5 Common Problems at the Root of Extreme Picky Eating

What's At The Root Of Your Child's Picky Eating? -- Real Mom Nutrition

Picky eating is very common among kids–but sometimes it’s more than just garden-variety pickiness. In their new book, Helping Your Child With Extreme Picky Eating, authors Katja Rowell MD and Jenny McGlothlin SLP define “extreme” picky eating (EPE) as not eating enough quantity or variety to support healthy emotional, physical, or social development, or eating patterns that are a significant source of conflict or worry. Some red flags that your child may have EPE include being upset or crying often around food, falling off her growth curves, and social isolation due to menu limitations. But exactly what’s behind extreme picky eating? Here are five of the most common problems:

by Katja Rowell MD and Jenny McGlothlin SLP

Children with extreme picky eating (EPE) are not just being naughty or willful (though they are at times more than capable of being so). Addressing feeding problems is not a matter of “breaking” your child or making her comply. Rather, there is almost always an underlying reason that starts a child and his parents down the path of feeding difficulties. We’ve simplified things by breaking it into the five most common challenges, as seen from your child’s point of view (some children have more than one challenge):

1. Medical Challenges: “It hurts! It doesn’t feel good!”

Contributing medical issues must be ruled out or addressed. These might include allergies, reflux, eosinophilic esophagitis (painful allergy-related erosions of the esophagus), or severe constipation—basically anything that can cause pain or make a child feel poorly.

2. Oral Motor Challenges: “I can’t.”

Any physical issue that makes it hard to get food to the mouth, chew, breathe, swallow, or sit upright impacts eating. Anatomical problems like a cleft palate, malformations of the trachea or esophagus, dental issues, significant tongue-tie, or even enlarged adenoids and tonsils can play a role.

3. Sensory Challenges: “I don’t like how this feels/tastes/sounds. I’m uncomfortable.”

Children with sensory integration challenges process sensory input differently. Tastes and textures can feel too intense. Some children with sensory challenges eat only smooth or crunchy foods with uniform texture. Some examples of sensory preference include liking only bland or strong flavors, being turned off by strong smells, or preferring food at certain temperatures.

4. Temperament and Mood: “I don’t want to! I want to do it my way.”

Many of our clients describe their children similarly: highly verbal and intelligent; having a strong desire to figure things out in their own time and their own way; easily upset and frustrated; and feeling and expressing intense emotions. Many neurologically typical children with EPE exhibit an independent nature (determined and not wanting to lose) or are very tuned in to a parent’s agenda and pressure, resulting in increased anxiety.

5. Negative experiences: “I’m scared _______ will happen again.”

If, in the past, acting on his desire to eat has resulted in an uncomfortable or scary sensation, a child’s appetite may decrease. For example, a choking episode can trigger fear of choking to the point where a child stops eating and drops weight quickly. A child who has experienced coercive or forced feeding may develop an extreme fear. Other aversive experiences include aspiration (food in airway or lungs) or vomiting.

It’s important to consider your child’s challenges and experiences so that you can understand how her efforts to avoid certain foods and situations help her feel comfortable, safe, and in control. In essence, her “abnormal” eating behaviors are adaptations that protect her from further distress. Understanding where your child is coming from helps you partner with your child, build empathy and trust and begin to help your child heal her relationship with food.

For more information on extreme picky eating and our STEPS+ approach to addressing anxiety and conflict and supporting your child’s appetite and nutrition, check out our book Helping Your Child with Extreme Picky Eating: A Step-by-Step Guide for Overcoming Selective Eating, Food Aversion, and Feeding Disorders and visit our website Extreme Picky Eating Help.

Katja Rowell, MD, is a family doctor and childhood feeding specialist and the author of Love Me, Feed Me: The Adoptive Parent’s Guide to Ending the Worry About Weight, Picky Eating, Power Struggles and More. Jenny McGlothlin, MS, SLP, is a certified speech-language pathologist specializing in pediatric feeding disorders.  

Excerpted from Helping Your Child with Extreme Picky Eating: A Step-by-Step Guide for Overcoming Selective Eating, Food Aversion, and Feeding Disorders by Katja Rowell MD and Jenny McGlothlin SLP with permission from the authors and New Harbinger Publications 2015.

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  1. Katie @ Mom to Mom Nutrition says

    Parents with picky eaters [and extreme picky eaters at that] can never have too many resources! Looking forward to sharing this post with my readers.

  2. Dakota says

    I was hoping at least one of these 5 reasons could be reverse engineered to make my child MORE of a picky eater…in the correct direction, of course. My child will eat practically anything and that’s the problem. She loves flavorful foods and anything baked super crunchy. She vacuums them up without thinking. I am fearful she will become a junk food addict. So, how can I make her more finnicky to exclude flavors that “burst in your mouth” and all of the textured junk foods out there. Also she gobbles up McDonalds crap when her grandparents take her there (this infuriates me behond description, of course). So, short of staging a frightening choking incident with some of these nasty foods how can I make her more correct in her eating habits? Any suggestions?

    • says

      Dakota–it’s natural that your daughter likes those packaged and fast foods because they’re engineered to taste amazing and make you want to eat more. My advice is to stock your home with the foods that you DO want her to be eating. The outside world is full of junk food, and we can’t always control that. But we can control what’s in the home food environment. As for the grandparents, if they watch her regularly and you are bothered by the fast food, I would encourage you to talk with them about it. And be sure your daughter isn’t feeling any sense of anxiety or deprivation when it comes to junk food that could be causing her to overeat it when she has access to it. Check out this post I had recently for some good advice on that from two feeding experts: http://www.realmomnutrition.com/2015/06/19/deprived-of-junk-food/


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