Picky Eating: A Precursor of Trouble Down the Line?

A three-year-old eats only chicken nuggets and french fries. A four-year-old limits her diet to light-brown crackers and bagels. These children are considered “selective eaters” to pediatricians. Moms and dads know them as “picky eaters.” A study released this week in the journal Pediatrics found that moderate and severe cases of selective eating in toddlers were associated with an increased risk of developing anxiety or depression in later years.

As a pediatric psychologist specializing in toddlers, I have long observed this connection. Almost every week I witness the link between early sensitivities in toddlerhood and the stress it can cause for children and parents alike. My mentors, Serena Wieder, PhD, and the late Stanley Greenspan, MD, considered these early sensitivities potential “developmental pathways” to future mental-health challenges. In other words, if a young child has heightened reactions to everyday experiences (such as eating), and his body and mind interpret these as negative, over time this may lead to avoidance and anxiety.

This isn’t the garden-variety anxiety “disorder” found in the current diagnostic manuals. Rather, it’s what Dr. Wieder calls “developmental anxiety,” a result of differences in how children react to information coming in through the senses (seeing, hearing, tasting, smelling, touch, movement). In picky eaters, the taste, appearance, texture, and/or smell of food bombards children who have sensitivities and causes immediate negative reactions—even before the chewing and swallowing starts. This creates strong memories that will lead the child to avoid certain foods in the future.

To a certain extent, all toddlers are picky eaters, and this is a phase that will come and go. Yet for toddlers who consistently refuse foods based on how they look, smell, feel, or taste, this may be a signal for additional support. These children severely limit what they eat, and may even gag involuntarily at a certain smell or upon eating a new type of food. Of course, as parents we feel challenged to insure our children are getting enough nutrition. If you suspect that selective eating is a problem for your child, getting help sooner than later is a good idea.

Here are some things to consider in helping your picky eater:

  1. The Relationship Is at the Center. Your loving, caring relationship with your toddler sets the stage for support with feeding issues. Stay calm and positive around your toddler when exploring foods. Even though it’s difficult, try to calm your own strong reactions around this situation, as your toddler can pick up on your stress.
  2. Be a Keen Observer. Keep a record of the foods your child is avoiding to determine if selective eating is an issue. Toddlers typically develop preferences for certain foods over others, and this is not a cause for concern. Consistently avoiding or refusing most food  over months or years, however, is a red flag.
  3. Talk to Your Doctor. Contact your child’s health care provider with your concerns. If he or she is not familiar with selective eating, you might want to consider seeking the help of a specialist or feeding team.
  4. Specialists Can Help. If the selective eating is moderate to severe,  seek out a specialist in feeding issues, often an occupational therapist, pediatric registered dietitian,  or group of specialists that work as a “feeding team”. These professionals will help address the causes and solutions specific to your child. Since every child is different, there are no one-size-fits-all answers. These clinicians often have helpful strategies to help you expand your child’s food choices over time.
  5. Emphasize Joy. Joyful play is the language of toddlerhood. Try to make eating and playing with food fun. This helps calm your child’s mind, making her more likely to take risks with trying new foods.

Making sure your child eats enough and grows up strong and healthy is one of the most important tasks of early parenthood. Remember that the road to better eating will be much easier travelled if your child feels loved and understood in this early challenge. Selective eating is not a choice a child makes to be difficult but a very early marker of sensitivity. With an empathic and loving approach, you can help to prevent these early signs from growing into larger challenges in later years.

I welcome any comments or questions and invite you over to my Facebook page where I post information for parents and professionals.