Is It Picky Eating or Is It Something More Serious?

Parents often face challenges when attempting to get their children to eat healthy food, sometimes classifying them as "picky eaters." However, for some children, being a particular eater may be the result of an underlying condition.

According to the latest University of Michigan Mott Poll Report, a national poll on children's health, over half of parents with children ages 3 to 10 years say their child is a picky eater. What's more, over 60% become short-order cooks and offer their children an alternative food choice if they don't like the family dinner.

Parents surveyed say they face other significant challenges when attempting to provide a healthy diet for their children. For example, 27% report challenges related to the child not liking healthy food.

Still, what primarily stands out in the report is the significant number of parents who claim their child is a picky eater, and the strategies parents use to get their child to eat vary. According to the Mott Poll, 53% try to prepare vegetables in a way their child prefers, 25% hide vegetables in food, and 19% offer a reward if their child finishes their vegetables.

Moreover, the parents surveyed say they often use table rules to boost their child's food intake, like requiring them to try at least a bite or two of everything on their plate and only allowing dessert once the child finishes their food.

Still, being fussy about food can be a harmless aversion or a deeper underlying issue with food that could indicate a more serious condition.

University of Michigan Health C.S. Mott Children’s Hospital National Poll on Children’s Health
Image courtesy of C.S. Mott Children’s Hospital National Poll on Children’s Health

Is it more than just picky eating?

According to the Mott Poll, getting young children to eat healthy can be challenging since they are generally hesitant to try unfamiliar foods and change their food preferences frequently. The report's authors suggest that offering alternatives to what's already on the dinner table may not be an ideal solution, as the alternatives are often less healthy.

"Rather than allowing the child to choose an alternate menu, parents should provide a balanced meal and encourage the child to try at least a small amount of healthy foods that might not be their preference," the authors wrote.

However, that may not work for every child, especially those with a neurodiversity like autism spectrum disorder (ASD), pediatric feeding disorder (PFD), or the lesser-known condition called avoidant restrictive food intake disorder (ARFID).

For example, restricted eating patterns are common among autistic individuals. Due to sensory-related and other factors, some children with ASD will only eat a few specific foods or foods served on a preferred plate. Moreover, some avoid eating mixed foods, like casseroles.

ARFID, a relatively new diagnosis listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), is an eating disorder that also causes an aversion to food. According to a study published this year, approximately two children per 100,000 have ARFID.

However, ARFID differs from other eating disorders, such as anorexia, because it's characterized by anxiety about food, not about weight or body image. ARFID can impact autistic people and people with obsessive-compulsive disorder (OCD) or occur as a standalone condition.

Despite its significant impact on health and wellbeing, not many people know that ARFID exists.

Bringing awareness to this poorly understood condition has become a priority for a mother and daughter in Los Angeles. Michelle and her 8-year-old daughter Hannah have taken Hannah's daily challenges living with ARFID to social media.

Michelle's Instagram page @myarfidlife, which shares Hannah's journey with ARFID, including her attempts to try new foods, has garnered 1.5 million followers since its inception.

@myarfidlife Green is one of my fear colors, so I usually avoid foods that are green. I haven’t tried a green apple yet, and many of you recommended it. So far Inhave tried 5 different apples. The Honeycrisp, Cosmic Crisp, Pink Lady, Sweet Tango, and the Envy. One thing I like about apples is that they have a really good crunch. All of the apples I’ve tried have been either sweet or sweet and sour. I have heard that the Granny Smith is a sour apple so Ineas curious to see what it tasted like. It is way too dry and not juicy. It has a mushier texture and not enough crunch. I didn’t really like this one, and Envy is still my favorite. I rate these a 4.7/10 and still really want to try a yellow apple. 🍏 #arfidawareness #arfidjourney #arfidsupport #arfidwarrior #myarfidlife ♬ original sound - Myarfidlife - Hannah

Michelle, who prefers first names only for privacy reasons, tells Healthnews that, as an infant, her daughter did not have issues with formula, but when she started solid foods, Hannah began to spit out the food or push it off her highchair tray. Hannah would only eat specific foods, and she refused even those items as time passed. Because of this, Hannah was not gaining adequate weight based on her growth.

"Our friends and family were constantly making remarks that it's our fault," Michelle says. "[They would say] if we didn't give her the option to eat snacks, then she would eat real food when she got hungry — when someone's hungry, they're going to eat."

To help address what she thought was pickiness, Michelle had Hannah see an occupational therapist. However, feeding therapy designed for typical food aversion behaviors did not work for her.

"Typically, you can convince kids who are picky eaters to try things if there's a reward," Michelle explains. "The therapist would say, 'Let's have 10 bites of the sandwich, and after you finish it, then we'll go play on the jungle gym for five minutes."

But for Hannah, whose picky eating was later diagnosed as ARFID, the anxiety about food overshadows any reward. Moreover, strategies like feeding therapy, table rules, or encouraging a child to take bites of food on their plate are not effective for people with ARFID.

"There's so much fear and anxiety around the food that [people with ARFID] can't even be in the same room with the food," Michelle explains. "So, before you even attempt to have them take 10 bites, a lot of these kids need to get used to sitting next to the food. Then, they have to get used to smelling, touching, and licking the food. It's a very gradual process."

Michelle tells Healthnews she can recall when she realized there was more going on than just being finicky.

"We were driving to pick up lunch, and I was asking her in the car what she wanted to order, and she just started crying and saying, 'Why do you always have to talk about food? It makes me really anxious,'" Michelle says. "It was like a light bulb went off in my head, and I thought to myself, there's so much more to this. This has something to do with her anxiety related to food, and that's when I started looking desperately for help."

Since previous feeding therapy sessions did not work, Michelle searched for a therapist who specializes in ARFID, and Hannah started treatment. Michelle would update friends and family on Hannah's progress via posts on her Instagram page. The posts gained attention from others, eventually leading to millions of followers.

However, feedback has been mixed.

"On Instagram, I get so many messages saying, 'I'm calling the police,' or 'I'm calling child protective services,' 'You need to have your kids taken away from you,' 'You're a horrible mother,' or this, that and the other," Michelle says.

At the same time, some thank her for raising awareness of this condition and helping others with ARFID.

Michelle says that since they started this journey, it's been fascinating to see how many people have similar challenges, who either didn't know about ARFID or just assumed that they were fussy because that's what they've been told their whole lives.

And clearly, we've understood that there's not enough awareness out there. There are not enough providers out there who are familiar with ARFID and know how to treat it.

Michelle

Moving forward, Michelle says she plans to start a non-profit called ARFID Awareness to shine more light on this misunderstood eating disorder and to help families get the support they need.

When is picky eating a concern?

While being selective about food is common among children, signs that may indicate the child's picky eating behavior may need evaluation by a pediatrician, include severe aversion to food, gagging or vomiting at the sight or taste of specific foods, extremely limited food preferences, or anxiety related to foods and eating.

In addition, weight loss, failure to gain weight, and physical symptoms related to low-calorie consumption, such as anemia, may indicate that a child could benefit from an evaluation by a pediatrician or other qualified healthcare provider.


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