Sunday, December 28, 2014

Is picky eating harmful?

Picky eating can be inconvenient, annoying, and worrisome, but is it actually harmful to your child? That depends on how long it lasts and its severity.

Is picky eating harmful?

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Picky eating can be inconvenient, annoying, and worrisome, but is it actually harmful to your child?  That depends on how long it lasts and its severity. Most children tend to go through a vexing icky-picky phase when they are toddlers – that’s developmentally normal. What’s also developmentally normal is that children gradually come out of this phase and expand their diet beginning in the late preschool/early kindergarten years and then continue to diversify the range of foods they eat comfortably and enthusiastically into adulthood. 

By contrast, long-term picky eaters continue to eat food similar to the color of bride dresses, favoring variations on the theme of white, cream and beige (e.g., cereal, bagels, chicken nuggets, and plain buttered noodles). They are highly reluctant to try new foods, rigidly brand loyal, and uncommonly (often hysterically) sensitive to changes in the appearance, quality, or quantity of a preferred food.

Prolonged picky eating becomes unsafe in several ways.  First, a diet of soft, carbohydrate-based finger foods is naturally lacking in the vitamins and minerals that derive from a diverse diet, which leads to nutritional compromise even if the child remains normal weight

Second, picky eating is harmful from the standpoint of your child’s overall successful functioning in life. The picky eaters that I treat tell me heartbreaking stories of not being able to eat what all the other children are eating at birthday parties and field trips. They cry from hunger while at Disneyworld because the food there was too different to eat. They feel ashamed of their own rudeness when visiting friends’ houses because they refuse the foods offered them. Kids want to be like other kids – picky eating interferes with that.

Finally, picky eating is harmful to a family’s long-term happiness.  Parents understandably get tired of playing short order cook, patronizing only a handful of their child’s “approved” restaurants, and worrying each time they travel about what they are going to feed their child.  The parents that I work with are universally demoralized, telling me that “every meal is a battle” of cajoling, begging, pleading, bargaining, bribing, yelling, and crying, or they tearfully confide that after years of such battles, they reluctantly “just gave up” trying to expand their child’s diet, and now worry for the future: “What will he do when he wants to take a girl out on a date to a restaurant?”  “How will she survive when she gets to college?”

 So is picky eating harmful? It can be.  And in so many ways.

FYI: Severe picky (or selective) eating is considered enough of a problem that there’s a brand new diagnosis for it in the psychiatry bible, the DSM-5:  Avoidant/Restrictive Food Intake Disorder (ARFID).

 A diagnosis of ARFID requires that the individual:

  1. Eats a very narrow range of preferred foods.
  2. Is very distressed when presented with new or nonpreferred foods.  
  3. Such individuals are not motivated to restrict and avoid foods due to concerns with body shape or a desire to lose weight (as in anorexia and bulimia) and may be of low, normal, or high weight.

STAYED TUNED FOR A FUTURE POST: My child is a picky eater – what can I do as a parent to help?


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Katherine K. Dahlsgaard, Ph.D. Lead Psychologist of The Anxiety Behaviors Clinic at Children's Hospital of Philadelphia
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The Healthy Kids blog is your window into the latest news, research and advice around children's health. Learn more about our growing list of contributors here.

If you have questions about your child's health, ask them here.

Anna Nguyen Healthy Kids blog Editor
Sarah Levin Allen, Ph.D., CBIS Assistant Professor of Psychology at Philadelphia College of Osteopathic Medicine
Stephen Aronoff, M.D., M.B.A. Chair of the Department of Pediatrics at Temple University Hospital
Peter Bidey, D.O. Medical Director of Family Medicine at Philadelphia College of Osteopathic Medicine
Christopher C. Chang, MD, PhD, MBA, FAAAAI, FACAAI Associate Professor of Medicine in division of Rheumatology, Allergy and Clinical Immunology at UC Davis
Katherine K. Dahlsgaard, Ph.D. Lead Psychologist of The Anxiety Behaviors Clinic at Children's Hospital of Philadelphia
Gary A. Emmett, M.D., F.A.A.P Director of Hospital Pediatrics at TJU Hospital & Pediatrics Professor at Thomas Jefferson Univ.
Mario Cruz, M.D. Pediatrician, Associate Director of Pediatric Residency Program at St. Christopher’s Hospital for Children
Magee DeFelice, M.D. Division Chief of Allergy and Immunology at Nemours/Alfred I. duPont Hospital for Children
Hazel Guinto-Ocampo, M.D. Chief of Pediatric Emergency Services at Nemours duPont Pediatrics/Bryn Mawr Hospital
Rima Himelstein, M.D. Adolescent Medicine Specialist at Crozer-Keystone Health System
Jessica Kendorski, PhD, NCSP, BCBA-D Associate Professor in School Psychology/Applied Behavior Analysis at Philadelphia College of Osteopathic Medicine
Anita Kulick President & CEO, Educating Communities for Parenting
Janet Rosenzweig, MS, PhD, MPA VP for Programs & Research for Prevent Child Abuse America
Beth Wallace Smith, R.D. Registered Dietitian at Children's Hospital of Philadelphia
Jeanette Trella, Pharm.D Managing Director at The Poison Control Center at CHOP
W. Douglas Tynan, Ph.D., ABPP Director of Integrated Health Care for American Psychological Association
Flaura Koplin Winston, M.D., Ph.D. Scientific Director of the Children’s Hospital of Philadelphia’s Center for Injury Research and Prevention
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