Is Your Child a Picky Eater, Or Is it Something More?

Despite parents’ best efforts, kids often say ‘no’ to new foods, especially healthy ones like broccoli or tomatoes. Rest assured, however, that picky eating is a common phase of childhood. Most children’s tastes evolve, and in time they outgrow this finnicky behavior.

But when is fussy eating more than just a phase? Meghan Feehan, PsyD, doctor of psychology and manager of clinical services at Atlantic Health System, explains how a relatively new clinical diagnosis known as ARFID: Avoidant/Restrictive Food Intake Disorder is affecting children and adolescents.

“If a child has an extreme aversion to trying new foods and their preferred foods are severely limited,” she says, “it can lead to weight loss and nutritional deficiencies that stunt their growth and brain development.”

More Than Picky Eating

So, what exactly is ARFID? According to Dr. Feehan, it can show up in three different ways.

1. Lack-of-interest eaters who are hesitant to try new foods or simply don’t find eating enjoyable.
2. Highly selective eaters who react adversely to food textures, smells, and flavors.
3. Fearful eaters who believe foods trigger illness, choking, nausea, or allergies.

“There’s a lot of overlap among these, but all three are rooted in anxiety,” says Dr. Feehan. “For some kids, trying a new food is overwhelming and creates stress and fear. So, they’ve learned to avoid most foods and this avoidance cycle just continues.”

Signs Your Child Might Have ARFID

Dr. Feehan cautions that sometimes parents don't see the signs when picky eating has gone too far. If a child can’t go to restaurants, eat dinner at a friend’s house, or attend a birthday party without feeling socially impaired or anxious, it’s time to talk to a doctor. Here are some other telltale signs:

1. Your child eats fewer than 20 foods, which is nutritionally limiting and severely restrictive.
2. You see noticeable weight loss and limited growth in your child.
3. Social situations and eating with others has become a source of anxiety for your child.
4. Tantrums and meltdowns from eating distress are common at family dinners.
5. Your child frequently complains of stomach aches, nausea, or gastrointestinal issues from food.

When To Seek Help

According to Dr. Feehan, by the time parents reach her office, they’ve been dealing with this for a long time and are ready for professional help. Most of them have tried involving their child in food shopping and cooking; dined at restaurants with kid menus of chicken nuggets and spaghetti; kept food logs to track progress; and supported, coached, modeled, and substituted foods—only for the behavior pattern to continue.

That’s when therapeutic intervention is a great next step.

“Atlantic Health has an intensive after-school program designed for kids ages seven to 21 who are struggling with these types of serious eating challenges,” says Dr. Feehan. “Using cognitive behavioral therapy, we help give kids the confidence they need to change their restrictive-eating mindset.”

Developing a Healthy Relationship with Food

“Our therapists and nutritionists help children develop regular eating patterns,” she says.

“By the time a child leaves treatment, we haven’t created a foodie who's ready for fancy restaurants. Instead, we’ve helped that child incorporate five to 10 new foods into their diet, which ultimately helps boost their weight and fuel their growth.

“The program also empowers parents to continue to work on introducing new foods at home.”