Extreme Picky Eating In Kids: What Is It, and What Can Parents Do?
Extreme Picky Eating (EPE) is a selective eating disorder that doesn’t fall into the category of Avoidant Restrictive Food Intake Disorder (ARFID), namely because it hasn’t been sustained for long enough. So, who qualifies for this diagnosis, and what can we do to help prevent it from progressing into full blown ARFID?
In my practice, where I have treated children with EPE and ARFID for over a decade, I have found children commonly susceptible to this disorder tend to possess the following characteristics: generally tuned into parents’ agenda and pressure, cautious, and prone to shyness, emotionality, and irritability.
When informed about nutrition and variety, children suffering from this condition tend to appear nervous and admit that they don’t like to eat. They also have a genuinely hard time identifying any foods that they do like. They may appear wary when the topic of food is broached; as, by the time they are presenting to therapy, food intake has likely become a point of contention and a topic of regular debate at the family table. Overwhelmingly, children presenting with these conditions do not report any discomfort with their size or stature, or acknowledge difficulty with body image. In fact, they’re frequently as baffled about why they are so adamantly resistant to certain foods as the rest of us. They’ll go to tremendous lengths to avoid acquiescing to foods they admonish, but, when push comes to shove, are unsure why.
In my experience, when a cautious temperament is combined with sensory issues, feeding can become particularly hard, with landmines for parents at every crosshair. It is commonly known that taste and tactile processing issues are linked to eating difficulties. In cases where these issues are known, we commonly engage an occupational therapist to work parallel in our efforts for best results.
So, what are the underlying issues behind EPE? A cocktail of traits, one would find, including sensory preferences (bland/strong repetition, taste/smell, visual, ie, the look of food, tactile, ie, the feel of food, auditory, ie the volume of room/stimulation. We have had patients who cannot eat when their sibling is making loud chewing noises, and patients who are ‘grossed out’ by food appearing slimy, mushy, or too spicy/exotic.
As I mentioned, often, extreme picky eaters possess underlying sensory issues, or, just as frequently, anxiety or inattentive ADD. If a child has experienced an oral trauma such as choking, they may project that this occurrence will happen again should they consume the same, or a similar, food.
With this said, you can easily see how sensory seeking or avoidance children would experience similar difficulties relating to mealtimes. In childhood, we begin the process of encouraging self-regulation: helping children to learn to eat appropriately based on hunger, fullness, appetite, and teaching them to tune into hunger and satiety. For sensory seekers or sensory avoiders, this is challenging.
Ultimately, there are many factors to face before diagnosing a child with Extreme Picky Eating. Are they emotional at mealtime (crying or feeling bad around food?) Has their physical growth been impeded? Have there been social repercussions (has the child been teased, or has excessive attention been paid to the problem? Does the child’s limited menu prevent social functioning? If so, it is likely that the child qualifies for a diagnosis of ECE, and they (and caregivers) will require help.
Due to the complex nature of this topic, I will address tools and interventions in a blog to follow next week.
If you are concerned about your child suffering from EPE, you are welcome to email us at mary@liftupwellness.comfor an assessment.
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