Picky eating in children is a topic that concerns many parents and caregivers around the world. Generally speaking, people use the term “picky eating” to describe a range of behaviours, including developmentally typical food rejection and clinically significant feeding problems. Therefore, using the term can have a different meaning for each family.
Picky eating can be defined as consuming a limited variety of familiar foods and rejecting unfamiliar or new foods.
Developmentally typical food rejection is more prevalent in toddlers and preschool-age children (2 – 6 year-olds). Children may exhibit strong food preferences, aversions, and a limited range of accepted foods during this period. Many children gradually expand their food preferences and become less picky as they age. When reaching adolescence, most children have developed a broader palate. However, that is not to say paediatric feeding problems are always typical, and a child will “grow out of it”. In some cases, avoidant and selective eating behaviours can persist into adulthood. It is worth noting that many adult selective eaters are healthy and lead fulfilling, happy lives.
When I use the word "picky", I use it to describe a child's eating and not to judge a child or describe the child as picky. Other terms, such as selective or avoidant eating, are more accurate and neutral descriptions; I will use them interchangeably in this blog.
Over the years, as a dietitian-nutritionist and a parent, I have noticed that selective or avoidant eating is surrounded by myths and misconceptions that can make the experience even more challenging for parents and children. If I am honest, I believed some of these in the past. So, in this post, I want to debunk some of the most prevalent myths about picky eating in children and provide a more accurate understanding of this.
Myth #1: I am alone in this.
Social media posts of your best friend’s child happily eating a bowl of kale chips can make you feel alone in your experiences of feeding your selective eater child. You may have mentioned some of your feeding challenges to friends and family (or perhaps a healthcare worker), only to have your concerns dismissed or subjected to well-intentioned but mostly unhelpful or inappropriate advice (“Yes Karen, I have tried just serving something else?!”). This only further increases your feeling that you are alone in this challenge.
Evidence shows that picky eating is common.
Prevalence is tricky to measure, but the parental perception of their children’s pickiness with food ranges from 10% to 50%, based on studies in the United States, Australia, the United Kingdom, and China. In Singapore, nearly half of the surveyed parents (including caregivers) perceived their child as a picky eater, and a third of them would consult a doctor about their child’s eating behaviour. More extreme feeding challenges, such as ARFID (Avoidant/restrictive food intake disorder), are estimated at 1-5% of the population, but studies are still inconsistent as it is a newly diagnosed condition.
Fortunately, with the rise of social media, there are increasingly more supportive and non-judgmental communities to access support and resources. This is one of the reasons I created an online social community at Karlien, Dietitian.
Myth #2: Picky eating is the parent's fault.
The most prevalent misconception is that selective eating behaviours are mainly the parents' fault, specifically the mothers. When a child has specific feeding challenges, parents often experience shame and stigma. Every day, I see messages, either directly or implied, that tell parents (especially mothers) that if they do everything right, their child will love broccoli as much as sweets.
And so, when a child doesn’t like broccoli or can’t even be in the same room as it, it must mean they have done something wrong or didn’t do something they were supposed to and, therefore, failed.
It is also not uncommon for parents of adventurous or “good” eaters to understandably but incorrectly believe that their approach to feeding and parenting is the key reason for their child’s sophisticated and elaborate palate.
We know certain caregiving behaviours can be helpful or unhelpful in supporting a child with selective eating behaviours. However, that is not the same as saying they are the reason for the problem. That is why many families with selective eaters have siblings with more “typical” eating behaviour.
What is accurate, and I have said this before, is that feeding challenges can be distressing and significantly impact a parent and the rest of the family. Caring for a selective eater often influences how we feed a child. Many parents and caregivers resort to coercive feeding practices (using pressure or reward) out of fear, frustration, and desperation, with varying results. Many families may also have received inappropriate or unhelpful advice for their situation, potentially making matters worse. But the desire to help your children eat a healthy, varied diet is entirely separate from the notion that you caused your child’s difficulties as a parent.
So, whether you blame yourself or someone else blames you, please believe me when I tell you it’s not your fault.
The reality is that many uncontrollable factors influence a child’s relationship with food and eating ability. Most of those we know about are intrinsic to the child (such as sensory profile), and some are extrinsic (such as the feeding environment) – which I will explore in more detail in the next point.
Myth #3: The child is spoilt, naughty, stubborn, or manipulative.
I don’t like using those words to describe a child’s behaviour in any situation. But we know all children, not just those with selective feeding behaviours, have times when they experience big emotions, display challenging behaviour, and have developmentally typical boundary testing. But a child not wanting to eat is not naughty or manipulative.
Not understanding typical development and feeding can create misguided worries, inaccurate labels, and inappropriate interventions.
What many new parents find surprising is that typical eating for a child, especially an infant and a toddler, is unpredictable. Children often eat large amounts on some occasions and little on others and can change their likes and dislikes on a whim. Children have long been known to have an innate capacity to regulate their energy intake. There are periods when it is developmentally appropriate and psychologically healthy for children to be more cautious of new foods and strive for autonomy.
Also, our palates are influenced by many things, including our genetics. Although we need more research to determine its links with selective eating, we know there are supertasters (people able to sense bitter tastes and other flavours more intensely) and non-tasters (with fewer taste buds and less ability to taste) which can significantly impact the eating experience of a young child. Furthermore, theories based on evolutionary psychology have proposed that when children become physically mobile (in early toddlerhood), to reduce the risk of eating poisonous items, a wariness of brightly coloured, unfamiliar foods and an aversion for bitterness may have been protective.
Thirdly, learning to eat solid foods is a complex, multi-sensory, and multi-step (31 steps to be exact) experience and takes about two to three years for a child to learn.
Certain sensory profile temperaments (such as tactile defensiveness or sensory sensitivity), developmental delays, or any challenges with oral-motor development or sensory processing can predispose a child to develop feeding challenges. About 80% of children diagnosed with developmental delays are described as picky eaters.
Finally, I have spoken to many families where a child with an underlying medical condition such as reflux, constipation, or food allergies, or who had a negative experience around food or eating (e.g., choking or a tummy bug) started a child and his parents down the path of feeding difficulties.
Many other factors may affect avoidant eating that we are only beginning to understand. For example, some studies have found the unique interplay between parent and child factors relevant. So, in summary, avoidant eating is complex, and simply blaming a parent or a child is neither accurate nor helpful.
Myth #4: If your child is growing, you don't need professional help.
There are situations like if your child’s growth falters or they cannot meet their nutritional requirements through food alone, when you need to consult a health professional with expertise in feeding challenges, such as a dietitian. However, research has often found that many selective eaters had typical growth and weight, and using this as the only measure ignores other equally important factors that may warrant seeking professional support. Your child also doesn’t need to have a severe diagnosis such as ARFID before you want to get help.
Many parents I meet who describe their children as picky eaters have resorted to controlling or coercive feeding practices (e.g., pressuring or rewarding them to eat), which has consistently been shown in research to have adverse outcomes on health and intuitive eating behaviours later in life. Parents of avoidant eaters often complain that mealtimes are stressful, even traumatic and cause significant distress to the whole family, even affecting the relationship between parents. Others have lost hope and are resigned to serving only a handful of accepted foods but continue to feel anxious and guilty about their child’s current and future eating and dislike feeding them. Many parents also feel concerned about food waste and costs adding to their burden.
As a fellow parent, I know how challenging picky eating can be and know you are doing your best to support and feed your family. You probably have tried many things, feeling that none have worked in getting your child to eat differently.
When working with parents, I follow a responsive feeding approach.
One of the first steps I focus on with parents I work with is helping them let go of unrealistic expectations and accept their child’s eating for what it is. However, this is not the same as embracing a give-up attitude. Instead, by letting go of unhelpful or harmful behaviours, you can use your energy to focus on responsive feeding behaviours that are shown to be helpful in the long run and create a positive environment where change is most likely. By increasing your intuition and confidence and reducing stress and anxiety, we can work on restoring trust, connection, and enjoyment for everyone around mealtimes.
In conclusion, feeding a child, especially when a child is young, is one of the most significant parts of parenting. It can affect your identity, self-efficacy as a parent, and overall well-being. It can also impact your relationship with your child and partner and affect the whole family. Please know that you are not alone. It is neither your fault nor that of your child. You don’t need an extreme diagnosis to seek support and help. If unsure where to start, reach out and start the conversation here.
References:
Chilman, L.; Kennedy-Behr, A.; Frakking, T.; Swanepoel, L.; Verdonck, M. Picky Eating in Children: A Scoping Review to Examine Its Intrinsic and Extrinsic Features and How They Relate to Identification. Int. J. Environ. Res. Public Health 2021, 18, 9067. https://doi.org/10.3390/ ijerph18179067
Cormack, J. L. (2022). “Wading Through Sludge”: An Interpretative Phenomenological Analysis of Parental Experiences of Child Feeding in the Context of Avoidant Eating (Version 1). University of Leicester. https://doi.org/10.25392/leicester.data.19193279.v1
Rowell, K.; McGlothlin, J. Helping your child with extreme picky eating. (2015). New Harbinger Publications, Inc: Canada.