When Is It More Than Picky Eating?

Many parents are familiar with picky eating, and although managing it can be challenging for many of them, some children experience feeding difficulties that go beyond mere picky eating. Parents often carry huge concerns about their child’s eating. With usual approaches to managing picky eating may have little to no impact.  These children often require specialised support from experienced feeding specialists. But how can you determine if your child’s eating difficulties or differences are more than picky eating and if they need extra attention?

This blog will cover

• Why children may have feeding difficulties or differences beyond ‘picky’ or ‘fussy’ eating 
• Signs or symptoms that indicate it’s more than picky eating
• Possible diagnoses if your child is more than a picky eater and where to seek extra support 

Why do children have feeding difficulties or differences that are more than picky eating?

Picking apart picky eating and when a child’s feeding behaviours become a concern beyond just being “fussy” can reveal a range of underlying factors. While many children go through phases of selective eating, there are cases where feeding difficulties are more complex.  There are often specific characteristics, diagnoses or medical backgrounds that are known to increase a child’s likelihood of ‘persisting pickiness’ or feeding difficulties.  It is important to know that as a parent or caregiver, you are not the cause or reason your child has feeding challenges.  

Some common factors related to more complex food refusal or restricted eating patterns in children include;

Children with sensory differences or sensitivities

Some children may experience heightened or diminished sensory responses to textures, smells or tastes, which in turn affect their eating and food preferences.   Sensory processing differences can cause children to avoid certain foods or even whole food groups and/or impact their regulation at mealtimes.

Children with food allergies

Research indicates that up to 40% of children with food allergies may face feeding difficulties. Such as anxiety surrounding mealtimes or limited food acceptance. Concerns regarding food safety, fear of potential reactions, or a history of symptoms affecting eating (such as stomach issues). Can all influence a child’s long-term relationship with food.

Children with neurodevelopmental diagnoses like autism or ADHD

Research shows that rates of feeding difficulties and differences in children with these diagnoses are higher. Issues such as anxiety around mealtimes or unfamiliar foods, the need for predictable eating patterns, and a preference for specific textures, shapes or colours of food are often more prevalent in children with autism. While those with ADHD may struggle with mealtime routines or experience side effects of medication that can reduce their appetite.

Children with complex medical backgrounds or those who have experienced early discomfort associated with feeding

Premature babies, those requiring tube feeding, those with tummy troubles, or those who spent a lengthy period in hospital. These children often experience differences and difficulties in feeding related to their experiences and skill development.

Children who have missed key developmental milestones with feeding

Delays in milestones, such as weaning onto solids, can affect a child’s ability to transition to more complex textures and varieties of food. Children may lack the skills and experience they need to eat a range of foods.

How can you tell if it’s more than picky eating?

As a parent, it is important not to diagnose your child on your own. Instead, it is encouraged that parents consult health professionals experienced in feeding to better understand a child’s feeding difficulties, food refusal, or concerns in more detail. If you are wondering whether your child may need extra support and guidance with their selective eating, here are a few ‘red flags’ which can be essential signs your child needs some specialist advice;

1. Your child’s weight is faltering/dropping through centiles.  Children who are losing weight or not gaining weight over a period and therefore dropping across their centiles. Be sure to seek support if your child has dropped two centiles or more. (Important note: weight and growth centiles only tell part of the story. Having a child who is a ‘healthy’ weight doesn’t mean their feeding challenges do not require support.) 
2. Your child excludes entire food groups.  For example, they include no fruits or vegetables at all (in any form) in their diet or protein-rich foods.
3. Your child excludes big texture groups. For example, they will only consume foods that are meltable/dissolvable or pureed.
4. Your child consumes 10-15 foods or fewer. While there is no evidence-based ‘cut-off’ for how many foods a child should eat to warrant advice (or not). Generally, a child’s diet that consists of fewer than 10-15 foods would benefit from review.
5. Your child becomes very distressed or appears to melt down when around foods or others eating.
6. Your child seems to struggle with the skills needed for eating e.g. feeding themselves, chewing, or swallowing
7. Your child keeps dropping or losing foods from their list of accepted foods but never gains them back.
8. Your child has very specific preferences around food. For example, they will only accept certain brands of foods, or food presented in a certain way
9. Your child’s feeding difficulties have persisted or become worse over several months or years.
10. Your child’s eating habits or patterns affect your child and/or family in a psychological and/or social way. For example, you are not able to eat outside the home, you cannot travel without your child’s accepted foods, your child’s feeding challenges are having a notable impact on your feelings of competence as a parent, or are causing you distress or anxiety.

Above all else, if you as a parent have persisting concerns about your child’s feeding, it is important that you listen and acknowledge this. Seek reassurance or support from a health professional.

Possible diagnoses if your child is more than a picky eater and where to seek extra support 

Children with selective eating behaviours and feeding challenges that extend beyond ‘typical’ picky eating can sometimes meet characteristics (or ‘criteria’) for diagnoses. Conditions such as ARFID (Avoidant Restricted Food Intake Disorder) or Paediatric Feeding Disorder.  It is essential that specialists skilled and experienced with children’s feeding and development are involved in the diagnosis of these conditions. As well as an individualised plan suitable for your child’s needs and background is provided.  Professionals involved may include Paediatricians, Paediatric Dietitians, Occupational Therapists, Speech and Language Therapists and Psychologists.

A neuroaffirming approach

It’s also important to note that some feeding differences, particularly those associated with neurodevelopmental conditions like autism, are best approached with a neuroaffirming perspective. This approach acknowledges and respects the natural variations in how children think, learn, communicate, and process information. Including their relationship with food and mealtimes. A neuroaffirming approach does not aim to force a child to eat or adopt a diet that aligns with neurotypical children. Instead, it focuses on understanding and accommodating the child’s unique needs and preferences. Creating an environment that supports their well-being while respecting their individual feeding behaviours.