Parent Positive Series Essay: Helping Your Picky Eater

As a part of the Parent Positive Series, we will occasionally present articles for parents that may be helpful in overcoming the normal challenges in raising children.

This installment is about picky eating, written by Katherine K. Dahlsgaard, Ph.D., ABPP. She is Lead Psychologist at the Anxiety Behaviors Clinic (ABC) and Director of the Picky Eaters Clinic, Department of Child and Adolescent Psychiatry and Behavioral Sciences at the Children’s Hospital of Philadelphia (CHOP). This article was originally posted on philly.com.

picky-eaterPicky eating can be inconvenient, annoying, and worrisome, but is it actually harmful to your child?  That depends on how long it lasts and its severity. Most children tend to go through a vexing icky-picky phase when they are toddlers – that’s developmentally normal. What’s also developmentally normal is that children gradually come out of this phase and expand their diet beginning in the late preschool/early kindergarten years and then continue to diversify the range of foods they eat comfortably and enthusiastically into adulthood.

By contrast, long-term picky eaters continue to eat food similar to the color of bride dresses, favoring variations on the theme of white, cream and beige (e.g., cereal, bagels, chicken nuggets, and plain buttered noodles). They are highly reluctant to try new foods, rigidly brand loyal, and uncommonly (often hysterically) sensitive to changes in the appearance, quality, or quantity of a preferred food.

Prolonged picky eating becomes unsafe in several ways.  First, a diet of soft, carbohydrate-based finger foods is naturally lacking in the vitamins and minerals that derive from a diverse diet, which leads to nutritional compromise even if the child remains normal weight.

Second, picky eating is harmful from the standpoint of your child’s overall successful functioning in life. The picky eaters that I treat tell me heartbreaking stories of not being able to eat what all the other children are eating at birthday parties and field trips. They cry from hunger while at Disney World because the food there was too different to eat. They feel ashamed of their own rudeness when visiting friends’ houses because they refuse the foods offered them. Kids want to be like other kids – picky eating interferes with that.

54838354 - blond boy holds hand on his mouth to stop eatingFinally, picky eating is harmful to a family’s long-term happiness.  Parents understandably get tired of playing short order cook, patronizing only a handful of their child’s “approved” restaurants, and worrying each time they travel about what they are going to feed their child.  The parents that I work with are universally demoralized, telling me that “every meal is a battle” of cajoling, begging, pleading, bargaining, bribing, yelling, and crying, or they tearfully confide that after years of such battles, they reluctantly “just gave up” trying to expand their child’s diet, and now worry for the future: “What will he do when he wants to take a girl out on a date to a restaurant?”  “How will she survive when she gets to college?”

So is picky eating harmful? It can be.  And in so many ways.

FYI: Severe picky (or selective) eating is considered enough of a problem that there’s a brand new diagnosis for it in the psychiatry bible, the DSM-5:  Avoidant/Restrictive Food Intake Disorder (ARFID).

A diagnosis of ARFID requires that the individual:

  1. Eats a very narrow range of preferred foods.
  2. Is very distressed when presented with new or nonpreferred foods.
  3. Such individuals are not motivated to restrict and avoid foods due to concerns with body shape or a desire to lose weight (as in anorexia and bulimia) and may be of low, normal, or high weight.

The following are my recommendations to help your picky eater.  They are probably most appropriate for kids aged 5 to 10, the age group that I generally treat. The list assumes that you have already seen a physician to rule out any medical cause for the picky eating, such as swallowing difficulties or gastro-intestinal problems.

  1. Believe that your child is capable of eating just about any food.  That extreme distress he displays whenever there’s pressure to try a new or nonpreferred food?  It is not the result of a physical or psychological incapability. Rather, it is the result of years of avoidance. A basic rule of the brain is this: The longer something is avoided, the more distressing and impossible it seems. This goes for just about anything, from completing a big homework assignment, to starting a complicated project at work, to calling someone up and asking for a date.  It’s also true for a food.
  2. What’s needed, then, is repeated exposure to foods until your child habituates to them.  Habituation is just a fancy word for “learned safety” or “the brain gets used to it.”  Research has shown that young children need an average of 8 to 15 exposures to habituate to and accept a new food.  Unfortunately, how many times do most parents offer a food before deciding their child will never like it? Just 3-5.
  3. For the picky eater, exposure means tasting and swallowing the food.  It does not, in this case, mean merely having the food on the plate, looking at it, touching it, or smelling it.
  4. You are no doubt wondering, “But how do I get my kid to swallow it?”  Answer: By making it worth his while. Plenty of research confirms that kids will eat nonpreferred foods for rewards.  In my experience, the easiest and most motivating reward is access to screen time after a meal.
  5. Establish a consistent pattern, such as requiring your child to taste and swallow a new or nonpreferred food each night at dinner. Start with very small bites and then work up to larger and larger amounts as your child gets over the initial days of distress and comes to accept that a nightly “challenge food” is just another dreary fact of daily life.
  6. Many desperate parents have tried telling their children that they can’t leave the table until they have eaten a nonpreferred food. In my experience, this leads to a child who sits at the table for hours, whining loudly and often.  My recommendation is to require that he eats that nightly challenge food within the first 5 minutes of a meal. Go ahead and set a timer. The 5-minute rule means he gets it over with right at the start of the meal and then everybody can relax.
  7. Reward successes and mostly ignore failures. He eats the nightly challenge food = lots of praise and access to rewards/privileges. He doesn’t = “No screentime for the rest of the night, but I know you can do it tomorrow” said once, with sincerity and optimism.
  8. Don’t worry about rewarding or restricting privileges based on eating: There are no credible, converging lines of scientific evidence that doing so causes eating disorders or self-esteem problems.  Think about it: parents require their children do things they don’t want to do for their own good all the time (teeth brushing, taking a bath, getting homework done).  That’s called good parenting. Why should it be any different when it comes to insisting your child eat a varied and healthful diet?
  9. Remember, this will not happen overnight.  It will not happen over many nights. It will happen over many months – so be patient.  With enough successful exposures, your child will eventually habituate to enough foods that his diet is greatly expanded and mealtimes are a peaceful experience for everyone.

About Katherine Dahlsgaard, PhD

screen-shot-2016-11-16-at-11-20-19-amDr. Dahlsgaard is board certified in cognitive and behavioral psychology and is a licensed clinical psychologist in Pennsylvania and New York with expertise in cognitive-behavioral therapy (CBT) for children, adolescents, and young adults. She specializes in the evaluation and treatment of anxiety disorders, particularly Social Anxiety Disorder, Selective Mutism, Obsessive-Compulsive Disorder, Phobias, Panic Disorder, and generalized fears. Dr. Dahlsgaard also frequently treats children with disorders that commonly present with anxiety, such as sleep problems, food selectivity (“picky eating”), and sensory sensitivities.

A recipient of a National Science Foundation Fellowship award, Dr. Dahlsgaard is a frequent lecturer and guest speaker and has published widely in scientific journals, books, and mainstream media on the topics of child development, psychopathology, mental health, and human virtue. She was formerly Assistant Professor of Psychology at the Chestnut Hill College School of Professional Psychology and has taught undergraduate and graduate level courses on human development, child psychopathology, and cognitive-behavioral interventions.

Dr. Dahlsgaard received her Ph.D. in psychology from the University of Pennsylvania and her Bachelor of Arts magna cum laude and with honors in psychology from Bryn Mawr College.

Learn more at www.katherinedahlsgaard.com.