Why is my kid so picky and what can I do to help?

Is my toddler's eating developmentally normal, or is his pickiness something that needs to be addressed?

• Picky/selective eating is a normal part of development between 15 months to 4 years of age when children learn to exercise their autonomy and be selective. Normal growth rate and appetite also slows after age two. 

• It is normal for children to require many non-pressured exposures before they will accept a new food

• Extreme picky eating is when a child has a very limited number of accepted foods. 

• If a child is cutting out foods that were previously accepted, this is a red flag

  
  

Here are some of the underlying issues that cause picky eating: 

Medical challenges: 

• Allergies, Eosinophilic esophagitis (EOE)

• Reflux, choking, vomiting, GI issues, difficulty chewing/swallowing

• Oral motor weakness

• Structural issues (Tongue tie, cleft palate)

• Medications affecting appetite (ex ADHD meds)

  
  

Sensory needs / neurodivergence

• Hyposensitivity: “sensory seekers” are looking for excitement with food (spicy, sour, crunchy), smooth foods may be pocketed when kids don’t realize they are there

• Hypersensitivity: aversion to strong flavors/ textures, misophonia (sound of chewing)

• Occurs with the ASD population along with sensory integration challenges and personality rigidity 

• ADHD population (medications, increased interest in highly palatable foods, grazing/impulsivity and inattention may affect appetite.)

  
  

Temperament: 

• Anxious temperament

• Fear of choking/vomiting/aspiration happening again

• Trauma – history of forced feeding or other trauma

• Sensitive kids with big feelings

• Sudden onset: might be PANS (pediatric acute neuropsychiatric syndrome)

• Anxiety and OCD 

  
  

Who can help? 

• Pediatric dietitian for any feeding challenges

• Pediatrician, allergist, ENT, gastroenterologist, dentist for medical/structural challenges

• Speech therapist for oral motor weakness 

• Occupational therapist for sensory and nervous system regulation for anxiety and sensory challenges

• Psychologist/psychiatrist/therapist for anxiety, OCD, adhd, behavioral challenges

Credit: “Helping your child with extreme picky eating” Katja Rowell, Jenny McGlothlin

Any picky eating deserves discussion with a knowledgeable dietitian when it’s causing stress in the feeding process. I'd love to help you pick apart your child's eating, and build a more peaceful and nourished future!

Best,

Noa