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“Picky Eaters” Will Not Starve Themselves But Problem or Resistant Eaters Might

I spend a lot of time writing and speaking about picky eating. When I say “picky eater” I am referring to a child who has picky behaviors but can learn to eat a broader diet and change the bad habits that are negatively impacting themselves and their families. However, when it comes to feeding disorders there is a continuum of severity. And many of you have children with more severe food aversions.

Approximately two-thirds of children on the autistic spectrum have severe food aversions which can impact their growth and development. While this population of children often has feeding aversions it is in no way limited to them.

Children with medical conditions that have caused pain when eating often have severe food aversions as do children with sensory integration dysfunction. Children with oral motor impairments may also have a severe fear of eating due to their inability to move food around in their mouth and safely chew and swallow.

Children with these severe food aversions are often referred to as resistant eaters or problem eaters.

The Wrong Advice Is Dangerous

As a feeding therapist who has worked with many children with severe food aversions it is scary to me to read information with no disclaimer that says children will eat when they are hungry and they will not starve themselves .

While typically developing children who are “picky eaters” will not starve themselves or make themselves ill,  problem or resistant eaters might.

If there is any doubt whether a child is a picky eater or a resistant eat I always recommend seeking professional guidance from a feeding therapist.

Some Characteristics of Resistant Eaters

One of the characteristics of a resistant eater is the limited acceptance of food items. This is often the same with picky eaters but more pronounced and severe in the resistant eater. I have seen children with as few as 2 different foods in their repertoire. Often these children will start with more foods and begin to eliminate them over time.

They may suddenly eliminate a favorite food or bring back an old favorite. These children are also very aware of imperfections in foods, even their favorites such as dark spots, cracks, bumps etc. Some children will also eliminate whole food groups such as fruit and vegetables, or meats. However some resistant eaters will only eat from one food group they have chosen which is often carbohydrates, but can even be meat.

Children with oral motor impairments may only accept pureed foods that do not require chewing. These types of behaviors cause fear and frustration in parents and caregivers. It also causes judgment from extended family members and friends who have never dealt with a resistant eater.

Children who are resistant eaters may also gag and/or vomit when presented with new or disliked food. They may also exhibit extreme behavioral reactions which impacts everyone around them. For these children and their families any situation which food is involved can be scary causing avoidance and isolation.

Feelings Of Isolation

Parents have told me stories of feeling isolated in social situations when they are unable to explain their child’s food aversions to other parents. This often leads them to stop making these social plans in hopes of avoiding these awkward situations. They also express fear of leaving their child in a situation where food may be offered which can lead to social isolation for the child. And in many cases these children need the social experiences the most.

Just like picky eating, problem eating can be improved. However, the process is more complicated, ongoing and most often requires professional intervention with a feeding therapist. Children with severe food aversions will likely struggle with these aversions through adulthood.

However they can become healthier eaters with guidance. When parents begin to see early signs of picky eating and food aversions there are tips that will keep the problem from growing larger and out of hand. Often the best of intentions can unknowingly make a problem worse.

There is No Better Feeling

Just recently when in the company of a good friend and his child, watching his 2 year old eat broccoli and chicken, he exclaimed “There is no better feeling than watching your child eat a healthy meal.”

As I have said before, feeding disorders are all consuming to everyone involved. For those of you who have not had the experience of having a child with a feeding disorder, be supportive to those families you may come across in the future.

And for those of you living with food aversions in your family, change is always possible.

(if you would like your child to eat a broader diet and change the bad habits that are negatively impacting themselves and your family call (914) 488-5282 now to request a confidential consultation)

About the author: Isa Marrs is a board-certified speech-language pathologist who specializes in articulation, pragmatic language and feeding disorders in children. She is an expert in the field who is frequently sought after by institutions and therapists to provide training for working with these and other disorders. Isa also served as a guest expert on Nickelodeon’s ParentsConnect.com, and has been quoted by numerous top media such as Disney’s BabyZone.com, LoveToKnow.com, and Univision. She can be reached at 914.488.5282

  • Emanuela

    dear Isa,
    I have a two years old son who refuses to eat practically everything. it started 4 months ago for no apparent reason. First he refused to eat soups at all, then all the mail courses and finally desserts. evrything ws fine before – quantities, varieties, but now he only eats yougurt from time to time, frozen fish fingers and McDonald’s french fries. and even this in so small quantities. plus some biscuits. I am so frustrated, we made blood tests and other tests – everything seems normal, but he refuses to eat and when presented with food, he show sign to be ready to vomitm it seems revulsive to him, no matter how appealing i try to make the food. We tried a food therapist – he is so stressed and shows no signs of improvement. Unfortunately we live in Bulgaria where this problem is not regarded as serious and i have no one to turn to. I feel so isolated! i’ve been told to let him start for at least 3 days- but i feel it’s not the right way, ‘cos he prefers to starve than to try something from the healthier choices we give him. I will be grateful for any advice! Even by email, from parents with similar experiences. Can you tell me is there some online therapy i could buy or download to apply it myself at home with my resistent eater kid? Plus, i am 8 months pregnant and it gets harder for me to deal with it, i really don’t know what to do and need urgent help. Thanks in advance!

  • Connie

    Hello, Isa,

    My son is now 19 years old. We didn’t know about food therapy, so have struggled with his food aversion since he was two – when his Asperger’s Syndrome kicked in.

    Can the same techniques work for adults as children in trying to learn how to eat more normally and nutriously? He eats about 15 things on a rotating basis. Oh, if he could only go to a party, a potluck dinner, a buffet, etc. – and eat something! Plus our family is limited to going to only one restaurant (other than McDonald’s) where he likes the grilled cheese.

    Thank you so much for your work in helping people with these difficult issues.
    Connie

  • Isa Marrs

    Hi Kaitlyn,
    What did UC Davis recommend? Feeding issues, while common in the ASD population,are not limited to that population. There are many otherwise typically developing children with food aversions. There are medications that doctors can prescribe that will increase appetite if they feel it is necessary. I would recommend talking to the nutritionist and your feeding team about this. Please let us know how this goes.

  • Isa Marrs

    Hi Shilpi,
    Your daughter’s medical diagnosis definitely makes her food refusals even more complex. I am sure yo are really worried. I do recommend working closely with a feeding team in your area if you are not already doing so. I do not feel comfortable giving any specific recommendations without a more detailed review of your daughters medical records.

  • Isa Marrs

    Hi Noelle,
    So sorry to hear about your son’s feeding difficulties. There are several feeding clinics in CA although I am not sure where they are in relationship to you. There is a program in California State University Sacramento, Children’s Hospital of Orange County, California Pacific Medical Center, and Pasadena Child Development Associates. These are not facilities I have worked with. They are part of the Pediatric Feeding Disorders Consortium. Good Luck. Please let us know how it goes.

  • Isa Marrs

    Hi Dhana,
    I am happy to hear you have scheduled a feeding evaluation. While your son’s feeding issues could be related to reflux he could also have a motor based feeding disorder or a sensory based feeding disorder. He also may have some components of each. In order for him to make progress it is very important to find out the cause of his difficulties. Children can grow out of acid reflux. The reflux could also be due to allergies?? If he even has reflux. Sometimes babies have reflux that subsides however the behavioral responses remain. Please let me know how the feeding evaluation goes and what they recommend.

  • Isa Marrs

    Hi Emanuela,
    It is great to hear that you are working with a feeding therapist. What is she telling you about your son? What are her impressions? Feeding therapy is a long slow progress so I would not expect quick changes. It is common for children to become more fearful of food around the age of 2. Some children get through this phase quickly and some become more picky for extended periods of time. Please let me know what the therapist is doing in therapy.

  • Isa Marrs

    Hi Connie,
    Many of the strategies used with children can also be used with adults. The approach I use with this population is behavioral. I have been very successful with teenagers although it is a long slow process!

  • Sandi

    I’ve probably asked before, but how can I find help for my son? I live in Colorado and I have no idea who could help. We tried “feeding therapy” locally and it was a waste of time. Wish I could find someone who could actually help.

  • Isa Marrs

    Hi Sandi,
    I know of 2 feeding clinics in CO. One is Next Step Feeding & Behavioral Services and the other is SOS Feeding Solutions @ The Star Center (Sensory Therapies and Research). Please let me know if you explore either of these programs.

  • Shannon

    My 9 month old son has recently stopped eating almost anything. He was a good eater for a few months and all of a sudden he will barely eat anything. At firstwe thought it was just a phase, him learning to feed himself, but for three weeks he has taken to spitting out 90% of what he happily gets in his mouth and he will mainly only accept food by nursing. When he is in the highchair and is done eating (or spitting out the food) he cries until we take him out, which means mom doesn’t really get to eat.

    Should we be concerned that this might be the first sign of trouble, is he spoiled somehow, or is it too soon to tell? Any suggestions on what we can try? He’s normally a super happy baby so this is very concerning to me.

    Thank you so very much for your blog and for your thoughts!

  • Isa Marrs

    Hi Shannon,
    I definitely would not ignore the fact that he has stopped swallowing solid food. There is a chance that it is just him exploring however the outcome will on how you handle these behaviors. There also could be a reason why he does not want to swallow. I would recommend that you have him evaluated by a Speech Language Pathologist who specializes in feeding. Please let us know how it goes.

  • Pauline Brown

    I have a 4 year old who has a very restricted diet. She eats no meat fruit veg. She will only eat rice and pasta with nothing added,bread crackers, cheese and scones. It appears that she will only eat food with little colour. She will only eat the base of a pizza ….no toppings at all. She gets very upset at the mention of trying different foods. If I put a new food in front of her she visably gets distraught and fearful. She is eager to please and will tell me that she really wants to eat the food but is afraid. I do not know what to do to turn things around.
    Pauline Brown

  • Heather Talbert

    Hi Isa,

    Do you know of any feeding clinics in the SW Milwaukee area? I need some advice regarding my 6 year old son, H, and his food issues: picky eating and texture aversion. I haven’t usually categorized him as HSC but I’m realizing now that he probably is. H has been a picky eater, really a resistant eater, since he was 15 months old. For 4 years after that, all he ate was crackers, white bread, fries and chicken nuggets. I believe it stems from a combination of 3 factors: food allergies, texture issues, and stubbornness. We only discovered his food allergies 9 mos ago to wheat, soy and a bit to dairy, giving him constant dull tummy aches and stool hard enough to give him a hemorrhoid. So all he wanted were foods that would soothe that, like crackers, and like many other children, was drawn to the foods that he was sensitive to. (Ref. one of my book faves, What’s Eating Your Child, by Kelly Dorfman.) Since then we’ve switched to gluten and soy free, and tried to expand his diet. But aside from chicken nuggets and now raisins, he will still not eat any meat, fruit or vegetables. I’ve gone so far as to make him take a bite and tell him he can’t spit it out until he chews it and tries it, and he will stubbornly cry for 10 even 15 minutes until I let him spit it out. I know now that is not the right or kind way to handle it, but you get desperate. And as for the texture, he gags at applesauce, and worries so much about other foods in his mouth that he doesn’t know. He even worries about food touching him from other people’s plates at the table. This is what I am most worried about right now in the short run as he will be starting all day kindergarten next Tuesday. He cringes away from the table where we are all eating, wants to pull his chair far away, wimpers, says “no!” when we try to get him to sit close enough to the table for him to eat. We try to get him to pretend he is in his own little bubble and nothing can get at him, but he is still afraid. And he can hardly get any food eaten unless he feels far enough away. I’m worried he either won’t get any lunch eaten during the day because he will be so afraid of other kids food touching him at the cafeteria tables, or he will be laughed at and teased for being so “weird”. He may even need to sit alone at another table like they do to punish kids sometimes, just so he can eat his food. But he is so social, that would be sad for him too. Sorry for the long post, I’m just at my wits end trying to manage H and his food issues and Tuesday will be a threshold he needs to walk through as he begins to grow up in this world of normal eating. Someone just made me aware of food therapy and I can look around but a referral would be most helpful. Thank you!

  • Isa Marrs

    Hi Pauline,
    It sounds like your daughter would benefit from feeding therapy to help desensitize her to new foods/colors/textures. If you tell me where you live I can look for a program in your area.

  • briana

    My 4 year old daughter is meets the definition of a resistant eater to a T. She eats about 15 different foods at the moment but she refuses to try any form of vegetable or meat product (with the exception of chicken nuggets and only 1 brand at that). I am located in Worcester, MA and I am having a very hard time finding a form of feeding therapy in my area. Is there anyone that you know of in Mass that offers these services? This has been an ongoing problem for as long as I can remember and it is only getting worse. She has begun eliminating foods from her diet and will absolutely not try anything new. The few times she has tried in the past she has gagged to the point of vomiting. please help! :(

  • Isa Marrs

    Hi Heather,
    I only have one feeding clinic on my list in WI. I am not exactly sure where it is located. It is Childern’s Hospital of Wisconsin Wal-Mart/Sam’s Club Feeding, Swallowing, and Nutrition Center. If this is no where near you I do suggest calling a local hospital and talking to their speech language pathology department. Let me know if you are able to locate a feeding therapist so I can add them to my list! Good Luck!

  • Isa Marrs

    Hi Briana,
    I have 3 centers on my list in MA. I am not sure if they are located near you or not. If not they can probably refer you to someone closer. The centers are New England Center for Children, Braintree Rehabilitation Hospital at Taunton, and U. of Mass Memorial Medical Center, Pediatric Feeding Clinic. Let us know how it goes and if you find anyone.

  • Megan

    Do you know of any good feeding therapists in Seattle? My 8 year old is a selective eater, fairly good with fruits and veggies but doesn’t eat enough protein as he’ll eat no meat or eggs, rarely cheese and rarely beans and rice. We are looking for a gentle and respectful approach, not a bribing with stickers approach as we don’t use rewards and punishments in our family.

  • Isa Marrs

    I am not sure of their approach but Seattle Children’s Hospital has a feeding clinic.