Tuesday, October 15, 2013

When Has Picky Eating Gone Too Far?






This topic is long over due around here. Many parents consider one or more of their kids to be a so called "picky eater".  But what does that really mean? If you scroll the comments on this blog, you will see a whole spectrum of picky eaters, from parents looking for advice for a child that is refusing several vegetables, to one that is gagging at the site of food. Do they all fall into the same category? Hardly. Moreover, a few well-intentioned, but vastly incorrect comments about how parents need to just give their kids some tough love when it comes to eating.  That may work for some kids that fall on the picky eating spectrum, but for others it could be disastrous - leading to a feeding tube.  That may sound dramatic, and although it is unlikely, it is possible.  So how does a parent know when they need to be concerned? When does picky eating go too far?


The SOS Approach to Feeding, by Kay A. Toomey, has clearly defined when a child falls into picky eating and when they are problem feeders.  The term, "problem feeders", is one that few have heard of, but the distinction is important.  Generally speaking, picky eating can be a normal part of childhood, albeit annoying and frustrating. Problem feeders are beyond picky eating and usually need the help of a feeding therapist to make progress eating new foods.  In these cases, eating is actually a problem for the child and the family, general feeding advice often doesn't apply to these kids, I'll elaborate more on that in a minute.  I have used these guidelines for years to determine just how serious a child's picky-ness is.

Picky Eaters:
  • Have at least 20 foods in their diet.
  • Eats at least a few fruits/vegetables, carbs, and proteins.
  • Can be coaxed to occasionally try new foods.
  • Usually will eat foods similar to preferred foods. For example, will eat a variety of chicken nuggets or pizza, they will typically not reject different brands or styles.
  • Sometimes eats foods different than the rest of the family.
  • Will suddenly refuse a food they have preferred, but will eat it again in the future.

Problem Feeders:
  • Eats less than 15 foods consistently.
  • May gag or vomit at the site or taste of foods.
  • May become emotionally upset when a they are encouraged to interact with non preferred foods.
  • Refuses large categories of foods (i.e.: vegetables, meat, etc.)
  • May insist on foods being preferred in specific ways or will only eat a specific brand/style of food.
  • Almost always eats food different than the rest of the family.
  • Will suddenly refuse a food they previously preferred and never eat it again.

SOS has a .pdf form here of the differences between picky eaters and problem feeders, if you would like to print one out. Keep in mind that the lists above are just guidelines and if you aren't sure where your child falls or you feel confident they are a problem feeder, consider having a feeding evaluation. Usually, that is completed by an occupational therapist, like myself, or a speech therapist. If your child is under 3 and in the states, you should qualify for a free evaluation. More info on that here. I also offer consultation services via phone, skype, or facetime. Get details by clicking the link or the tab in the menu bar at the top.

I mentioned above that problem feeders typically don't usually respond to general feeding advice - which isn't the advice I am giving here. All of the strategies and tips I share can work for picky eaters and problem feeders, BUT problem feeders likely will need some additional strategies that need to be determined on an individual basis. Also, the one piece of advice that will not work on a problem feeder and that you will never see here on Your Kid's Table is to: serve your kid what your eating and they will eventually get hungry and eat. This is a huge myth and many well meaning people love to dispense this advice: Moms, Grandpa's, neighbors, and friends that haven't had a problem feeder. Many problem feeders will NOT eventually eat, they will end up in the hospital because they are starving. Fortunately,  parental instincts tell moms and dads this and they usually don't try or give up on this approach quickly.  That isn't to say that the problem feeder should be allowed to rule the roost, either.  I address some of these key points in Basic Strategies to Improve Eating- a great place for a parent of a problem feeder or picky eater to start.

If you think you do have just a picky eater, it doesn't mean that eating can't or shouldn't be improved.  A consultation may be beneficial, and perusing the article index in the menu bar, because it lists all of the picky eating articles - and there are a lot! If you have more questions about a consult, don't hesitate to contact me at YourKidsTable@gmail.com 


15 comments:

  1. Thank you so much for finally saying what I already knew about my 5 year old son. So many people tell me to be strict, don't allow him to get up from the table, give him what is for dinner and nothing else. My poor son would starve if I did this and I try to tell them and they do not seem to understand. People look at me like I'm crazy when I would let him eat oatmeal cookies for breakfast just so his tummy would be full. As he gets older he is more accepting towards foods and he is growing into a picky eater but there was a time around age 3 when popcorn and apples and dry cereal was the menu for the day! The children's hospital feeding team was no help either he just basically had to grow out of it! Thank you for this article though it was really helpful.

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    1. Thank you for your comment- so many people share with me a similar story! I'm glad it is getting better and so sorry that the feeding team wasn't any help. There are a lot of good feeding teams and therapists out there though, if you ever want to get a second opinion.

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  2. My 7-year old is on the threshold between picky and problem. I suspect sensory issues play a part. And she will go hungry if we don't provide the foods she will eat. Thankfully, over time, she gets a somewhat balanced diet over time with fruits, rice and quinoa and dairy. A huge blessing occurred this fall with her acceptance of peanut butter- another healthy fat and protein! I took her to an OT who supposedly specialized in children with eating issues. It was disastrous. My daughter and I both left crying, and I got the unhelpful advice to offer her more of what the family eats. Thank you for delineating the difference, and confirming that the methods to manage their diets are different as well. Blessings

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    1. I'm so sorry that your experience wasn't helpful either. It sounds like you guys are making good progress, but keep in mind there are good therapists out there that might be a better fit for you and your family. They would hopefully be able to resolve some of those underlying sensory issues. Make sure you check out my Basic Strategies to Improve Eating and the article index, where there are a lot of strategies to improve variety. Thank you for your comment!

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  3. I loved reading your articles. It an certain I have a problem eater ohand. He wasn't always like this though, as a baby he had a huge appetite and loved eating off my plate. At 6 month, he got dysentery resulting in food aversion. I still managed to purée foods and feed it to him while playing and singing. Again at 13 month he got the stomach flu, where he was hospitalized with severe vomiting and dirreoah. There was blood in his stool and the blood test revealed he was anaemic with below normal levels for iron and vitamin D. The doctor put him on multivitamins. However, feeding from that point on has been a nightmare. As a mother, I panicked. Against my better judgement, I started force feeding, using the TV and only giving him puréed food till he was two. Slowly,I started sneaking chicken and veggies in his food while I distracted him with puzzles and crayons. The birth of my second child aggravated his disorder. Now at four, he only eats buttered rice, Nutella with bread and some fruits. He is averse to textures and sauces, even ketchup. The hardest thing on my plate is to feed him chicken and eggs. The food therapist suggested the cold turkey method, but he has gone days without eating. Please help.

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    1. Oh boy, well, I wouldn't want to go against something a feeding therapist said, especially since I am not working him directly. However, I can't think of an instance that I would recommend going cold turkey. I am going to be honest, when you have a problem feeder it takes a lot of time to make real changes. Start slow, with my Basics to Eating Tab at the top of the page. Then go to my article index, see the posts on Picky Eating: Expand What Your Kid is Already Eating and Exploring new foods. I'm not sure of where you are located or if it is possible, but if so I would consider getting a second opinion. There is no pressure at all, but I'm also available for consults, which would allow me to get a complete history and give more specific strategies. Let me know how it goes!

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  4. I have a two year old son who most classify as a picky eater including his pediatrician. However, I am not so sure. When your describe of 20 vs 30 foods (problem vs.picky), does deli meat count as one type or would diff types of deli meat classify individually? He was diagnosed at 1 to be severely allergic to eggs and tested positive for a nut allergy (both a RAST and Blood test). This Jan he took the peanut component panel allgery test and the results came back negative. Our allegergist wants him to do a food challenge, but I know he won't eat peanut butter and am trying to get him to broaden his pallet so we can get real answers to his allergy. Any suggestions? The Allergist is afraid the longer I wait the more harm I am doing to his possibility of outgrowing his peanut allergy.

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    1. Every individual food is counted as a specific type and goes towards the total, BUT if you have more concerns I wouldn't hesitate to get a feeding evaluation and get another opinion. Pediatricians are in a tricky position with picky eaters- they don't have a lot of training in this area and see kids all day long that aren't eating well but seem to be growing. I have seen so many kids that desperately needed help and it was delayed because a doctor said they would grow out of it. As for the peanuts- will eat a peanut butter cookie, cupcake, or the sandwich cracker? Some trace of pb just needs to be in the product as a first step.

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  5. Thanks Alisha. The list of foods my son will eat just grew now that I know each type of deli meat, or yogurt flavor he eats counts individually. Unfortunately I cannot bake the peanut butter into anything. When they do testing he has to consume 1/4 tspn of pure peanut butter 4 times througout a 1/2 day testing. I am currently trying soy butter and sunflower butter on diff types of crackers/breads, but with no luck.

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    1. Right, I know they want you to get that amount in, but with a picky eater that can take time. I know it won't help for their specific test, but it would still give you good information if he eats pb in any form. Using it in cookies and breads will help him get used to the flavor. Also, have him help you cook with it- a severe reaction would show up if even touched it. This will also help him get used to the smell and texture and closer to eating it. Keep trying consistency is the key.

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  6. Hello, my son is borderline picky eater/problem feeder. He will eat any type of bread, noodle, carb. He is a carb a holic. I can't complain too much though because he still eats black olives, applesauce, yogurt, raw carrots-not cooked, corn, grean beans, peas, and pretty much any kind of bean minus refried. He will not touch meat, chicken, sausage, brisket whatever kinda meat you can imagine. He will eat chicken nuggets, but not chicken strips-because when he bites into it, the white strings as he calls it are all stringy and he thinks its gross. So, do you think I'm alright with what he does eat? Should I be thankful he even eats that? I myself have texture issues, so I get it...But. I also feel like his food is the only thing he can really control in his life, so he pushes it to the extreme. Usually every single meal I have to make him something different. Its a pain! Help!

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    1. He does have a decent variety of food and meat is notoriously difficult for a lot of kids. I actually have a post devoted completely to that, which you can find in the article index in the menu bar at the top under Picky Eaters. I think you'll find a lot of helpful tips there. I would strongly recommend setting up a meal and not catering to him. Try to eat together and have one food you know he will eat at each meal. Let him know that if he doesn't eat that is fine, but he won't be having anything until the next meal. I cover a lot of this in Eating Basics in the menu bar. If you can make the changes I talk about there it is very likely you will see some nice progress. I do totally agree with you about the control, which is why it is important to not let meals turn into a power struggle. Let me know if I can be of more help!

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  7. Alisha, my 7 1/2 year old ate evrything I put in front of him as a baby and toddler. Fruits, vegetables, small amounts of meat, fresh baked bread, gluten free items, nuts seeds, if it was healthy he was shocing itbin his face. Then around three, I began letting him stay at his grandmas house. She fed him chocolate milk, freezer pancakes, buckets of ice cream, donuts (she evn called ahead to the bakery so that his favorites would not be sold out) spaghettios, well you get the picture. Also, my older son who was about 7 at the time began gaining weight like crazy. The younger all but stopped eating at ALL. I could not figure out what was happening! My MIL made the boys swear not to tell me about the "fun goodies" or they wouldnt get them anymore. It would be two years of diarrhea, weight loss for one son and weight gain for the other before I figured it out. Grandma was junk fooding my kids to death. We are still working hard to recover. Both boys were diagnosed with a milk allergy so theres where the diarrhea came from. The youngest refused to eat at home and passed out in the bathroom. He then realized he had to eat something and it was chicken nuggets. He still refuses fruits and veggies except apples without skin and baby carrots. He was eating watermelon and now says no thanks. Every day is a struggle thanks to the selfishness of one person. If there is anyonebout there who child is struggling and you cant figure out why, start investigating their diets when away from home. It might just save your childs life.

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    1. Oh my goodness, what a terrible situation. I hope you can find some helpful tools here. Thanks for sharing your story.

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