Most children go through a phase of picky eating. As children transition from a milk diet to solid food, they learn a great deal about eating. Children at this age typically have a natural preference for sweet and salty tastes, and a protective evolutionary dislike for things that taste sour and bitter (6). This “unlearned preference” for tastes is a likely factor contributing to the success of the human race.
The appetite of the typical toddler is erratic – they eat a lot, a little, or not at all, and often prefer foods that are more energy-dense than nutrient-rich, much to the panic and worry of parents. In the absence of illness or lethargy, typically, this is considered normal child development.
“Parents believe that their feeding practices can exert a major influence on children’s food preferences and on developing control of children’s food intake, although recent research indicates that the influence is not necessarily in the ways that parents intend. The pervasive messages directed at ways that nutrition can improve health and appearance have created an increasingly complex eating environment in which parents attempt to foster healthy eating behaviors in their children. For example, the messages of the dietary guidelines convey the importance of consuming certain types of foods and limiting the consumption of others. The means by which parents attempt to shape children’s eating toward nutritionally desirable dietary outcomes can have unintended consequences for children’s eating behavior.” ~Birch and Fisher, 1998
What If This Isn’t Typical ‘Picky Eating’?
Approximately 20% of all children are born with a high reactive temperament. These children are, by nature, more anxious that the average, at higher risk for developing anxiety related disorders (7), and are often extremely selective with food.
Some kids really do not know how to chew or manage with certain textures of food. Some kids have uncomfortable reactions to foods or to eating in general. Sometimes a professional is needed to treat medical conditions or to develop skills required for successful eating.
Some kids have small appetites, or would just rather play instead of eat. Other kids are exceptionally sensitive to the sensory characteristics of food. Young children lack the cognitive ability to refuse to eat for the sole purpose of irritating their parents. There is always a reason why children refuse food.
Always.
Avoidant Restrictive Food Intake Disorder (ARFID)(9) is food refusal due to highly selective intake, lack of interest in eating, or fear of the unpleasant effects of eating without concerns of body image or weight. The ‘disorder’ part of eating disorder means the behaviour around food impairs the ability to function adaptively in social situations (8). Currently, ARFID clinical criteria makes psychosocial impairment optional, which is very odd indeed, as the ability to manage more than a very limited dietary variety often has negative implications for social eating occasions.
In the published literature, there is no consensus on the definition or even an agreement on a name for what is considered ‘picky eating’. Although it is estimated that 25-50% of parents consider their child ‘a picky eater’, only 1-5% of children meet criteria for a feeding disorder. This difference between parental concern and clinical feeding definition contributes to the perception that parents are unreliable at recognizing problem eating behaviour. Recent literature suggests that parents are more reliable at identifying selective eating behaviour that may be consistent with a potential ARFID diagnosis.(10) This is likely due to the recent agreement in clinical criteria. As a parent, you may still find support difficult to find through your primary healthcare provider, as many are not yet familiar with the DSM-5 category of ARFID.(11) Additionally, the majority of children with ARFID are a normal weight, therefore doctors may not take the accompanying parental anxiety seriously.
Research on restrictive eating disorders in children estimate incidence at 2.6 – 3.01% per 100,000 person-years. In clinical settings, 19 – 25% of children under age 13 years meet criteria for ARFID (1-2). One study from Switzerland (3) determined ARFID was present in 3.2% of school age children (age 5-12 years) in the general population. The data, although limited, consistently shows ARFID to be 10 times more common than Type 2 diabetes mellitus (roi 0.27% in children under age 10y). The American Diabetes Association has described the latter as “an epidemic” (4-5).
What Can I Do?
After addressing any medical concerns (ie gastrointestinal, swallowing, oral motor, autoimmune disorders), focus on a feeding relationship built on trust. Anxiety is high on both sides of the table: children are often exceptionally suspicious of unfamiliar food, and parents are (understandably) frustrated and worried by the persistent food refusal, often without support from the healthcare community. The key is to create an eating environment where anxiety isn’t the center of attention.
A home feeding environment that heals the parent-child relationship and supports the child’s eating ability is essential. The older the child, the more healing there is to do around eating. Feeding struggles impact the entire family, not just the child, therefore it is both unrealistic and unfair to expect the child to shoulder the entire responsibility for successful eating. What you and your child need depends on many factors, and in some cases, it may be necessary to involve the expertise of a knowledgeable therapist.
I welcome questions, and I offer evidence-based support. This is a place of hope and learning.
This is our journey with ARFID. We are learning to love food, or at least, like it more than we used to.
Welcome to the table.
References:
1. Leora Pinhas, MD, FRCPC; Anne Morris, MBBS, MPH, FRACP; Ross D. Crosby, PhD; Debra K. Katzman, MD, FRCPC Incidence and Age-Specific Presentation of Restrictive Eating Disorders in Children: Canadian Paediatric Surveillance Program Study Arch Pediatr Adolesc Med. 2011;165(10):895-899. doi:10.1001/archpediatrics.2011.145
2. Kurz S, van Dyck Z. Dremmel D. Munsch S. Hilbert A Early-onset restrictive eating disturbances in primary school boys and girls Eur Child Adolesc Psychiatry DOI 10.1007/s00787-014-0622-z
3. Nicholls, DE; Lynn, R; Viner, RM Childhood eating disorders: British national surveillance study Br J Psychiatry 2011;198(4):295–301 doi:10.1192/bjp.bp.110.081356
4. Kaufman, FR Type 2 diabetes mellitus in children and youth: a new epidemic J Pediatr Endocrinol Metab. 2002;15:(supp 2) 737-744
5. Vivian, EM Type 2 diabetes in children and adolescents: the next epidemic? Curr Med Res Opin. 2006;22(2):297-306
6. Birch LL, Fisher JO Development of eating behaviours among children and adolescents Pediatrics, 1998 Mar;101(3 pt 2):539-49
7. Medina, John J The Genetics of Temperament—An Update Cultural Psychiatry, Addiction, 2010, March 10, Psychiatric Times
8. Satter, E What is ARFID and What Does It Have To Do With Feeding Dynamics and Eating Competence? 2014 Feb; Family Meals Focus #89
9. Fisher, M; Rosen, D; Ornstein, R; Mammel, K; Katzman, D; Rome, E; Callahan, S; Walsh, B; Malizio, J; Kearney, S. Avoidant / Restrictive Food Intake Disorder: A Proposed Diagnosis in DSM-5 J Adolesc Health. 2014; 55: 49–52 doi:10.1016/j.jadohealth.2012.10.027
10. Zucker, N; Copeland, W; Franz, L; Carpenter, K; Keeling, L; Angold, A; Egger, H. Psychological and Psychosocial Impairment in Preschoolers With Selective Eating Pediatrics, 2015 (peds-2014) doi:10.1542/peds.2014-2386
11. Norris, M; Katzman, D Change Is Never Easy, but It Is Possible: Reflections on Avoidant/Restrictive Food Intake Disorder Two Years After Its Introduction in the DSM-5 J Adolesc Health. 2015; 57: 8-9 doi:10.1016/j.jadohealth.2015.04.021
Mealtime Hostage 
LOL I want to say I LOVE YOU TOO….I’m 49 yrs. old and have been this way my whole life. I cried when I found out there was a disorder, a name for why I am this way. My life would have/be so much easier if I wasn’t picky. But honestly I will never understand why what I put in my mouth concerns another person. For the parents here, I don’t know if I have any ADHD, Autism issues (I don’t seem too) but what I do remember is the torture of being force feed and dreading meals with my Mom. I was spanked, forced food in my mouth, punched, yelled at, forced to sit at the table until midnight, & forced to eat my left over cold dinner for breakfast. I feel like that made it much worse. When faced with trying to try something new, I gag, mentally I believe its disgusting, my heart beats fast…..etc. Go try to eat one of your shoes, or pull weeds up and try to make yourself eat it…bugs….anything you find disgusting. That is what it’s like. I’m so happy to have found this site, and a name. Whether I can change it or not, I don’t know. I tried a little this year, but really it doesn’t bother me that much (until I travel), only everyone else.
I try to eat a good amount of protein and take a multi-vitamin. The vitamin turned my life around. At 32 I almost died with a blood sugar level of 28, ambulance to the hospital for a week stay. After a good talking too from a nutritionist I changed somethings, ate what I could that works for me. Still no fruits (only bananas) and no veggies at all.
So protein and a good multi, now I’m healthier than most of my high school classmates.
I dont know if you will see this message, but I need to THANK YOU for all of the information you have gathered regarding ARFID aka selective eating disorder. It is sooooo hard to find people who “get it” and finding your blogs are a Godsend for my daughter and I. She is almost 14 and has been dealing with this since she was 3. When I came across an article about selective eating disorder about 2 years, my daughter and I practically jumped up and down. Finally, we had a name for this !!!! That article helped me to convince my husband that she was not just being stubborn, that just the feeling of most foods in her mouth (or even just the thought of having to put certain foods in her mouth) makes her physically and emotionally sick. Getting him to understand was the “easy” part (NOT!) It has been a living hell trying to find a therapist who understands ARFID. We have seen 3 different counselors over the past 5 years (in the beginning my husband thought it was a control issue, or behavioral problem) and they JUST.DON’T.GET IT. I will forever continue my search for information and help for my daughter.
Her diet consists of McDonald’s nuggets and fries, Goldfish crackers (they have to be in the snack size bags, all other packaging makes them taste “weird”) , chocolate ice cream (has to be our local store brand), water, sometimes she can handle mini Oreos or a berry tie-dye fruit by the foot. The number of her food choices has declined over the years. She used to like orange juice (had to be store brand with calcium), gogurts and mac and cheese. I know there are people out there who roll their eyes at this, I’m related to some of them! My mother-in-law thinks it’s absurd that my daughter eats so much McDonalds. I worry about that too. But I had an epiphany at the drive-thru about a year ago…McDonald’s food isn’t killing my daughter, it’s keeping her alive! And I will continue to feed her nuggets and fries until we can find the help she needs in order to live without them.
I am a nana to a seven year old darling girl, that’s list of tolerable foods gets smaller daily, ..she eats broccoli, carrots, toast , dry crackers, pizza (now without the pepperoni) roast potatoes, and very occasionally tiny piece of chicken breast, occasionally chicken bites (mcdonalds) though this is becoming increasingly rare, plus a particular brand of chocolate, and coconut ice cream..this is the only ‘dairy’ she touch’s!
I have stumbled on this page in Facebook, and feel that maybe this is her problem?? ARFID ?
Meals are very stressful, as is going out as family to eat, and we try to take pizza or chicken bites with us..
We have between ourselves wondered if it’s a control thing, my daughter is a single parent, and at times they clash verbally over her eating, and I know there are feelings of failure on both sides.
My granddaughter was under peodiotrician until five, but he felt that as she was above all her markers in learning, height, though very slim, she was a picky eater that would grow out of it.
She has boundless energy, does dance, swimming, gymnastics, is on the go constantly, where the energy comes from is beyond me, with the tiny amounts she eats.
She us above her learning line in all her subjects at school, she had some temper and disruptive behaviour towards my daughters during transition to year one last September, and had play therapist sessions within the school for twelve weeks, and she said she is a delight, and a picky eater, … and she is all that and more, but her food list gets smaller and smaller, vitamins are out of the question because of either ,taste, look or assumed texture , gag reflex is alive and kicking and must be do awful for her..as it is for us also, plus frustrating ..
She has very .limited calcium, just from the one particular ice cream man each day, but in winter he doesn’t come..we are desperate..
Where do we start to help her??
Can you recommend books, point us in right direction somehow, she really is on the exterior a beautiful, clever, witty, academic wonderful little girl, but around food she must be in turmoil..because we are just as observers
Thank you for any thoughts in advance xxx
Concernednana
Concerned Nana,
You describe a very typical situation for many families. A youngster doesn’t eat as well as parents would like and parents worry. The child picks up on the worry and everyone is stressed about what isn’t being eaten. Stressful family meals are appetite killers. The environment is so important.
Everyone likes to feel in control, and around food, both children and parents have responsibilities. Your granddaughter’s job is to decide how much to eat. Your daughter decides what foods to serve. The issue at the table is not eating, it’s trust. Building trust around food requires the parent to consider the child’s eating ability so the child can come to the table and expect to find enough to eat, even if what the child can handle is roast potato or crackers.
The current list of accepted food is a good base to build on. She is active and energetic and bright. It sounds like she is a sensitive kid so she will pick up on the worry that comes from the trusted adults in her life and turn that into feelings of being unable to please you with her eating. She wants to do well, and she will, with her mom’s and nana’s support.
That support is available. A gem of a book is “Helping Your Child with Extreme Picky Eating” (Rowell and McGlothlin)
Also valuable for your own peace of mind is “Secrets of Feeding a Healthy Family” (Satter).
Both books will give you the tools you need to be the support your grand-daughter needs. Your daughter may need some support herself to transition to feeding with trust. If so, please send a message through the contact page.
Hi, I am not on Facebook but interested in joining your support group if possible. Is there a way I could join? Or is there another similar support group online not on FB? I just started removing the pressure with our 3 year old this week, and have been seeing improvement already, but my husband is not convinced….just hoping to hear some success stories and also hopefully to be able to share our challenges on this journey with other people going through it.
Unfortunately, the group is dependent on FB at this time. It isn’t ideal, as it limits access to people, who for any number of understandable reasons, don’t have time for or interest for the social media giant. I’m accessible by e-mail via the Contact page. Perhaps we can chat more and address your husband’s concerns?
I just wanted to say thank you for sharing your writings. I have been excruciatingly picky my whole life, and so has my younger sister. It is a massive source of embarrassment for both of us. I can’t remember how many times I stayed home or excused myself to avoid being teased or berated for what I ate at a friend’s house or when visiting family. The fact that I would turn down so many foods when I’m hungry baffles my boyfriend but he is kind about it. It is a very strange revulsion that I don’t think any of us can explain.
I remember throwing up at a dinner party when I was 7 because my grandpa was being stern about me eating the salad, and I couldn’t bring myself to swallow it. It may be of interest that I have ADHD with some anxious and ocd tendencies, and anosmia (born with no sense of smell at all). I also have some pretty severe binge-eating problems and obsessions with food. I can definitely see how they all could be connected, although my sister only has the picky eating. My parents never made us go hungry and always strove to introduce us to new foods, I don’t feel as if they stressed us out or guilted us, but here we are! We both absolutely cannot tolerate fruits/veggies, and would be more likely to vomit from revulsion than eat a whole serving. I really really wish I could, it’s such a source of shame and worry.
I hope I can find help thanks to blogs like yours and its recognition in the DSM.
You don’t ever have to eat anything you don’t want to. Ever. Shame and worry make everything smell and taste awful.
thank you. ive been so worried that i was just being a brat for 16 years. my mom doesn’t believe in any eating disorders she hasnt heard of before so she still thinks i’m just picky and is still using the same tactics she’s been using since i was 3 to get me to eat vegetables, most fruits (raspberries, blackberries, stawberries and cherries are ok, everything else is only acceptable as a smoothie, lemons are ok as a sauce) and nuts (i’m lucky, those are the only food group i’m averse to but it’s so extreme, one time i accidentally ate watercress and cried+ vomited for 15 minutes. hot sauce is also ok, i love ot sauce but hot peppers make me want to die). she doesnt understand that i would literally rather starve to death than eat tomatoes.
I don’t get along with tomatoes either. This is from a registered dietitian and therapist. It might help open the door of communication with your mom? More importantly, it may help you better understand where you’re at with food and determine where you want to get to.
http://ellynsatterinstitute.org/fmf/fmf91.php
Is telling you I love you too creepy? Ok, I feel an extreme sense of euphoric relief knowing you and your blog exist and that I’m not alone. My son has been a selective eater from the moment he refused baby food. I have been around and around with health care professionals (OT: he’s fine, it’s a mental thing, he’s choosing to be stubborn; Mental Health: he’s fine, he’s at a healthy weight, he’s probably eating more than you think). We have made all the mistakes in the book – pressuring, bribing, blackmailing, shaming, etc.–**none of which worked, by the way. Once I found you – over a year ago – we let so much of it go. He didn’t eat more/better, but it was less stressful for all of us. Unfortunately, something always comes up. He is now acting out at school and long story short was assessed over the summer and diagnosed with anxiety, depressive disorder, and ARFID. There is a new path to follow of what issue to seek treatment for first — I’m being told OT (but I’m worried that’s going to be the same useless path as before), behavioral therapy, individual counseling, etc. It’s overwhelming and I find myself back here just to get a little psyched up for another journey and potential battle. So thank you!!!
I highly recommend the work of Dr Ross Greene (book – Lost at School and livesinthebalance [dot] org). Keep in mind along this new path you’ll travel… it’s the therapist, not the therapy, that makes all the difference. Thanks for the love! xo
I wish to thank you for your blog it has opened my eyes to my sons picky eating habits we went shoppong together and he pocked his own food and now has started trying new thongs instead of the same thing I think ir book idea is good and I will definitely go to the shop to buy and read I dont know how long this intetst on him will last but I have never made a big deal on hos food habits school had a large part to play with his school meals and my husband dpesnt understand my spn at all as he is very old school and set in his ways ove even arranged to get him a private tudor as he has serious learning on maths called dysculia I only found that out on the internet aswell as your blog but its given me hope that he can grow and mature wothout any barriers please keep updating me I like your ideas and suggestions tjank you
hii also stumbled on your blog but it sounds like my son has the same problem with food , as a toddler he treid different varieties of foods and veg and fruit and aquired tastes and flavours but over the years the food has just dimished he doesnt like his food touching other food on his plate his favorite food is chips or mash potato he wont touch food he hasnt tried he will taste it but pulls a face and drops it i dont try and make him eat veg any more he will try peas or sweetcorn but it has to have grapes or a apple with it to take the taste away i just thought he was being awkward then i realised that he looks at packets too to find the food he is familar with if they have different packaging he will not try it sometimes companies change packaging on their food to entice customers to buy it . it took along time to convice my son that it was the same food inside he is now 15 yrs of age and i worry about his height and his weight as all he eats is chicken sausages as meat occasionally ham if persuaded lol he is willing to try and does take vitamins but will now not eat dairy products such as cheese or yogurt ive tried getting him to have milkshakes or saya drinks but he doesnt like the taste i dont get on at him about the food on his plate but do encourage him to use his knife and fork because if he hasnt washed his hands he can catch alsorts he has a short term memory loss so it is hard to get him to understand the importance of hygeine without reminding him all the time he does well at school but ive got his school on my back about his pack lunches which he does himself or lack of it , i really enjoyed reading that im not the only parent that has a child with this disorder it seems very common i just worry about my sons development if there is anyway to get more protien or calcuim into his system please advise .
Protein is quite easy to come by, even in a selective eater’s diet. Calcium, you would need an RD to really evaluate his diet to see what might be missing, and even then, he may not be deficient.
Keeping the stress out of mealtimes is important. Not only is anxiety counter productive to food acceptance, it is also thought to decrease the absorption of vitamins and minerals. Also helping feel comfortable around unfamiliar food will build his confidence with eating. I would recommend the book Helping Your Child with Extreme Picky Eating, and Secrets of Feeding a Healthy Family- both available in the Pantry Shop to guide you in supporting your son’s eating.
This is a helpful resource site for anyone dealing with selective eating issues. I’m an adult picky eater and can relate to it so much. Wish there’d been things like this around for my mother 50 some years ago when I was a little squirt just starting to have these issues! Might have saved us both a lot of grief. I still struggle with it though I’ve managed to expand my food repertoire somewhat. But like many others I can also “lose” a food or group of foods again. I have anxiety problems, ADD, and OCD, and can sensory overload quickly in several ways. Autism is present in my maternal side of the family. My late mother herself wasn’t a picky eater but she had trouble with a strong gag reflex and in the last years of her life had a feeding tube. So I believe there are many genetic links even if they are difficult to define and manifest differently in different individuals.
Thank you! Research is starting to emerge and shedding much needed light on just how complex and diverse the eating spectrum under the umbrella of ARFID is.
Wow! Thank you!!!
Key phrases that strike me: specific brand preference even for “favorite” foods, “willingness” to not eat rather than eat something new/other/different, and “gag reflex”!
My 23 year old has always been very selective in what he’d eat – and the quote about “losing” a food/group when a change is enforced struck home with the memory that when I stopped peeling my son’s apples (on the rationale he was old enough to peel them himself), he just stopped eating them altogether!
I am thankful that fairly early on I “gave up” and didn’t force new foods on him, and just made sure there were rolls available at large family gatherings… We eventually found the Carnation Breakfast drinks and a calcium/vitamin chew to “round” out his nutrition, but he pretty much exists on those, plus pizza, (dry) chicken ramen, peanut butter (and only grape jelly if in a sandwich), grilled cheese, cheerios, and a few other foods.
Two thoughts/questions: I have a very strong gag reflex (dental xrays were truly traumatic until one hygienist came up with the idea of a topical anesthetic), which has been passed to (all) my sons; but only the one is a selective eater. Is there any evidence of a genetic aspect to selective eating?
One aspect of his eating that I didn’t see mentioned was his preference for “perfect” foods: when he ate bananas, they had to be completely unblemished (peel and inside); although he now eats hot dogs, there was a time when he’d prefer to eat them uncooked if they were “burnt” in any way. Is this part of the Asberger’s/autism spectrum that I’m beginning to suspect he has or selective eating?
Thank you again – I feel like a huge guilt trip has been lifted off my shoulders!!
Hi Michelle,
What great questions! There is evidence (a study using twins) that suggests selective eating is a highly heritable trait. There is a gene that makes some individuals extremely sensitive to bitter tastes that others cannot detect. Human beings are very complicated.
As for perfect food – keep in mind that selective eating and the autism spectrum have anxiety in common. As bananas go, the flavour and texture changes as they ripen, and surprises are a great trigger for anxiety. When I was abroad, I found packages in the grocery that had unfamiliar characters I couldn’t read, and no photo or visual of the contents. I didn’t know if I was buying peaches or pancakes and I didn’t always want to guess. Essentially, it’s the same thing – we put a great deal of trust in the food we choose to eat. Selective eating is common on the spectrum, but the majority of selective eaters are not autistic.
Thank you for this blog… I feel vindicated finally. My eight year old has been picky ever since starting solid foods, and his safe food list has shrunk in the last 2 years. When he was a baby and preschooler he was in the <5% for weight, but now is normal weight, so it was hard for his pediatrician to get on board with our concerns about his eating. She gave us some names of therapists and there are several eating disorders programs here in the Baltimore area, but I still have trouble believing we'd be taken seriously at one of them. I am ready to try Dr. Rowell's approach, and have ordered her book. Thank you again!
My son at 6 lives off custard, bread buns and butter, chips and yogurts! He has never ate anything else and things that needs chewing he pushes them to the roof of his mouth with his tongue rather than chew them. I asked the doctor about this disorder when researching and all I got is ‘I’ve never heard of it’ apparently here it’s not looked into much! No one will help him he has been tested for ADHD, Autism and aspurges and apparently doesn’t have any. He has to take every vitamin going in liquid form because he can’t put anything hard in his mouth and has iron medicine everyday too. He is very pale but his weight is borderline they said. All they say is he’ll eat one day and give me advice however ive tried everything and I’m still persisting with it but he can’t even stand anyone near him with other food! His food on his plate is not allowed to touch either or he has a breakdown! I really need help with him x
I am late to make a comment but so glad to have found this blog. Our daughter had several allergies and reflex when she was little which made her not even want to drink a bottle by 4.5 months old. That was when it all started. Now she is 5 and although a joy in our lives , we rather be anywhere else than close to her at mealtimes. It is such a struggle to get her to eat. Mealtimes make us feel, like your blog is called, hostages! I read a lot of information in your blog, and decided to seek help. I want all of us to be happy at the table. She will be having an evaluation from a OT next week. We hope to get the help we need. In the meantime, I will be tune to learn more.
Thank you!
Just a note to encourage other to seek help. Our daughter was accepted after the evaluation. she will be doing feeding therapy once a week from now on. I am excited to try new things and change the eating struggle into eating excitement.
Shachi, Thanks for reaching out! My email is ericacreighton@att.net. I would love to hear from you. And I hear you on mealtimes, the struggle never ends at our house. If you would please, just start by telling me your child’s story. I’ll write back and fill you in on mine and we can compare notes. I’m also curious what area you are in, we are near Atlanta.
Thank you so much for your articulate, sensitive, and thoughtful blog. Our son is 10 years old and has struggled with selective eating since he was about 2 years old. He has some very mild ASD traits, and immediately gags, vomits, and becomes extremely anxious when presented with a new food, texture, or odor. Around age 5, as the list of “safe foods” continued to shrink—and following a week during which he vomited every night at dinner—we felt desperate and called the behavioral health clinic at our local children’s hospital. The woman who answered the phone actually laughed when I described our problem, which, to me, only underscores how little awareness and empathy there is for this disorder. During our appointment, the possibility of an eating disorder was not brought up, but they did treat him from an “anxiety disorder” perspective, which was somewhat helpful. We worked on “self-talk” and managing anxious feelings, as well as slowly trying a few new foods of our son’s choice. While ultimately we didn’t add any new foods to the safe list, we did manage to keep the safe-food window from closing more, so I suppose in that respect the treatment was somewhat successful. But watching my little boy in the doctor’s office—trying so hard to eat a single green pea or simply touch a piece of deli ham to his tongue without throwing up—I could tell without a doubt that no matter what other people said, there was more going on than typical childhood picky eating or run-of-the-mill anxiety. Since then we haven’t pushed new foods on him too much, and have instead focused on keeping his diet as healthy as possible. I stumbled upon a helpful article about Selective Eating Disorder yesterday, which has led me to other excellent posts, like this blog. My question now is, what techniques have other folks with SED found useful? Is it better to keep introducing new foods in a non-threatening way? Or do we wait until our son is a little older and perhaps has more control over his gag reflex (it’s gotten a bit less touchy as he’s aged)? We’re just not sure what approach to take and there seems to be so little information out there. Any thoughts from the community would be much appreciated!
I have found these posts really helpful. My son is 19 and very underweight. I also think he is deficient in some vitamins because of some physical symptoms he has and that worries me. Food just doesn’t seem to be a priority for him, although he eats fast food when he’s out and eats the 10 or so dishes I rotate for dinner. He will eat some fruit if i cut it up for him but he never eats vegetables, going so far as to pick out bits from dishes like spaghetti bolognese and beef stroganof. If he’s home all day, he often won’t bother to eat at all. He says he just doesn’t get hungry much and he isn’t very physically active. If he does get hungry, he might grab a loaf of bread and eat most of it without butter or anything else on it. Then again, we went to France last year and he ordered snails to try. He only ate one and gulped it down but I was astounded. He’s a fraternal twin and was always harder to breastfeed than his brother. I also think in hindsight that he might have had silent reflux which could be relevant. I am a recovering control freak and all-around anxious mum and he is anxious and not very social. I place a multi-vitamin next to his plate at dinner but don’t comment if he doesn’t take it. He’s definitely happier and livelier when he does take vitamins. In the past, we have all commented on his eating habits but don’t now. Sorry for the long post but do you think I should just keep doing what i’m doing?
I’ve learned that weight is an unreliable standard to assess health. The average teenager can be expected to be unreliable about feeding himself. From what you describe, he can manage quite well around food – able to choose from a fast food menu, pick out what he doesn’t like, and eat what he does.
I think “anxious” comes with the mom territory. Being able to let go and trust our kids with eating is really hard. It sounds like you are doing fantastic!! 🙂
Hi there. First, you are an amazing mom. Second, you are doing a great job. Third, your son’s feeding issues are not because of you!!
Those are three things that all moms need to hear when dealing with this overwhelming issue.
I have a 2 1/2 year old and feeding issues are our life. He only eats puréed food and has never ever chewed food. Mealtimes are a battle where everyone ends up in tears. The threat of a feeding tube is on us everyday.
Just curious……did your son follow a similar path?? Reflux?? Puréed food only as a toddler??
We have gone through our fair share of doctors, meds, tests, specialists. Only to be told…..he will out grow it.
I just want to see my son eat and enjoy food, normal!!
Our path to eating struggles was PRESSURE. “Just try it, just a lick,” “What do you want to eat?” “You have to eat more before you leave the table,” and assuming he wouldn’t touch what the rest of the family ate so he got a different meal.
Reflux is common – no one wants to eat with a sore tummy! And it’s difficult to progress with developmentally appropriate textures when eating is painful. Poor little guy! 😦
Do you have the reflux under control? Do you know the triggers? Join over 900 parents supporting one another at
https://m.facebook.com/groups/142191142622854
Dear Mommytoboys, my 3 1/2 year old son is also still only on purees. Is there a way to connect so we can talk? I’ve never met another parent with this exact issue and would love to compare stories and what’s working and what isn’t.
Dear Mommytoboys and Erica Creighton,
I have a 3 year old boy with reflux and still on mashed/pureed food and mealtimes are never ending struggles. I would love to get in touch.
I came across this blog while doing some research on my selective eating. I’m a 28-year-old male who lives in the United States and I’ve had strong taste aversions ever since I was a toddler.
For the most part, I don’t think my selective eating prevents me from living a fulfilling or healthy life. I like certain things from all of the food groups and eat a balanced diet. What others don’t seem to understand is that I’m content eating the same things over and over (I have pasta for lunch almost every day and I don’t feel like my aversion to shellfish prevents me from enjoying so-called delicacies such as lobster or oysters) and if I don’t like what somebody else has served me then they need to not take it as an insult.
One of the issues I’m going to have to conquer is the fact I recently moved in with my girlfriend, who likes to cook and eat things I don’t like. I’ve already admitted I’m a selective eater, but it’s still embarrassing when she asks me if I like something she might want to prepare and I have to tell her I don’t like it.
I have become better in recent years when it comes to being able to eat and swallow certain things I don’t like without gagging or feeling nervous, but eating some foods will always be a bit of a chore for me. This helps in social situations (being able to eat without gagging and offending whoever prepared it, or going to a restaurant that serves food I don’t like), but I’ll probably never truly enjoy those offerings.
Then there are things I know I’ll NEVER like: casserole, potato salad, oysters, shrimp, nuts, Thai food, etc. Things with a lot of things mixed and/or really strong or hot flavors are my kryptonite.
For those of you reading who know somebody who is a selective eater (either a child or an adult), here are a few tips: DON’T be judgmental or tell the person they are weird. Turning eating into a stressful situation will only make things worse. DO encourage them to try new things, but don’t dwell on it if they don’t. And DO understand there might be items they’ll never like and don’t force them to keep trying them.
Thank you, Joey Joe Joe! 🙂 I’m really pleased to hear you have come to amicable terms with SED, as have we. Your tips will surely be helpful to many. 🙂
I am so happy to read this!!! I am exactly the same way. For years its caused nothing by anxiety and a feeling like I am some outcast, freak. Eating out with friends was never possible as they always made me feel bad about it.
I am 33 now and I still cannot eat anything that is “mixed” or spicy so most casserols, thai food, indian food etc. I love my meat and potatoes, french fries, I am lucky in that like some veggies and fruits, apples, carrots, green beans, corn on the cob, frozen peas. No veg from a can and dislike most sweets. And my own pasta meat sauce – but thats it for sauces. If its cream based, forget it.
My mum says that I use to eat more when I was little, but then I turned 4 and refused just about everything – I honestly can’t remember but hope my son does not inherit what I have. I don’t force him, I don’t starve him, I just keep presenting new foods and see what works – mostly mashed potatoes, but he recently ate broccoli! (took me till I was 15 before I’d eat it)
Thank you so much for posting this!
While reading your message, I was instantly taken back to the dating days of my own life. My husband sounds exactly like you. I enjoyed cooking, however after marriage and several years of him quietly discretely picking things out, being polite but not eating so many things, I decided it wasn’t worth it, he killed so much of my joy. His food issues affected our friends. They were offended and didn’t invite us out anymore. It was a slow process of less and less BBQ’s, dinner date invites, etc…It affected our social scene as a couple, individual friendships, my cooking joy. He felt the whole time he was very polite, very discrete it, etc…and it was their problem. They shouldn’t be offended. Fast forward, And then came kids. One of our kids is a very picky eater. My husband had to step up and start eating things he did not like to role model for our child and our child’s anxiety around certain foods. I found this phase of life hilarious! Watching him doing his best to not grimace while the texture of certain foods grated on his teeth, or the taste of certain foods were overwhelming his tastebuds. My husband was/is a champ and he will suffer thru, eating almost anything for the sake of his kids. He even popped a pearl onion into his mouth e other night, we can say he is NOT AN ONION MAN! He has learned to over come so many of his food aversions. His whole personality has changed. He is so much more positive and happy in his daily life. I ask myself why this couldn’t take place 25 years ago, who knows. Kids are a game changer for sure! I still HATE cooking with a dreaded passion due to the history! But the consequence, he helps cook! I wish you the best in your relationship, but I advise not complete contentment. Know those around you are sacrificing themselves for you because they love you and a good healthy compromise comes from both sides.
I am 29, and have suffered from this my entire life. For over two decades, I tried to explain it to people, only to be met with skepticism, frustration, disbelief, and mockery. Because of these responses, social eating became my worst fear and most hated event. The more pressure that was applied, the worse it got. Then, experts slowly started to pay attention to it. They gave it a name. It’s amazing the power a little name carries. Now, with a name, people believe me (sometimes, at least). Now, those of us afflicted with this disorder can find each other and most importantly, for once in our lives, feel normal and accepted among each other.
I believe that the most important thing someone can do for a person with this disorder is to accept them as they are. Don’t emphasize changing them, because it makes them feel like a freak, and it only makes the problem worse. But when people work WITH us instead of against us, it makes a world of difference.
I just found your blog, and I love it. Thank you for providing a mouthpiece for us.
I just stumbled across you blog. It’s very well done! I am the mother of a picky eater. She has been treated at Duke. That was about three and half years ago. She’s made good progress but I fear we are stalling out – it’s a long battle that I fear will never end. Would love to exchange ideas and things that you try with TJ. If you would be up for that. Again, thank for creating such a great blog to help people understand that this is a real problem.
I’m very excited to read your blog. I am a speech therapist that works with children like TJ. I have been working in the field for 15 years and have been moving away from traditional interventions toward a trust-based, integrated approach. Your words and experience speak to what I have seen as well. I also grew up as a selective eater and over time have broken free of many fears I had placed on food as a child. I love to see the thoughtful approach and wisdom you are using with TJ. This type of perspective was not available for me when I was a child and I do believe it would have made a huge difference. I will make sure to send my families to your blog for your insight and support.
Thank you SO MUCH for your blog. I’ll echo the sentiments of the others before me. I’m an adult woman with selective eating issues and this has just been an enlightening and emboldening read for me. I’ve started “conquering” many foods on my own in the last year, mostly for health but also for social reasons. Selective eating can be such a cause for anxiety in social situations. Outsiders will never know how individuals like TJ (or me) are conflicted and anxious every time they’re faced with a meal in the presence of others. That is, unless people like you continue to speak out. Thank you for being a voice for the previously branded “picky” eaters.
I cannot express to you what I am feeling as I read your blog and the replies from your readers. THERE ARE OTHER FAMILIES LIKE MINE OUT THERE!!!! My son is now 16 and is EXACTLY what you describe as SED. He’s never eaten a meat or veggie or fruit… His food of choice is bacon…turkey bacon… And only Jennie o brand.
I have been searching and searching for help. No body and I mean NOBODY had answers. Your blog is a light for me….thank you
I came across this website in my search to figure out what is “wrong” with my 3 1/2 year old daughter. It is refreshing to read other similar stories. I am pretty much at my breaking point. And if I am told one more time, she is ” just picky” or ” she is trying to control you” or ” let her go hungry” I think I might loose it 😦 I just figured she was a really picky eater. I always tried to introduce new foods and things that were refused always re-presented. But things never got better. She will eat snacks, like crackers, pretzels, and goldfish all day long if I let her. Her current “dinner diet” consists of peanut butter and jelly, grilled cheese, pizza, yogurt and cheerios. She will also eat fruit, but only bananas, grapes and apples. I know this may seem like a variety but it is challenging. What really has bothered me and what makes me feel like this is more than control, is when trying something new, she will gag, choke and cough. When she sees something new, she covers her mouth and looks like she is in fear! I tried to have her try a chicken nugget the other night ( not healthy, but a “normal kid food”) After much coaxing, She eventually took a bite, but refused to swallow. She seemed almost fearful, She literally kept in her mouth for more than 20 minutes. I was not sure what to do? If I let her spit it out, she got to “escape” but having a chicken nugget in your mouth for more than 20 minutes seemed like torture 😦 I eventually told her to spit it out.
I know my little girl and I really do not , in my gut, feel as though she is trying to control me. I am puzzled b/c in a lot of the reading I am doing she does not fit the categories associated with SED……OCD, ASD, SPD, oral motor delay, swallowing disorder, Intestinal disorders. She is a very active, social, typical developing 3 year old. I just do not know what to do??? Wait and see if she out grows this, Keep making her try new foods and watching her gag ? 😦 I want to do the right things for my children and want them to be happy and healthy, what all parents want! I just feel very frustrated and until reading this blog, very along and judged 😦
There is ALWAYS a reason why a child avoids food. She has acquired the items in her current diet because, for some reason, she trusts them. They don’t hurt, are easy to chew/swallow, predictable textures/taste, etc…
It is worthwhile to investigate and rule out possible causes (is she physically able to properly manipulate food in the mouth? Is there a food sensitivity/allergy? Digestive issue? etc.) Selective eating often includes anxiety experienced around unfamiliar food.
I recommend you order and read “Love Me Feed Me” by Dr. Katja Rowell. I wish I had this book when my son was 2-3, when we first realized he was more than being “picky”. I also suggest joining the FB closed parent support group (Mealtime Hostage – The Group).
Your daughter is not trying to control you, fear is shutting down her hunger and what she sees on her plate doesn’t look like food. There is hope and there is help.
Light bulb just went off here. I’ve been baffled at my son’s transition from a toddler willing to try anything to a preschooler who seems to like fewer and fewer foods.
I blamed feeding those darn pureed pouches – maybe they did cause textural issues. And I was a bit squeamish about huge food messes so I’d try to offer “cleaner” offerings at first (not to the extreme but if you’ve dealt with a kid who hardly eats, you really look for any answer).
Then I blamed my mom. Her diet is very carb heavy. I thought being in her care was part of it. Knowing if he was hungry, he’d be at grandma’s soon so he’d get crackers and pretzels and all that. I tried following all the advice – if he’s hungry he’ll eat. I’ve cried over it, feeling like a failure.
I just found out he has cavities and I believe diet is a huge factor in his case. Breaks my heart. But I’ve spent enough time feeling guilty and unfit. I decided today to do something so I began researching.
I just couldn’t figure it out. We recently discovered he has a peanut sensitivity and it would all make sense if that was the issue. I think he does have the sensitive temperament described as well.
How can we heal this fear? He just turned 4. I don’t know that he has this condition because he often happily tries new foods but just the tiniest bit and moves on nonchalantly. He just seems to have stubborn preferences. He used to refuse hamburger meat – now burgers are one of his staples.
Anyways, please help! Should I talk to him about it? Ask if it is because of bad peanut experiences? He us very intelligent. I don’t know what to do.
Big hugs! You’re a great mom doing your best with the tools you have, as we all do. Kids with sensitive temperaments are typically very … well… sensitive. They thrive in areas where they feel confident and withdraw/avoid from situations where they perceive success is unlikely. It’s not anyone’s “fault”, it just is.
It’s pretty typical for a 4yo to have “stubborn preferences” for food, in fact, it’s quite normal for kids between 2-6 to be inherently cautious about anything unfamiliar – especially around food. The good news is it sounds like whatever negative eating experiences he may have had don’t seem to have entrenched into a disordered eating attitude. He’s cautious, and slow to warm up to new food, which is understandable for his age and eating ability. You can support him by continuing to expose him to new food experiences under neutral, no-pressure terms, and be patient with his very slow progress. I would recommend the reading resources in the Pantry Shop – the wisdom of Ellyn’s Satter (RD), Katja Rowell (MD), and Jenny McGlothlin (SLP) is comforting, plus the strategies are very sensible and possible for any parent struggling with feeding.
If you’re on Facebook- parents who are intimately familiar with the struggles you face are at https://www.facebook.com/groups/MealtimeHostage
I’m 19 years old and I have struggled with this since I was a toddler. My parents tried everything to get me to eat but it was a terrible and horrifying ordeal. I remember going to friends houses and their parents not letting me eat dessert because I wouldn’t eat what they had made for supper. I would hide my tears until I got home wondering what was wrong with me, but if I tried it I would gag. Luckily my parents took the route of, lets make her everything she will eat, instead of, you better eat it or you’ll starve. By my teen years I was able to expand my preferences about 25% to this point now. But it’s still an ordeal, and just something I have to live with. I really appreciate this post, I thought I was just messed up.
You aren’t messed up at all, in fact, you are one of many. Duke University’s adult picky eating study (at last count) had some 30,000 respondents.
I’m so glad that they are finding out what’s going on. If only my parents and I would have known. I’ve been struggling with anemia and malnutrition because of it, and only now have I reached healthy weight. I’ll definitely be following here. Thank you so much for sharing.
I also just happened to stumble across the almost by accident and this sounds SO familiar to our everyday life with my son who is now 16…. People are shocked when i tell them what he will only eat. I’ve had parents call me while he is at a sleepover “concerned” that he isnt eating what everyone else is, though he is perfectly content to NOT eat that stuff… No meat, no fruit and no veggies. Shredded cheese only, no bread, pasta, casseroles, nada..Drinks white milk (not chocolate), will eat vanilla an choc chip ice cream but NOT if it has melted too much and definitely not a shake! Will however eat ANY kind of chip, snack, cracker, fruit snack, fruit roll up, most cereals, and pretty much anything chocolate that is candy. I have looked and looked online to try and find other who have children like my son and never have. All the pediatrics we have been to have always believed he IS just picky and CHOOSES to be like this tho i continue to try and explain to them that this is something physical that makes him actually ILL to be around food he doesn’t like, even the smell of certain foods still make him gag! He eats less now as a 16 year old than he ever has which is sad for me since I really thought that the older he might actually try new things. Some of the things i do not understand would be he would eat a funnel cake knowing the batter is the same as a pancake or waffle, but wouldnt touch either one of those with a 10 for pole or for a $100 bill (which my father has offered to him several times on several occasions to try various foods). I would love to hear of other families that are and have been dealing with this. There is NO way to explain to anyone else what it is like for your child to not be eating what they are “supposed” to and that you CANNOT as a parent physically make them.
He has NEVER just sat at the table eating whatever it is that he eats for that meal with us because of the food whether it be the smell or look or whatever… that is sad to me but it has happened for so long that “it is what it is” and not going to change. The child has never had a burger, pizza, grilled cheese, mac and cheese, hot dog, green bean, mashed potato or any of the other typical kid foods.
So glad you stopped by! 🙂 I wish I had the information I do now when my son was younger. It would have saved me a lot of stress and worry.
I’ve come to accept that what my son eats is not nearly as important as helping him to feel “normal” around food and to let him enjoy what he can eat. With all the focus on eating healthy, knowing that my son can still grow up to become a respectable citizen without ever having eaten a vegetable takes a lot of stress out of meals. Building that foundation of trust has started to open up his willingness to want to try new things. It’s a start.
Getting here (after a lot of stumbling) has been a process of very very small steps, but the good news is we have only been following Dr. Rowell’s Trust Model from “Love Me Feed Me” for a few weeks and trying to remove all pressure for just a few months. I was certain there was no hope for us. As much as this probably sounds like an infomercial, there are answers in that book – written by a physician – and she really gets it!
My research tonight, along with stumbling upon this blog, may have just changed my life, and that of my resistant eater. Before tonight, I didn’t even know that term existed. I just thought he was stubborn. Now I feel terrible about the tactics I have used over the past couple of years to get him to eat: bribes, screaming, crying, shaming him… I just didn’t know. His pediatrician, along with everyone else, just told me to withhold his favorite foods (all 6 of them) until he ate. After all, it’s against human nature to starve when food is available, right? Yeah, been there, tried that (twice), caved on Day Three both times. I just couldn’t see my baby suffering like that. He will gag or vomit if a new food enters his mouth. Absolutely NO meats, fruits, veggies, pasta, or condiments, and very little dairy. No yogurt or pudding, and cheese is only allowed when melted (in grilled cheese or quesadillas, but even these cannot be made at home – they must be from a restaurant). It is an all carb party, and only peanut butter is invited.
Other than the eating disorder, he is perfectly normal. He is intelligent, social, funny, energetic and loving. However, he is also a bit more risk-averse than normal and has a slight tendency toward hoarding behaviors. Not sure if they are related, but hoping to seek out some professional help to rule out any possible OCD issues.
It is amazing to know that we are not alone in our struggle. I am tired of what I call Battleground Dinner. It is stressing out my son, and our approach to my son’s “issue” has even created struggles in my marriage. No longer though…I think we will be on the same page now.
I applaud you for this blog. I can relate to your son’s struggle with food more than anyone could ever know. I am now 26-years-old and even to this day have difficulty with food and everything that has to do with it. (I have been diagnosed with OCD). Many people in my family don’t understand it and its upsetting they dont accept me for who I am and not for what I do or do not eat.
Thank you so much for bringing this to light. I am definitely going to ‘stay tuned.’ 🙂
God Bless. 🙂
Thank you very much! 🙂