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

by Isa Marrs

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)

{ 124 comments… read them below or add one }

yvonne December 27, 2013 at 8:23 pm

Hi my 8 year old son , would not eat or try any kind of meat fruit or vegies tryd hypnosis about 3 years ago but I think he was s bid to young and just wasn’t interested now 3 years on I would like to give it another try can you please help me

Carrielynn A December 30, 2013 at 10:43 am

Dear Isa,

Hoping you can help. I have a 7 year old DD who has just been diagnosed with a generalized anxiety disorder and a feeding aversion. DD was a 30-week only preemie who had mutliple feeding and physical challenges at an early age: including reflux, food allergies, eosinophilic esophighitis, constipation, delayed potty training and sensory and texture issues. As time went on and the physical issues stabilized, the behavior issues at the table and poor calorie consumption and picky eating increased. As a nervous parent, my approach was not the best. Out of concern for her growth, we put pressure on her to eat and constantly criticized her acting out behavior at the table — which in retrospect probably was coming from food anxiety. At the time, we saw it as a behavior issue and tried to insist that she eat. We never force fed, but there was always pressure at the table and a negative experience for her. The end result is that we now have a 7 year old with intense control issues with eating and the eating issues have resulted in her fear to be at the table with us or eat in front of us for fear that she will be yelled at or criticized for her eating. It’s also carried over to school and eating with peers. She eats virtually no lunch at school and is tired and achy at the end of the day.

It’s taken me a few years to recognize the impact of our choices. I’ve always been afraid to take the doctor’s advice to “remove the pressure” during eating because I was afraid that she would simply choose not to eat. She was never a child who would eat if she was uncomfortable or nervous and never a child who responded to hunger. She would often prefer to not eat and feel bad – instead of be uncomfortable. My concern always came from the fact that she was not consuming enough calories (average of 1000 per day) and recently her growth has slowed. We’ve tried supplements (can’t do dairy) but she rejects them after a while. Recently we have decided to bite the bullet and change our strategy. It’s been one week and, as expected her calorie consumption has taken a nose dive. She’s consuming mostly liquids with a few solids but seems afraid to eat. She tells me she is hungry, then when we sit down, she can’t eat. We’ve tried meals in front of the tv but she has ADHD and would rather watch tv than eat. We’ve greatly changed our behavior, but we feel she is shutting down and are concerned she will starve herself, unintentionally. She is being monitored by her pediatrician, a psychologist and speech therapist at the feeding clinic. She has been started on a low dose of Zoloft for anziety and we will be working with a psychologist. My questions is have you ever seen a food aversion or fear of eating develop from too much pressure to eat? And if this has gone on most of her life, can it be reversed? Do you have any recommendations on how to handle this stage when she chooses not to eat? It’s terrifying to watch as a parent. I’m mostly terrified that this will result in her having a feeding tube. I should also note that her anxiety and willingness to eat are greatly improved when she is with her wonderful calm sitter (once evening per week) or with the SLP during group feeding therapy. She is surrounded by calm adults in feeding therapy, motivated by peer eating, no pressure and when the focus is not on her eating. She also does well if we have company for dinner and she is not the focus, but when it’s just my DD, my DH and I, she can’t seem to eat. So hard to make her not the focus at meals, if it’s just the three of us. Any advice or inspiration would be greatly appreciated.

Isa Marrs January 7, 2014 at 3:31 pm

Carrielynn
It sounds like you all have been through so much. Thank you for sharing. It is such great news that there are environments that your daughter has made progress and is becoming comfortable eating. No two children are ever alike however I have seen many children with severe anxieties related to eating for many different reasons. From your story I don’t believe the pressure that you put on her was the only reason she became so anxious,it sounds like there were many contributing factors. It sounds like you are moving in the right direction and have a team of professionals working closely with you. Given the serious nature of your daughter’s feeding disorder I would not feel comfortable given direct therapy advice. What I would say is that if you trust the team you are working with follow everything they say to do and stay committed. That could make all the difference.

katy January 31, 2014 at 4:05 am

Hi,
I have a nearly 6 year old son who stopped eating when he turned 9 months old.. he gagged once on lumpy food and that was nearly the end of it all.. for about 2 years all he would eat was yogurts.
now at 5 he is struggling more than ever, he is very thin for his age and very short,however most of that is heridetory since i am only 4″11 and 6 stone. He is only 14.3kg and 3″
The strange thing is i went through the same thing when i was a child and also refused food around 9 months but as i have gotten older i accepted food and even though i am picky and have a few things i don’t like i typically enjoy food in all aspects..
Like with Carrielynn i also feel i have put too much pressure on him to eat.. now however it has gotten to a stage where he gags at the sight of food and gets extremely anxious at the thought of eating.he is on iron supplements but is very pale and i have on more than one occasion been called in by the school because they think he is sick or not sleeping because he is finding it very hard to concentrate and has very little energy after 11am.
He is under pediactric care but they just see him as your typical picky eater and i have beeen told that “he wont starve himself”.. but he would,quite happily at that.. he even asks to go to bed rather than to eat..
Recently he has started to reject foods that he once loved and refuses to eat meat or veg so basically his diet consist of bread and potatoes ,a bit of cheese and mayonnaise.
We have come to a point where we have no idea what to do and the resources don’t seem to be readily available as i have to wait up to 7 months just to see a consultant who then takes another year to refer me to a nutritionist who takes another 6 months to refer me to a physiologist who then tells me he will get better in time..We feel like we are going around in circles.We also have another son 2 who has no problems with food whatsoever..
ANY advice would be greatly appreciated.
Katy

Isa Marrs February 1, 2014 at 10:39 am

Katy,
First and foremost DO NOT listen to anyone who tells you that your son will not starve himself. That is just not true. A typical picky eater will not however it sounds like your son is NOT a typical picky eater. I would recommend having him evaluated at a pediatric feeding facility if there is one in your area. Where do you live?

katy February 1, 2014 at 12:33 pm

We live in the west of ireland,we did have a short stay in dublin (5 days) when they evalutaed what he would eat but they where more concerned about his genetics and getting him tested,which they did and all was normal but then they sent him to another nutritionist who just said put the food there and if he doesn’t eat it he will be hungry for the next meal.. i did not listen to this because i know that he wont eat any of the meals given that choice,i never went back to her after that,this is the second nutritionist i have seen that has said this.. they think because i do give him the foods he does like that we never attempt to give him others(which is not the case), im just trying to do it in a way that wont leave him more fearful and my fear is if i do follow their advice is that he will end up quite sick and perhaps hospitalized.
Katy

Isa Marrs February 5, 2014 at 5:09 pm

Katy
Unfortunately I do not know of any feeding clinics outside of the US. I feel from your initial post that your son needs a strong behavioral approach to his feeding difficulties. Have you contacted the Speech Language Pathologists in the area? They may not work with this population however they may be able to refer you to someone who does. I also recommend contacting Psychologists. There are therapists who work with individuals with feeding disorders. I would even look into ABA therapists. They also work with children who have behavioral feeding disorders. If you are ever interested in a phone consult to guide you please give me a call!

Heather February 6, 2014 at 2:45 pm

My son is 10 years old. We had many issues during the first year including eight months of extreme colic, ear infections resulting in tubes at nine months, asthma, and he required ailmentim formula and then lactaid milk. When he began eating foods he showed strong preferences which continue to this day. He would eat certain foods every meal for weeks then stop and never touch them again. The pediatrician did not see a problem “he will eat when he is hungry” or “when he eats ice cream he is getting his dairy intake”. About three years of age all of his medical issues resolved and he has been illness free since. He has had a feeding evaluation and they think he might have acid reflux which he refuses to take the medication. They do not see a sensory issue however he makes comments everyday about the different smells and how repulsive they are. He sees a play therapist for anxiety issues but she even feels the eating is not a primary issue. I struggle each day trying to keep the peace because my husband gets angry that he doesn’t eat my mother worries and I relate to him in some ways because I can be totally repulsed by looking at a food with certain textures. His current foods are made up of mostly tan carbs however we go through periods were he will be more limited than usual and it seems like he isn’t eating at all. I wish this was easier but I can not seem to figure out how to help him. I have another child a 7 year old girl who is the complete opposite and will eat everything to the point my husband gets worried because she won’t stop eating. I just want to have a healthy non stressful meal time.

Isa Marrs February 12, 2014 at 3:06 pm

Heather
It sounds like your son’s feeding issues are behavioral and sensory based. If he is repulsed by the smell of food there is definitely a sensory component. With children like your son I usually use a desensitizing approach mixed with food chaining. The refusal to eat is probably also due to a negative association he has towards food due to his past and present medical conditions. It is rare to see a feeding disorder that does not have many components. The best thing you can do for him along with finding a feeding therapist is to avoid food battles at home. Where do you live?

Kris March 2, 2014 at 1:41 pm

Hello,
My 5 year old daughter has food aversion that affects our daily lives. I have tried to get our Dr. to take my concerns seriously for at least a year but because my daughter maintains her weight & growth it has always been kind of brushed aside & “lets take the wait & see approach & just keep offering her new foods”. I too have been told “most children won’t let themselves starve”. If I hear that one more time I’m going to scream because I know my child would rather go hungry than even touch a new food. How do I even introduce a new food when she can’t even bring herself to touch it?
I ended up insisting on a referral to someone, anyone, so GP referred us to a Pediatrician. After seeing the Pediatrician who also advised me to “try bribing her & using a sticker chart”, yeah like that’ll work! I have tried it all with no success at all. After being so discouraged I insisted at our last visit that I think there is a lot more involved then her just being stubborn & not wanting to eat, she can’t physically make herself eat unfamiliar foods. The Peadiatrician has now referred us to Psych for possible OCD/Anxiety issues.
Upon much reading I came across Sensory Processing Disorders which I firmly believe is the route cause. There are so many things that describe my daughter. She was extremely colicky as an infant, never crawled, has issues with certain clothing, has a fear of falling in certain situations, smells bother her that nobody else can detect, etc. we have an appt this week for our first Psych “assessment ” which will decide if she is “severe” enough to be accepted for a year long waiting list!!! Yes, a year wait for help. My concern now is getting them to believe & take my opinion on sensory issues seriously enough so we can be referred to the correct people. I am in Canada & wait times are horrible! I think her sensory issues mainly majorly impact her eating but there are a few mild things along with it. How do I get myself heard & if they don’t consider her “bad” enough to warrant help, then where do I go?

Susan Martin March 10, 2014 at 10:41 am

Kris,

I am in the EXACT same situation as you!!! My 9 year old has the same issues totally — and after trying a speech therapy program that didn’t pan out, we went to a new pediatrician who has referred us to a clinic for OCD and Anxiety!! So we are trying to get there but are having problems doing so because the place they referred us to deals only with social anxiety and Post Traumatic Stress Disorder….so basically we are back to square one!!! I wish you the best of luck and please keep us updated on how things go. It’s so tough dealing with this..for our CHILDREN.

Best,
Susan

Isa Marrs March 10, 2014 at 6:03 pm

Kris,
Thanks for your comment. Just about all feeding disorders have many causes. Sometimes the original cause has resolved and the feeding disorder still remains. It would be helpful, if you believe she still has sensory issues, to get an OT eval as well. It is important to remember that if she works with a psychologist because of anxiety/ocd the eating must be directly addressed.

Sarah Schafer March 11, 2014 at 7:20 pm

My daughter has been a “picky eater” since the day she was born. After birth she couldn’t form the proper suction on a bottle and had to stay in the NIC unit until she got the hang of it. From there it has been an uphill struggle most of which I blamed on myself. I was so worried about her not eating that me forcing the issue just made it worse. She is almost nine now and we have worked our way up to where she does eat a few things but is by no means a balanced diet. At the advice of a doctor we started letting have pedisure which reassured me that she was at least getting the nutrition that she needed and I felt that in time she would start trying more foods. About two weeks ago, she was eating a cheese pizza and began to choke on the cheese. There was a lot of stringy cheese on the pizza and a long piece got stuck on the way down. The last few days I noticed that she was starting to spit out her food into the garbage. It has gradually gotten worse to where now she won’t even eat her favorite foods. She tells me that she is afraid of choking again. Living off of pedisure is not the answer and if I can not get her past this I know that I will have a very serious problem on our hands. I’m so worried! What can I do to help her overcome this?

Isa Marrs March 12, 2014 at 4:13 pm

Hi Sarah,
It was nice speaking to you today. Please let us know how everything turns out.

Carrielynn A March 17, 2014 at 10:46 am

Dear Isa,

I posted our long story in December of 2013 and would like to post an update and ask for your advice. As you know, my 7 year old DD has has a long history of physical eating issues (reflux, EoE, food allergies), developmental delays (oral motor due to prematurity), and a recent diagnosis of anxiety and ADD-Inattentive. We have been working with a few professionals to better understand the problem. She attends a school-based feeding group run by an SLP who understands feeding issues and has been seen by a child psychologist who understand anxiety (not part of the same group). The problem is that the team process is not working well. My DD does very well in weekly feeding group and shows no signs of anxiety when there is no pressure to eat, when there is motivation from peers and is facilitated by a supportive adult. In group, there are also very few signs of current sensory issues or actual oral motor problems. The main problem appears to be that she has felt so much pressure to eat at home (which has extended to school and other environments), that eating and food have become a negative experience. She has never responded to hunger, would prefer to skip meals to do something more fun and never seems motivated by the taste of food. So, we resorted to telling her she must eat in order to be healthy (since about age 3). Without asking her to eat, she simply chooses not to and the more pressure or limits we apply (If you eat 10 bites, you will earn..), the worse the situation gets. She hates coming to the table, displays numerous nervous habits, has developed learned behaviors of avoidance with food and has even resorted to hiding food. I’ve read many of your articles that talk about not making food a battle, or it could lead to eating disorders. So my question is – how do you treat a child who has developed negative feelings of food from force? And what do you do if backing off and allowing her to make good choices doesn’t work? The SLP we are working with understands feeding issues, but not anxiety and tells me this is beyond their scope of practice and the psychologist understands how to treat generalized anxiety, but does not understand food issues such as these. The process feels very disconnected and we still do not have an answer about the cause or how to treat. We do believe she also has some other issues with food – such as sensory (as she seems unable to tolerate anything but plain, soft food with no mixed textures). But, the primary reason for her problems – which has now affected her overall growth and nutritional status – seems to be her negative relationship with food and us. How do we begin to turn this around and remain calm when we are always concerned that she’s not getting enough to eat? Would you be open to a phone consultation to discuss?

Tiko March 24, 2014 at 8:11 pm

Please help me. I cried enough . I want this problem to be solved. I don’t want bad thing happens to my boy. I have twins , both boys. They were good eaters until 1.5 years of age. One of them who would eat everything I gave him( I fed 6 times a day with big portions) and suddenly at 1.5 years of age he started refuse eating . It has been 9 months that he eats ONLY crackers. I tried not to feed him the whole day so he would eat at the end of the day but he didn’t so I gave again crackers . Please help me. What do you think happened to him that he turned into a bad eater from being such a good eater? Are we able to fix this. Will he ever eat normal food. He doesn’t let me bring the spoon to his mouth, he pushes it away. He also doesn’t touch any food besides bread and crackers. He is too sensitive . Is this fixable? Please give me some hope

Alicia Moreno March 29, 2014 at 12:06 am

I have a a 3yr old nephew who was diagnoses with autism, he is very thin as he hardly eats. He smells all food before first and most of the food he would not even try once he smells it. The whole family is worried because he doesnt eat. The only thing I know that he drinks dauly ix milk, he still uses a botle and probably has 2 of 3 foods that he is comfortable eating. Is there anything that can help him?
Thank you
Alicia

Judith April 2, 2014 at 3:38 am

Hi,
I have an 8 year old son who I think might be a picky eater I hope. He hardly want to eat anything. An example may be like if I made him fried chicken w rice he will eat the rice but he will eat maybe one or 2 bites of the chicken. It’s always with the meats he never wants to eat as much, but fruits ohh he will eat those. Veggies he has stopped completely which is weird because when he was lil he would eat anything and was alil on the big side and now he weighs I say 50 Lbs and measures 64 inch. He seems to only want to eat junk food which I try to limit but I guess I’m just letting him eat it because sometimes that’s all he wants to eat. Please help thanks.

Erica heymann April 7, 2014 at 7:01 am

I am newly married with a combined family. My husband’s daughter is 7 years old and is a very picky eater. Most of her nutrition comes from processed foods, carbs, hotdogs, (I think we might have her shying away from them.) and sweets!!! The problem is that her Mother isn’t consistent with her having to try new foods because she doesn’t want to her their daughter whine/cry. I don’t think she is patience enough. Example, she hasn’t had vegetables in over 5 years. She will finally ear a few peas at our house, but when she goes to her Mother’s house, she won’t even make them. She’d rather give her pizza 4-5 times in 2-3 days. She’s gone 36 hr without eating, then when she does her stomach is so empty. She attempts to eat but fails and ends up puking for hours later.
She can just look at the food and cry. Her tantrums are somewhat better, possibly. I’m really worried that she starves herself here because we offer healthy choices and then binges when she goes back home to her Mother’s house. Her typical foods that she eats is: yogurt, apple(sauce), hoy dogs, chicken nuggets, peas, any candy and almost anything dessert, milk, juice, cheese, chips, etc.
i am worried that this might further complicate things later down the road and she might learn worse eating habits or even worse, an eating disorder.
Thanks,
Erica

Isa Marrs April 10, 2014 at 9:07 am

Carrielynn
Thank you for the update on your daughter. It is great to hear that she will eat comfortably in her feeding group at school. It is also so nice to hear that this kind of group exists. It also gives us more insight into what is going on which you explain so clearly in your post. Does your feeding therapist give your daughter any goals to work on at home? Sometimes if a child is comfortable with a therapist and eating for her, demands coming from her for home practice will be more accepted.The transition from eating in the therapy room to eating at home is often very difficult. Is it at all possible to host any of these groups at your house? This could be a way to desensitize her and make her feel safe.
I do think you need to be working with a Psychologist who has an expertise in eating disorders.
I can do phone consults if you are interested. Feel free to call my office and schedule.

Isa Marrs April 10, 2014 at 9:12 am

Tiko
It is common for children to become “picky” at about 18 months however it seems as though your son has become extremely picky. Have you spoken to your pediatrician? Usually the change is not that sudden or extreme. I would first recommend ruling out any underlying medical issues before talking about how to change his behavior. In order to do this I recommend seeing a Pediatric Gastroenterologist.

Isa Marrs April 10, 2014 at 9:16 am

Alicia,
Your nephew can definitely make progress with his eating. It will take time and patience. Children with Autism Spectrum Disorders usually do best with a behavioral approach to feeding therapy. If he receives ABA therapy you should talk to his therapists about incorporating eating into his program. There are also programs around the country for children with Autism who struggle with eating. Where do you live?

Isa Marrs April 10, 2014 at 9:27 am

Hi Judith,
It seems like your son is a bit picky but not outside of the norm. First thing I would recommend is to remove all the junk food from the house if that is what he is eating most. If the junk food is not there he can’t eat it and you don’t need to fight over it. This way he can make healthier choices. I also recommend not watching too closely what he eats and doesn’t eat on his plate as long as he is eating. If he likes fruit and used to like vegetables I would put those on his plate with his rice and chicken and let him eat what he wants. If he likes to eat he will get past this.

Isa Marrs April 10, 2014 at 9:44 am

Erica,
This is an extremely difficult situation.Feeding requires a team effort and consistency and if she is living 2 different lives change will be hard. My suggestion would be to pick the healthier foods from her diet that she enjoys and feed them to her when she is at your house. I definitely agree that you should not offer the junk food however yogurt, cheese, apple sauce, peas and chicken are healthier options. I would continue to offer healthy foods along side these foods however i would not recommend creating a battle. Because of the 2 houses you can’t win. I assume you have already spoken to her mother however if you have not I would try to come up with a plan that you all can follow.

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