Picky Eating: Just a phase or cause for greater concern?

Published by Cuyler Romeo, M.O.T., OTR/L, SCFES, IBCLC on Jan 30, 2023

How to know if your child will outgrow picky eating. Plus, how to survive mealtimes with the pickiest palates.

From birth, the majority of time you spend with your infants and young children revolves around food. Children eat a minimum of six times a day. It takes hours to prepare food, feed kids and clean up.

This means that when feeding becomes a challenge, parents can feel like a failure. That was the case for Natalie Peterson, mom of Easton.

When Natalie introduced Easton to solid foods at 4.5 months, she immediately knew something was off. “How he reacted felt different. I brushed it off initially but I think deep down in my gut, that mom instinct knew something was different.”

They tried again and ran into that same reaction. Easton pushed the food away, refused it and even became angry. “It was incredibly isolating. It felt like we had failed him.”

Easton was the first child in the U.S. to be diagnosed with pediatric feeding disorder (PFD).

And Natalie certainly wasn’t the only parent to feel anxiety, frustration and shame over picky eating.

How common is picky eating?

Picky eating is a common disorder during childhood. According to Dr. Kay Toomey, pediatric psychologist and member of Feeding Matters, a variety of studies across the world suggest that approximately one-fourth to one-third of children on average will struggle with some type of feeding and/or growth issue in their first decade.

Picky eating can look similar, but the causes vary. Many toddlers experience a phase of picky eating when they need fewer calories than during months when they were growing faster. That decrease in appetite coupled with their curiosity about boundaries can lead to fussy eating.

It’s when this persists or becomes more extreme that picky eating could be a sign of another underlying condition, such as pediatric feeding disorder (PFD).

What is considered picky eating?

According to Dr. Toomey, the operational definition of picky eating is children who demonstrate either transient or more extended challenges (up to 2 years duration). She outlined the following feeding and eating patterns in a presentation for Feeding Matters:

  1. Strong preferences
  2. Limited variety
  3. A restricted number of foods they will eat.
  4. Avoiding new foods
  5. Refusing the “right” foods or the “right” amounts
  6. Getting more upset than peers
  7. Requiring a special meal by their parents
  8. May eat differently in different contexts

How can I help my child with picky eating?

While many children will be picky eaters in spite of parents’ best efforts, there are a few ways to encourage children to eat better.

Following are a few ideas you can try if you’re experiencing stressful mealtimes:

Establish a mealtime routine. Children find comfort and confidence in a predictable routine. This will depend on the needs of your family. There’s no right answer.

Set up loving, appropriate boundaries. I don’t expect a toddler to stay seated at the table for 30 minutes, but I would expect a two year old to eat at the table for 10 minutes instead of taking a bite from the table and running around. If your child is on the autism spectrum, this may not be an appropriate expectation.

Harness the power of hunger. You’re more likely to have successful mealtimes if your kids come to the table hungry. Having a predictable schedule will help.

Make meal time social. Eating with your child, enjoying foods together and modeling appropriate mealtime behavior can help.

Limit the introduction to new foods. New foods are an important way to teach your child about healthy eating. Introduce something new together with something familiar to help your child acclimate.

How long does picky eating last?

Among children who are picky eaters, only about one-third to one-half will outgrow their picky eating within two to three years. Three to 10 percent of infants and children have significant, persistent feeding and/or growth problems over time. These are the children who have pediatric feeding disorder (PFD) and need feeding treatment.

When should I be worried about picky eating?

While picky eating is a common behavior among children, extreme picky eating can lead to nutrient deficiencies or poor growth.

Extreme picky eating is a sign of PFD if a child displays some of the following characteristics:

  • Extreme food selectivity: based on texture, color and taste
  • Food refusal: gagging, vomiting, hitting, crying
  • Limited appetite
  • Poor weight or failure to gain weight
  • Delayed or dysfunctional eating skills
  • Disruptive mealtime behavior
  • Eats differently in different environments
  • Negatively impacts family functioning

Children with PFD need medical intervention to manage the diagnosis. When a child isn’t eating or drinking the quantity or the variety they need to grow and be healthy, it’s not just because they are being “fussy.” There is usually an underlying reason. Talk to your pediatrician about PFD and check out our family roadmap for support.

Cuyler Romeo is director of strategic initiatives at Feeding Matters and a clinician at Banner-University Medical Center’s NICU.