Picky eating is a common and normal behavior, starting between ages 2 and 3, when many children refuse greens, new tastes, and practically anything non-pizza. They are at the developmental stage where they understand the connection between cause and effect, and they want to learn what they can control. For others, feeding difficulties and selective eating are not a phase but symptoms of conditions like sensory processing disorder (SPD), attention deficit hyperactivity disorder (ADHD or ADD), autism, and/or, at the extreme end, Avoidant/Restrictive Food Intake Disorder (ARFID).
To successfully address picky eating and related food issues, parents must first recognize possible underlying factors so they can seek the appropriate professional help and treatments.
Also known as “extreme picky eating,” ARFID is described in the DSM-5, the guide clinicians use to diagnose health conditions, as an eating or feeding disturbance that can include:
- Lack of interest in eating or food
- Avoiding foods based on sensory characteristics
- Avoiding foods out of concern over aversive experiences like choking or vomiting
These disturbances result in failure to meet appropriate nutritional and/or energy needs, as manifested by one of more of the following:
- Significant weight loss (or failure to achieve expected weight gain or faltering growth in children)
- Significant nutritional deficiency
- Dependence on enteral feeding or oral nutritional supplements
- Marked interference with psychosocial functioning
Parents can take small daily steps to better fulfill a child’s nutritional needs and reduce stress around meals. Serious feeding difficulties and eating problems warrant professional help. Occupational therapists, speech therapists, nutritionists, GI specialists, and psychologists are several of the professionals who can help evaluate and treat youngsters that resist your best efforts.
Assess the Severity of Sensory and/or Behavioral Challenges
The following are potential signs of feeding difficulties and sensory/behavioral challenges that may require discussion with a doctor and/or therapeutic intervention:
- Only eating one type of texture (e.g. crunchy, mushy or foods that require limited chewing, like crackers)
- Avoiding food at certain temperatures (e.g. will only eat cold food)
- Exaggerated reactions to new food experiences. (e.g. vomiting and/or lengthy, explosive temper tantrums)
- Extreme sensitivity to smells
- Brand loyalty, only eating products made by a certain company. (Processed foods may have more sugar and salt to boost flavor, which can exacerbate feeding problems)
- Refusing to eat foods if small changes are made, including in the packaging or presentation
- Refusing to eat or excessive fussing over unpreferred foods on the same plate or table when eating
- Taking 45 minutes or more to finish a meal
- Losing weight over several months (note, however, that feeding difficulties can occur in individuals of all sizes)
Physical and biological problems can also contribute to feeding difficulties, including:
- Reflux; esophagitis
- Allergies and aversive food reactions
- Poor digestion and gut issues including excessive gas, bloat, constipation, diarrhea, and abdominal pain
- Underdeveloped oral motor skills. Symptoms include frequent gagging, pocketing food, takes forever to get through a meal, difficulty transitioning from baby food to solid food, drooling.
- Chronic nasal congestion.
The content for this article was derived from the ADDitude Expert Webinar Got a Picky Eater? How to Solve Unhealthy Food Challenges in Children with SPD and ADHD