children's in Arlington and Mansfield. “The anxiety severe picky eaters cope with is real and it can be intense. These kiddos often have months or years of negative food experiences fueling this fear, and unraveling it takes real work on everyone’s part. “

Fyfe says severely picky eaters:

  • Have a significantly limited food repertoires (think 10 foods). These foods are probably similar in some way, although figuring out the rhyme or reason to what your little guy will or won’t eat can be mind boggling. It may be that his safe foods are the same color or have the same texture.
  • Frustrate us with behavior that makes mealtime at home a catastrophe and eating out unheard of. He may refuse to eat with your family or cry and scream at the sight of the casserole you’ve so lovingly prepared.
  • Refuse foods based on ALL sensory properties, including appearance, smell, texture, and taste. A picky eater may not even tolerate an offensive food on his plate. The sight of a non-preferred food may cause gagging, retching, and vomiting. Eating is more than simply chewing and swallowing. Interacting with, smelling, touching, and tasting are ALL important steps in the eating process. And disruption can occur at any step.
  • May struggle to meet nutritional demands

“A child will not eat the broccoli and pork chops if you wait him out. He just won’t,” Fyfe said. “In fact, he may grow more and more rigid in his food selection because he IS hungry and grumpy. If a food or experience causes a child stress, discomfort, or pain, he will avoid it, plain and simple.”

Fyfe says these children are hypersensitive to foods in ways most of us might not even consider when planning our meals. Foods have to pass many tests before deemed acceptable for consumption, believe it or not, and severely picky eaters really put their meals to the test.

The first and possibly the most important test his dinner must pass? What it looks like. Children are acutely aware of the color of the food and may question why the color, shape, or size changes from bite to bite or from meal to meal. In addition, they might become overwhelmed by the smell of a particularly pungent food (think roasted broccoli, guys) and lose all ability to even consider tasting it. The texture of yogurt or pudding may cause a gag with incredible force. All of these reactions to food can lead to increased behavior disruption and meal time chaos.

“They can taste everything,” Everett said. “Zucchini pasta does not fool anyone and they are likely to stop eating pasta altogether. Presenting motivators like extra video game time can help, but it doesn’t solve the underlying anxiety. The scenario will just repeat itself when the next new food is presented.”

If your child shows signs of extreme picky eating, you will need some help. Talk to your child’s pediatrician about scheduling a feeding evaluation with a speech-language pathologist to determine the origin of the feeding woes and develop strategies to improve the eating experience for the entire family. A child psychologist may also be used if necessary.

How do we help our picky eaters?

So, what can we do as parents to alleviate some of the stress when it comes to meals?

  • Keep calm and model on. Model healthy and appropriate eating behaviors and routines. And while you’re at it? Create a routine. Assign seats, placemats, and cups. Serve dinner at approximately the same time. Bring your family to the table to experience food together and try not to let dinner become a battlefield.
  • Be sure to offer his preferred foods at all meals so you can alleviate concerns with hydration and nutrition. Fyfe says to offer green beans alongside his favorite chicken nuggets. If he can’t handle the horror of those beans touching his beloved nugget, that’s OK. Turn this into an opportunity for him to explore the food in other ways: he can pick up the beans and set them on another plate or in the trash. This may not seem like much but in actuality, he’s getting the chance to see, touch, and if he’s feeling adventurous, smell or taste a new food.
  • Family mealtimes are stressful for families with picky eaters without the added stress of cajoling your child into eating.  “I suggest exploring food together during a lower stress time to begin with,” Fyfe said. “Many severe picky eaters begin to experience an increase in anxiety as soon as they hear mommy prepping dinner. Explore new food at snack time or during an impromptu picnic. Take turns looking at, smelling, touching the foods. In my practice, older kiddos (think 4-5) love the chance to become ‘food explorers’ and explore all the properties of food in a safe environment.”
  • Speaking of safe environments, it is so critically important that we do NOT force feed our picky little guys. As hard as it may be to grin and bear another meal of frozen waffles, Fyfe says we simply must do it. Forcing children to eat can cause children to develop negative attitudes about food and can actually cause them to refuse with more force in the future. In addition, force feeding takes away a child’s sense of control with regards to eating, which may cause an increase in anxiety and fear.
  • Remember that slow and steady wins this race. An extremely picky eater may require up to 52 presentations of a new food before the novelty wears off and he feels comfortable enough to take a taste. This process is lengthy. Do not give up! Continue to expose your child to novel foods.
  • Remember that a food may be refused based on appearance alone. Get creative with your serving techniques. Have fun with your food prep!
  • Start early if you can. Offer a variety of foods as soon as you and your child’s pediatrician agree he is ready for solids. If possible, make your own baby foods so your little love will be introduced to a wider variety of foods and tastes. Roasted beets, blueberries, and bananas were always a big hit in our house! There are some great resources for baby food recipes out there!
  • Try to tolerate your child’s preferred foods despite your feelings about them. In my practice, parents frequently express the desire for their children to eat more fresh foods and lay off the processed eats. Many extremely picky eaters sustain on processed foods. Why? Processed foods can feel comforting to these kiddos because they are CONSISTENT. A chicken nugget will most likely have the same color, texture, and taste each and every time it passes a child’s lips. In contrast, a grilled chicken breast may vary color, shape, texture, and taste from bite to bite which makes for an unpredictable eating experience. Unpredictability and inconsistency may cause heightened anxiety and therefore, greater likelihood the food will be (vehemently) refused.
  • Avoid words like “yucky” or “yummy” or “bad” when describing foods. Describe foods based on properties. For example, a carrot is orange, hard, crunchy, and sweet.

About the author

Amanda Fyfe is a speech-language pathologist at Cook Children's in Arlington and Mansfield. Speech/language pathologists focus on oral motor, speech, language and communication skills to enhance development, restore function and to prevent disability from pediatric conditions, illness or injury. Click here to find the closest Cook Children's Rehabilition Services near you.

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