When to Worry About Your Picky Eater

Feb 14, 2020, 00:00 AM by Dr. Sally Robinson

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Most parents have some anxiety about whether their child is getting the best nutrition for their developing brain and body.  Their anxiety is worse if their child is a picky eater.  Most picky eaters will be responsive to interventions described in the book, The Picky Eater Project, by Natalie Muth and Sally Sampson.  However if the game plan described by these authors does not bring about change and if their child demonstrates any of the red flags they describe in their book, the parent should discuss this with their health care provider.

Red flags can be divided into 2 groups.  The first indicate an underlying health problem and the second indicates an underlying mental health or social problem.

The first groups is as follows: Failure to grow, difficulty chewing or swallowing, food going into the lungs, pain with feeding, vomiting or diarrhea with eating, developmental delays or some lung or heart problems such as cystic fibrosis or congenital heart disease.  The second group are as follows: extreme selectivity to the point of having only a handful of tolerable foods, forceful feeding by the caregiver, sudden rejection of food after choking or an otherwise traumatic event, anticipatory gagging, failure to grow or gain weight, refusal to eat or fear of fat, excessive weight loss or insistence on maintaining a very low body weight or compensatory behaviors such as vomiting or excessive exercise after eating.

Health problems that can trigger or present with severe picky eating can be divided into 3 categories: limited appetite, selective intake and fear of feeding.  The conditions that fit into these categories do have methods that can be beneficial to help their diet.  Some cases the cause of the severe pickiness is not identified and meet the criteria for a feeding disorder called avoidant/restrictive food intake disorder (ARFID).

The criteria for this diagnosis include the following: persistent failure to meet appropriate nutrition or energy needs causing significant weight loss or failure to gain weight, dependence on tube feeding or oral nutrition supplements, interference with psychosocial functioning; disturbance cannot be explained by lack of available food or a culturally sanctioned practice; disturbance does not occur exclusively during the course of another eating disorder such as anorexia or bulimia nervosa; there is no body image disturbance; and these persistent failure to meet energy needs cannot be explained by another condition.

If a parent is worried about their child’s weight gain and/or weight loss and they have any red flags listed above, please consult your physician.  If a parent is worried that their child have a feeding disorder such as ARFID, please consult your physician.  Growth is an extremely important part of a child’s life and poor growth impacts brain growth as well.  Feeding disorders are complicated and difficult to treat and may need specialized attention.

by Sally Robinson, MD Clinical Professor
Keeping Kids Healthy
Published 2/14/2020

Also See:  UTMB Pediatrics - Pediatric Primary Care
  UTMB After Hours Urgent Care


 

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