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Is It Picky Eating or Something More Serious?

Is It Picky Eating or Something More Serious?

By Laura Roias

As some parents can attest, “picky eating” is extremely common among children of all ages.

Some kids may love green vegetables, others don’t. Some may despise the soft texture of oatmeal. Others might only eat bread if there’s peanut butter on it. And some might prefer a diet confined to mac and cheese or chicken nuggets. In the end, every child has his or her own set of unique practices and preferences.

Most children will naturally begin to expand their dietary repertoire as they grow. For others, however, picky eating might not be just a phase — it may actually represent symptoms of a more serious problem. Avoidant restrictive food intake disorder (ARFID) is a condition that results when eating habits or patterns become too extreme, leading to significant nutritional deficiencies, energy loss, or delays in weight gain.

Before you go perusing the Internet thinking your child might have ARFID, here are some key distinguishers of ARFID vs. picky eating:

Avoidance of food for sensory reasons. Children who are exceptionally sensitive to temperature, taste, smell, sight, and texture are prone to more serious feeding or eating disorders. Children with ARFID will often refuse to eat food because of its smell, appearance, or texture. This commonly includes foods with a more pronounced texture or smell, such as sulfurous vegetables or grapes that are “too soft.”

Fear of perceived negative consequences of eating. Individuals with feeding or eating disorders will avoid numerous foods or entire food groups based on perceived negative consequences. These fears range from bloating to vomiting, choking, stomach pain, and/or GI distress.

Little interest in food or eating. In cases of ARFID, the lack of interest or desire to eat is independent of any concerns related to weight or appearance, or attributable to other medical conditions. Food and/or eating is often simply deemed to be unenjoyable.

Nutritional deficits. While few children will eat anything and everything, most children are properly nourished. Children with ARFID often present with nutritional deficits, such as weight loss or failure to gain weight expected for height, anemia, bone loss, or stunted growth.

Problems with friends, school, or relationships. ARFID can also result in social deficiencies. Children who have ARFID may avoid gatherings involving food, isolate from friends, demonstrate poor concentration, or exhibit greater anxiety than peers.

Again, picky eating is quite common, and most cases likely don’t require any medical intervention. But cases can involve a more serious underlying illness, such as ARFID. Understanding the distinction between normal picky eating and ARFID is essential for early intervention and treatment. 

Laura Roias is director of Walden Behavioral Care’s Worcester clinic. She can be reached at lroias@waldenbehavioralcare.com.

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