If your child’s eating is causing ongoing distress, trust your instincts and seek a professional assessment.

What is “picky eating”? It is important not to confuse picky eaters with the labels of feeding disorders or eating disorders. Picky eating is also known as fussy, faddy or choosy eating. It is usually classified as part of a range of feeding difficulties. Sometimes this is viewed as picky eating at one end of the spectrum, feeding disorders in the middle, and severe eating disorders at the other end. Picky eating is characterised by an unwillingness to eat familiar foods, try new foods as well as having strong food preferences (Taylor, Wernimont, Northstone & Emmett, 2015; Taylor & Emmett, 2018).

Picky eating and autism. It has been suggested that children with autism are five times more likely to have challenges relating to food and mealtimes. Matters such as narrow food choice selections (often due to sensory issues such as taste and texture), rituals relating to food (for example foods not being able to touch on the plate), and meal related tantrums are some challenges relating specifically to this group of children (Autism Speaks, 2018).

A helpful checklist when thinking about picky eating.

Picky eaters …..

Foods groups: … are willing to eat one or two foods from each of the food groups (eg fruits, vegetables, grains and protein).

Selectivity: … will have favourite foods but will tolerate some variation. For example they will eat a few different kinds of macaroni cheese.

Degree of resistance: …may resist certain foods with some mild behaviours such as arguing, whining or face pulling.

Effect on daily life: …can usually find something to eat when away from home. For example at restaurants, parties or staying at friends places.

Response to motivation: … may be motivated to try a food if they see a friend or parent eat it or with a promise of a reward (preferably a non-food reward).

Chewing and swallowing delays: …don’t have problems chewing or swallowing

Nutritional difficulties: …in general have a daily diet that provides the majority of nutritional needs

Factors to consider. Some factors for adults to consider when thinking about picky eating.

Have medical problems been considered and ruled out?
Am I staying calm and being patient when introducing new food to my child?
Am I offering choice and control when it comes to food or are meal times becoming like a “battlefield”? – for example let your child choose something while at the supermarket
Is eating developmentally appropriate? – for example children like to look at, touch, smell, lick and play with their food and may like to try new foods in small portions alongside favourite foods
Is it the texture of the food that your child does not like? – for example if your child prefers crunchy foods provide raw rather than cooked carrots

Am I modelling good food choices and structured eating times?
Am I being careful with snacks and treats during the day-time so my child/ren are more likely to be ready to eat at meal times?

Summary of the research:

In 2015 Cardona and others reviewed the literature on picky eating. They found that published research general covered three themes: characterisation of picky eating, factors contributing to the development of picky eating, and how to manage picky eating. Cardona and others found that picky eating was a “reasonably robust concept” (2015, p. 448) and was made up of food neophobia (extreme or irrational fear or dislike of something new or unfamiliar), consuming a limited variety of food, and features associated with eating food such as limited enjoyment, slow eating and high levels of feeling full. They found that picky eating was more prevalent in pre-school children then decreased as children got older. They also highlighted further research is required and there was still uncertainty around when something was normal or concerning picky eating.

Taylor and others (2015; 2018) identified how picky eating may lead to poor dietary variety in early childhood and how this in turn can lead to concern about getting adequate nutrients and the impact on general child health. They suggested that further longitudinal studies are required to fully evaluate health related outcomes. They highlighted the importance of cultural differences in food consumption is an important variable to consider in future research.

Overall, picky eating may resolve with minimal or no intervention. Some key strategies in addition to those identified above are (Cardrona et al 2015: Taylor et al 2015; 2018).

Have realistic expectations of children’s portion sizes

Try phased and repeated exposure to unfamiliar foods (10-15 exposures positive experiences may be needed)
Use non-food rewards as motivation for trying something new
Have a positive approach, avoid negativity and pressure to eat
Model fruit and vegetable consumption and trying new foods
Promote appetite by limiting snacks and energy-providing drinks such as milk, juice and soft drinks between meals

Encourage social food experiences such as family meals with everyone eating the same food
Keep focused on long term eating goals and being consistent over time

Summary

Picky eating can cause stress for parents/caregivers which in turn may impact family relationships. It is important to see your GP or paediatrician if your child is having eating difficulties of any sort to firstly rule out any medically related matters such as food intolerances.

Julie Peake

Researcher, Parent to Parent/Altogether Autism ,B Soc. Sci (Hons) (Psychology and Sociology), Dip Social Work, PG Dip SSS

References

Cardona, C., Hoek, H., & Bryant-Waugh, R. (2015). Picky eating: the current state of research. Current Opinion is Psychiatry. Volume 28, 6, pp 448-454.

Autism Speaks. Seven ways to help a picky eater. Autism Speaks, 9 October 2018.

Taylor, C., Wernimont., Northstone, K., Emmett, P. (2015). Picky/fussy eating in children: Review of definitions, assessment, prevalence and dietary intakes. Science Direct, Appetite, 95, 349-359.

Taylor, C., & Emmett, P. (2018). Picky eating in children: causes and consequences. Proceeding of the Nutrition Society. University of Bristol.

When does autism-related picky eating cross the line to feeding disorder? Autism Speaks, 28 October 2016. https://www.autismspeaks.org/expert-opinion/when-does-autism-related-picky-eating-cross-line-feeding-disorder