How to help parents of picky eaters

Approximately 60% of children go through phases of selective feeding at some point in their childhood, most often during the preschool years.1 However, the fact that most children go through this phase does not make it any less worrying for parents.

Pediatricians can help parents through this phase by offering resources, support, and education.

The first step in addressing this problem is to educate parents about the normal phases of infant feeding. The prevalence of picky eating during the preschool years, primarily between the ages of 2 and 5, has led experts to believe that picky eating is normal developmental behavior for many children. Increased selectivity in food choices occurs around the same time as other independence-seeking behaviors and typically fades as children move into elementary school.1

In most cases, these children do well nutritionally despite being picky eaters. One study found that the majority of children (73.8%) who considered themselves picky eaters fell within normal weight ranges, while approximately 13% were considered underweight and 13% overweight.two

Picky eating behaviors usually decrease on their own as children move into elementary school age; however, the older children get while continuing these behaviors, the more concerning the behaviors become. Research indicates that eating quirks that extend into later childhood are often associated with later diagnoses, including the following3:

  • Obsessive-compulsive disorders
  • Hyperactive disorder and attention deficit
  • Sensory Processing Disorders

Before a diagnosis is made or treatment begins for picky eaters, researchers note that most parents embark on their own acceptance journey, adopting various positive food parenting strategies to help their picky eaters try other foods. foods.3 These may include involving children in food shopping, selection, and preparation, or encouraging play with food.

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Helen Coulthard, PhD, a developmental psychologist who specializes in eating behaviors at De Montfort University in Leicester, UK, said sensory play with food and non-food items can be a useful tool when dealing with sensory processing issues. It can also be used to screen for more serious food restriction issues, as some children will find that foods are so anxiety-provoking and disgusting during play that they serve as a red flag for more serious problems.

“Those are kids with extreme food aversions, where they only eat 1 or 2 types of food,” Coulthard said. “But usually any kind of sensory play seems to work well because they come into contact with different substances without the pressure of eating.”

Children who eat a very limited selection of foods are usually the ones of greatest concern, but it’s amazing how children can eat a meager selection and quantity of foods and still get adequate nutrition, she added. Humans have evolved to eat the amounts we do, she explained, but the actual types and amounts of food children need to grow may surprise some parents.

“Sometimes it seems like they deny themselves a lot, but still eat enough to be healthy and grow,” Coulthard explained, adding that he encourages families to allow children to help themselves at mealtimes when possible. “If a child is eating too little food, he can do blood tests and things to check her nutrition, but often they end up choosing foods that give them enough of what they need.”

When this isn’t the case, Coulthard suggested that parents be encouraged to wait for their children’s eating habits to pass and offer them supplements or vitamins as needed.
“It’s a really difficult issue because often the worry just makes the problem worse,” he said. “Some of the problems associated with a very restrictive diet are when people are older, so it’s almost like you have to play the long game. And part of that is taking the pressure off and accepting.”

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Some studies have even documented the circular negative effect that parental pressure can have on picky eating habits. For this reason, it is important for pediatricians to assess parents’ feeding practices and experience perceptions as well as behaviors of the picky eater.

“Children are highly aware of their parents’ eating goals, emotions, and practices,” concluded a study on eating dynamics. “In light of these parental expectations, children develop their own strategies for navigating food refusal, negotiating with parents, and overcoming aversions. This study highlights the need to listen to children and work with them to develop meaningful, relevant and effective feeding interventions.”4

This study and more illustrate the need for education, and often reassurance, for parents dealing with picky eaters.

Pediatricians may also want to share the following tips for parents dealing with feeding issues outside of a medical or psychological diagnosis.5.6:

  1. Begin having “no pressure” meals without urging “one more bite” or using blame or threats to encourage eating.
  2. Let children eat when they are ready or offer the option to eat again at the next meal.
  3. Offer meals and snacks at timed intervals, with “open” and “closed” times for the kitchen to set a schedule so the child knows what to expect and when. This can help ensure that the child comes to the table hungry.
  4. Have a set time and place to eat.
  5. Set the menu for a nutritionally balanced meal. Don’t cater to the child’s likes and dislikes, but do offer and be direct about choices and expectations (ie, no dessert without a nutritious meal).
  6. Make mealtimes fun with kid-friendly plates or utensils.
  7. Repeat foods that are rejected at first. It may take 15 tries before a child agrees to try or like a new food.
  8. Teach children about nutrition and what food does inside their bodies.
  9. Model healthy eating behaviors.
  10. Don’t blame (parents or children) for being a picky eater and seek additional help if needed.
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1. Cunliffe L, Coulthard H, Williamson IR. The lived experience of raising a child with sensory sensitivity and picky eating.Matern Child Nutr. 2022:e13330. doi:10.1111/mcn.13330

2. Angraini DI, Arisandi R, Rosa E, Zuraida R. The relationships between “picky eating” behavior and nutritional status in preschool children. IJND. 2021;9(1):49-55. do:10.21927/id.2021.9(1).49-55

3. Schwarzlose RF, Hennefield L, Hoyniak CP, Luby JL, Gilbert KE. Picky eating in childhood: associations with obsessive-compulsive symptoms. J Pediatr Psychol. 2022; jsac006. doi:10.1093/jpepsy/jsac006

4. Wolstenholme H, Kelly C, Heary C. “Picky eating” and eating dynamics: schoolchildren’s perceptions, experiences, and strategies. Appetite. 2022 Jun;173(1):106000. doi: 10.1016/j.appet.2022.106000

5. Feeding a picky eater: dos and don’ts. Children’s Hospital of Philadelphia. October 31, 2019. Retrieved June 6, 2022.

6. Solve picky eaters: 11 tips for parents of picky eaters. Children eat in color. Updated August 2021. Retrieved June 6, 2022.