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...

Doctors: Support Parents of Children with Picky Eating (from Typical to Extreme)

We were so excited to see this recent article, A Practical Approach to Classifying and Managing Feeding Difficulties (Kerzner et al. 2015) from the Journal of Pediatrics. It does a great job of providing an overview of feeding challenges: underlying factors, screening, red-flags, and a user-friendly format for primary care providers who are the front lines on this issue— most of whom receive little to no training in feeding challenges. This paper provides an excellent overview. Here are our summary points for clinicians: 1) Take every worry and complaint about picky eating seriously before jumping to reassurance. “…pediatricians must take all parental concerns seriously and offer appropriate guidance.” Parents may do well with reassurance and a handout, or they may need a referral to specialist care. You can’t reassure parents without listening to and addressing their concerns. 2) History, physical exam, potential lab tests, and red flags are discussed and help determine severity and what general category challenges fall under: misperceptions of typical variants, low appetite, medical/organic, selective, sensory, fear of feeding, and feeding style. This helps guide referral and treatment. Some sample red flags: using distraction to increase amount eaten, prolonged time at the table, gagging or coughing/choking, significant conflict, history of choking, or forceful feeding. “When it is apparent that a potential feeding difficulty exists, a complete history and physical examination, including carefully done anthropometrics and a brief dietary assessment, are necessary with special attention to serious red flags…” 3) Assess parents’ feeding style by asking parents how feeding is going, what they worry about, what they do if they think a child needs to eat more...

What is ‘Extreme’ Picky Eating?

It’s a hot topic at the playground and preschool pick-up; parents commiserating over their child’s sudden refusal of long-time favorites, or yearning for all foods “beige”. There is a lot of talk and worry around picky (fussy, finicky, choosy…) eating. Then there is the mother not saying much, wishing if only she had a child who would eat macaroni and cheese, or cucumbers with Ranch while other parents complain about the ubiquitous white sauce. Then there are the few moms and dads in the bunch who enthuse that if you only knew how to crisp kale chips properly, all the children would surely love them like theirs do. These discussions mirror what research tells us about the experiences of parents of young children: various studies suggest that between one and two-thirds of parents will describe their young child as “picky” at some point. Most will grow out of it and expand their tastes, but about 10-15% of children will become “persistent” picky eaters and many in that group have what we call “extreme” picky eating.   What’s in a name?   Researchers are still trying to agree upon consistent language and definitions. Clinicians and health insurers try to define ‘pathology’ that needs treatment and billing codes for reimbursement. Many of the labels and diagnoses we see include: feeding disorder, failure to thrive, infantile anorexia (outdated term), problem feeder, ARFID (avoidant restrictive food intake disorder), feeding aversion, selective eating, and selective eating disorder… Parents have also heard “spoiled”, or themselves been labeled as “neurotic”, “neglectful” or even “abusive” for letting their children eat foods not up to nutrition police standards....

Moving from GET to LET: Supporting the Child with Picky Eating

“I couldn’t get him to eat anything.” While reviewing the progress of the children in my feeding program with my graduate student clinicians, I hear this type of statement all the time. There is sometimes so much ‘get’ that I have to stop the discussion and tell the students to remove that word from their vocabulary during feeding therapy. Why? The words we say out loud, and even in our own heads, can make a huge difference in how we think and feel about others, ourselves, and our actions. How we behave is influenced by what we’re thinking . . . and words are a direct reflection of our thoughts. Words matter. They shape our thinking and other’s perceptions of our message. They can color a conversation, and can change someone’s mind. Words can drive a wedge between partners or support someone so they can go on to change the world.   Henry Ward Beecher said “All words are pegs to hang ideas on”. If we view words in that way, it can help us to see how our language can make a huge difference in not only how our children react to us, but how WE react to THEM. If you have an agenda and the child isn’t cooperating, your instinct is to do something to GET them to play along. So many parents I work with say the following types of things: “How do I GET her to eat more?” “I can’t figure out how to GET him to drink.” “His doctor said we need to GET 24 ounces in him.” “I just can’t GET him to...

Say Cheese! Exploring Preference and Changing Tastes with Picky Eating

When I was a child, I hated cheese. I couldn’t imagine eating it. Although I ate pizza, it didn’t really register that it was cheese on top. Once, when I was about 12, a good friend thought it would be hilarious to force me to eat some cold cheddar cheese. She easily held me down (being quite a bit taller than I was) and crammed a large chunk of cheese into my mouth and then kept her hand over my mouth so I couldn’t spit it out. In my memory, fumes were coming out of my ears. It was traumatic, and I haven’t ever let her live down that little stunt. Early in college, I went on a trip to Europe with my dad and we spent two days on the Orient Express. Every afternoon on the train, they served stinky French cheeses at tea. I literally had to stick my head out of the tiny window next to my seat while my father enjoyed the array of veined cheeses. My senior year found me at a friend’s parents’ house where they served us wine and, you guessed it— cheese. This time, though, there were grapes and strawberries and crackers to go with it. I voiced my apprehension, and my friend gently explained how I might enjoy Brie or Gouda since they were milder. And she suggested I try a small amount on a large cracker— with a grape in the same bite. To my surprise, I enjoyed it. And my love affair with cheese began. Mealtime Hostage blogger Skye VanZetten discusses her son’s journey toward cheese in this...

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