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When Does Picky Eating Become Something To Worry About?

It's important to remember that because eating disorders in young children are emerging more frequently, severe selective eating can be an early indicator that a very serious illness is developing in some cases.
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Having dedicated more than 30 years of my career to the study of eating disorders and the delivery of effective treatment, there's not much I haven't seen when it comes to anorexia, bulimia and EDNOS. Additionally, after raising children, I have come to understand a thing or two about the tendency of children to be picky eaters.

My three eldest children were relatively easy eaters -- they certainly had their preferences, but there were never tantrums or outright refusals to eat the food on their plate. Just when I thought I had avoided the dreaded picky eating drama altogether, the fourth child challenged my sanity as a parent. For years, it was a struggle to get him to ingest anything that wasn't frozen, processed "chicken" pressed into the shape of a dinosaur, and I recall one particularly intense public meltdown when "something green" (the smallest piece of cilantro that you have ever seen) made it onto the plate with said "chicken." Like most children, however, my son grew out of this phase and began consuming a wider range of foods as part of a well-balanced diet.

I share this anecdote with you because I want to stress that, in addition to being considered an expert in the diagnosis and treatment of eating disorders, I'm also a parent that has struggled with a picky eater. There's nothing more frustrating than being told not to worry about something that feels fundamentally worrisome, particularly when it pertains to your children. That being said, the good news for parents is that, in most cases, selective eating in children, or the restriction of diet to the point that it is a daily struggle to fulfill nutritional needs, is fairly common and generally resolves with age, maturity or any other variety of factors. However, as the prevalence of eating disorders in children continues to increase, it's prudent to evaluate the context surrounding your child's picky eating to determine whether these eating issues are merely a temporary phase or whether they could be early symptoms of more troublesome eating disordered thinking and behaviors.

Look at the Bigger Picture

Eating disorders are complex illnesses with biological, psychological and sociological implications. Given the diverse causes of eating disorders, behaviors around food and eating are only a part of the puzzle. Has your child recently lost weight, or has he or she not gained weight expected at his or her developmental stage? Has your child increased his or her activity or begun exercising excessively? Is your child dissatisfied with his or her body, evidenced by negative comments or excessive time looking in the mirror? If you have observed any, or all, of these eating disorder warning signs in your child, his or her picky eating may be indicative of the beginnings of an eating disorder, and early intervention may be necessary.

Examine Your Family Tree

Eating disorders are highly genetic in nature and have been shown to be as inheritable as bipolar disorder and schizophrenia. Many children with eating disorders have already had a latent genetic predisposition for developing the illness and a precipitating event, like a nasty bout of the flu or a mean comment from a family member or peer, triggered their bulimia, anorexia or related disorder. If there's a chance your child might have a genetic predisposition toward developing an eating disorder, parents should pay heightened attention to picky eating and other disordered eating behaviors, like cutting food up into tiny pieces, pushing food around his or her plate or chewing food and spitting it out.

Use Your Child's Pediatrician as an Ally

If picky eating is prolonged or feels worrisome to you, talk to your child's doctor about his or her food intake, thoughts and behaviors around eating, exercise and body image. While most pediatricians don't have extensive eating disorders training, they can generally help you determine if your child's relationship with food is affecting his or her development in an unhealthy way. If the situation warrants the examination of an eating disorders expert, your pediatrician can generally refer your family to a specialist. Eating disorders treatment resources for children abound online as well, with some (like this one) offering parents the opportunity to discuss their child's case with highly trained clinicians in real time via live online chat or phone.

Parenting lore tells us picky eating phases are common among children and that they generally resolve as your child develops. From a clinical perspective, this sentiment generally rings true, although it's important to remember that because eating disorders in young children are emerging more frequently, severe selective eating can be an early indicator that a very serious illness is developing in some cases. Parents should be diligent observers and trust their instincts. If your gut tells you that your child's picky eating may be an eating disorder, do your research, talk to professionals and intervene early.

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