Empathy and Understanding, The Foundation for Helping Your Child with Extreme Picky Eating

“Learning what issues play a role in our son’s picky eating helped us  connect the dots and problem-solve creatively.” *You can learn to trust yourself and your child around food. That may feel impossible when you worry that she won’t eat enough or hasn’t progressed in months or years, and that things may even be getting worse.  Understanding what is typical, what isn’t and the many factors that can contribute to extreme picky eating (EPE) will help you decide what you can let go, what you can work on to support your child’s eating, and above all, how to not make matters worse. Feeding Challenges From Your Child’s Point of View   Children with EPE are not just being naughty or willful (though they are at times more than capable of being so). Helping a reluctant eater is not a matter of making her comply. Rather, there is almost always an underlying reason that starts a child and his parents down the path of feeding difficulties. Struggles can start in the neonatal intensive care unit, during the transition to self-feeding, or in the tricky toddler phase. Understanding the factors that may contribute to your child’s challenges and the dynamics at play can help you empathize and facilitate her eating with confidence. Here are some of the main reasons why a child might struggle with eating (with a focus on sensory challenges and a few resources focused on understanding): Medical Challenges: “It hurts! It doesn’t feel good!” Contributing medical issues must be ruled out or addressed. These might include allergies, reflux, or severe constipation—basically anything that can cause pain or make a child feel poorly. Young children...

Medscape’s ‘War and Peace at the Dinner Table’: Is MAKING Kids Eat the “Only Way”, and Other Points to Ponder

This clip won the America’s Funniest Home Video $10,000 prize. Is it helping her learn to like green beans?   As clinicians, parents, and experts in childhood feeding struggles, we are concerned about the one-sided nature of the online article and video War and Peace at the Dinner Table: Advising Parents of Picky Eaters, presenting advice to physicians on how to help children with extreme picky eating. Below, we present a discussion and resources for parents and professionals who might like to learn more. First off, we agree with the following points in the article: clinicians should take a parent’s concerns about picky eating seriously (Kerzner), and that ARFID (avoidant restrictive food intake disorder) or extreme picky eating (EPE) impacts family life and the social and emotional development of the child. We also agree that without support, a significant proportion of children will not outgrow their eating struggles and that mealtime “hygiene”, like avoiding grazing, supports appetite and curiosity around new foods. However, we feel that several statements are not supported by the evidence, and in the absence of a widely accepted ‘best’ practice, must be examined. 1) This sweeping generalization: These children don’t have sensory sensitivities. Many children who suffer from ARFID or EPE had medical or underlying conditions and challenges, including sensory issues, that contribute to the establishment of a feeding disorder (Arts-Rodas, Chatoor). The DSM-V ARFID diagnostic criteria recognize three subtypes of the disorder sensory (emphasis ours), associated with an aversive experience, or associated with low appetite. Sensory challenges are at least a contributing factor for many children with EPE, particularly for those on the autism...

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....

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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