Musings on Anxiety, Sensitivities, and Extreme Picky Eating

Earlier this week, a study came out linking moderate and extreme picky eating with anxiety and depression in children. It has caused quite a stir in the media, with headlines like, “Is picky eating causing depression?” That grabs attention! With one in three parents describing their child as “picky” at some point, the reporting on this study has probably caused more anxiety.  Quick answer, no, typical picky eating, which impacts one in three kids at some point, does not lead to depression, anxiety or ADHD, nor was it associated. A small percentage of children have severe or moderate selective eating which were the two groups associated with anxiety and other concerns. Of note, this study, like all studies had some limitations. Among them, it was voluntary (meaning some parents opted not to partake which could alter findings), and the study followed a portion of the children for a few years, not to adulthood, and didn’t take into account how the challenges were addressed among other factors. The study itself doesn’t claim that picky eating causes depression, another example of how the media distorts science. Here is a nice summary of the study, and below are some more thoughts that we (Jenny and Katja) had on the issue to help parents unpack these scary headlines.   IS picky eating causing anxiety and depression? Do you see anxiety in children with more severe picky eating? This study found a correlation, not causation, between moderate to severe picky eating and other conditions like anxiety and ADHD, which has been suggested in other research. It does not mean that picky eating causes depression or anxiety...

Milk is Food: Improving Appetite for Toddlers with Picky Eating

Lately, we’ve been getting questions from parents whose toddlers are struggling with poor appetite for solid foods but eagerly take a bottle or want to nurse around the clock. Cow’s milk (or a milk alternative) is a recommended part of a toddler’s overall diet, and many toddlers continue taking formula or breast milk into the second year of life. Some children may need a more fortified liquid supplement like Pediasure if growth has been poor. The American Academy of Pediatrics recommends that low-fat/reduced-fat milk not be started before 2 years of age, and at age two, toddlers need approximately two cups of dairy per day. (And if your child prefers whole fat dairy, serve what he likes. There is no compelling evidence that low fat dairy reduces the risk of being overweight down the road.) A common problem with milk occurs when the amount he consumes or the timing of consumption interferes with appetite for other foods. Not only can nutritional variety suffer, but crucial early experiences eating a variety of foods can be missed. Whatever type of milk we are talking about, it is digested in the same way as food, and contains filling fat and protein. There’s only so much room in that toddler tummy! Let’s be honest. We all prefer the path of least resistance, and children are no different. Drinking most of their calories is just easier for some children. The comfort of being in mom’s arms, the soothing nature of sucking, and the ease of just swallowing- and not having to chew- are all reasons why some toddlers can have trouble transitioning to a more...

Chew on This: Considerations for Development of Oral Skills in Extreme Picky Eaters

When I evaluate a toddler that hasn’t made the transition to table food, one of the first questions I ask is “Did he mouth on toys/hands/lovies as an infant?” If the answer is yes, I always ask how much and how that child compared to other children in the home with regard to mouthing and early acceptance of oral play. However, more often than you would think, I hear from parents that these children with extreme aversion to texture in their food did not mouth at all. They blithely say “We didn’t have to baby-proof!”, unaware that their well-behaved infant’s choice to leave that paperclip on the floor is at least part of why he hasn’t moved on from pureed foods. I recently saw an older toddler who fit this description exactly—to the extreme. When observing her oral motor skills without food, there were no noticeable deficiencies. Lateral tongue movement was present, she could open and close her mouth in mock chewing, was able to blow a kiss, and kept her tongue in her mouth where it is supposed to be. No outward signs that this child had never had one bite of actual food. Not one bite swallowed. Theirs was a successful breast feeding dyad, but that was the only sustenance she got, and not from lack of trying on the parents’ part. So why couldn’t this child learn to eat? Interestingly, the family had many older siblings who had mouthed as infants, accepted spoon feedings of purees without incident, and had no trouble learning to eat the family foods. So it wasn’t what the parents had or...

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