Young girl feeding her mum at the dinner table

Picky eating or Avoidant Restrictive Food Intake Disorder (ARFID): When should parents worry?

How can a parent know whether their child’s selective eating habits are picky eating or Avoidant Restrictive Food Intake Disorder (ARFID), a more serious concern?

I had the great pleasure of talking with Leah Campbell at forbes.com about picky eating, ARFID, knowing the difference and when to see your child’s doctor. I share my tips for managing picky eating and when parents should seek help. You can read the whole article here.

My top tips for managing picky eating

  1. Try not to worry. While parents naturally worry when a child refuse to eat, or doesn’t eat well, young children quickly pick up their parents’ anxiety, which can often make the problem worse.
  2. Try to create a calm atmosphere at mealtimes. This might mean an award-winning performance for parents, as you try to relax and not show your own worries, but children will quickly pick up on anxiety at the dinner table. Calm indicates that there are no threats in the environment and that the food is safe to eat. You could practice my failsafe phrase: “You don’t have to eat this.” This helps take away worry for parents, but also indicates to your child that there is no pressure to eat a particular food.
  3. Show your child that the food is safe to eat. Young children learn so much from watching and copying parents and other role models. Learning which foods are safe to eat is no exception. Eat together as much as possible. By eating the same food as your child you are showing her that the food is safe to eat. It’s really important to keep a positive attitude towards the food. Children’s willingness to try new foods is profoundly affected by the facial expressions of adults.
  4. Keep trying. Children often need many exposures to new foods, tastes and textures before he or she will be ready to accept them, but parents often give up after a few, concluding that their child doesn’t like a particular food. Even if you have tried a new food several times, many parents find that their child will happily accept the food when tried again at a later date.
  5. Schedule regular meal and snacks. This way, children don’t have to go too long between opportunities to eat. Contrary to popular belief, a young child will not always eat better if he or she is very hungry. Having a regular routine of three meals and two or three snacks means there’s not too long between eating opportunities. This can also help tame parents’ anxiety if a child doesn’t eat well at a particular meal or snack.
  6. Offer liked foods alongside new foods. Instead of providing alternatives to missed meals and snacks, offer at least a few items you know your child will eat at each dining opportunity, alongside one or two more challenging foods.
  7. Allow children to serve themselves when possible. By serving themselves, children can exert some control and self-determination. It is very common for children to have some peculiar eating habits and this is in itself not a reason to worry. Children will often want to eat things in a certain way, not want foods to touch or not want a new food on his or her plate, but instead on side plate. All of this can be completely normal and is worth accommodating if it helps a child feel less anxiety about eating.
  8. Never force your child to eat. Forcing a child to eat never makes him eat well and can lead to long-lasting food aversions. A group of researchers demonstrated this point in a clever study called ‘Finish Your Soup‘ in which pre-schoolers were split into two groups and offered identical soup for lunch. The first group was allowed to eat as much or as little of the soup as they wanted. The second group was coaxed and cajoled into finishing their soup. At the end of the meal, both groups were asked how much they liked the soup. The group that had been coaxed and cajoled to finish liked the soup less than the group that had been allowed to eat as much or as little as they wanted. The first group also ate less of the soup the next time it was offered than the group who were allowed to eat as much as they wanted without pressure. Moral of the story? Let your child be the judge of how much to eat.
Young girl feeding her mum at the dinner table
Eating the same as your child shows her that it is safe to eat. Photo by National Cancer Institute on Unsplash

How common is picky eating?

Some degree of picky eating is normal, and is probably genetically determined. Food neophobia (from the Greek ‘fear of new’) is thought to be a natural part of toddler development, and helped young children, who were just starting to walk, to avoid ingesting substances that are potentially harmful.

This suspicion of new foods can sometimes even extend to familiar and previously enjoyed foods, especially if they are presented in new ways, with unknown foods, or under unfamiliar circumstances.

Estimates of picky eating prevalence can vary, but approximately 10 to 30 percent of children go through this stage at some point. For example, one study in Quebec, Canada assessed 1,498 children three times between the ages of 2½ to 4 years old. Some 30% were picky eaters at some point during the study. In the UK, researchers studying all babies born in the former Avon Health Authority area (The Children of the 90’s Study) between April 1991 and December 1992 (7,420 children in total) showed an incidence of picky eating of between 9.7% and 14.7%.

How can a parent know if it is picky eating or Avoidant Restrictive Food Intake Disorder (ARFID)?

Although most children grow out of picky eating, there are a few signs that your child’s eating habits might be something more serious. In these cases, you should take your child to see a doctor, who may organise blood tests and refer your child for expert assessments. This may include assessment by a Speech and Language Therapist/ Pathologist (SLT/SLP), an Occupational Therapist (OT) and/ or a paediatric dietitian.

Signs that your child should be seen by his or her doctor include:

  • Dramatic weight loss or picky eating that is affecting your child’s normal growth,
  • A problem with swallowing, or signs that your child might have a swallowing problem such as coughing, choking or drooling,
  • Your child displays a fear of choking or vomiting interfering with dietary intake,
  • Your child starts to show physical signs of malnutrition (such as anaemia, low blood cell counts, slow heart rate, dizziness or fainting, cold hands and feet or feeling the cold more than usual),
  • The range of foods your child eats becomes narrower over time,
  • Picky eating affects your child’s social life, such that as a family you cannot eat out or in other social situations, or your child cannot eat with friends or other people.

Want to hear more, including what to expect if you decide to take your child to see the doctor? Read the whole article here.

Keen to know just how picky your child is? Take the questionnaire. The questionnaire uses the Food Fussiness and Enjoyment of Food sub-scales of the Child Eating Behaviour Questionnaire (CEBQ) developed by researchers at University College London. It is a is a validated screening tool used in research studies to assess the degree of food fussiness in young children.

My book “Help! My Toddler Is Not Eating. A 30-Day Plan to Get Your Picky Eater to Try New Food.” takes you step-by-step through a structured plan that introduces your toddler to new foods with a series of practical exercises. You can buy your copy of the book here.

Dr-Elizabeth-Roberts-dietitian

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