All parents complain about their children being picky eaters. It is considered one of the most worries that parents present during their medical consultations with their child pediatrician.
Normally, Infants often experience a phase of neophilia, or curiosity about trying new foods, before they turn one. This is typically followed by a phase of neophobia, or reluctance to try unfamiliar foods, which usually occurs between the ages of 1 and 3. This stage is a natural part of their neuropsychological, sensory, and taste development.
However, certain negative experiences, such as choking, stressful mealtimes, or being forced to eat, can reinforce this fear and prolong it. It is recommended to make meals as calm as possible, avoiding anxiety, and trying the best to make the child eat at their pace, avoiding measures such as force-feeding. It is also suggested to make meals brief, and avoid snacks. All this while keeping an eye on the child.
Obviously, nutritional balance is key, but on many occasions, as it said in the article, “parents worry because they see food as a nutraceutical.” This means they think that any substance that is a food or a part of a food, provides medical or health benefits, including the prevention and treatment of diseases.
Tracking growth and weight trends is essential, and the Kanawati index (the ratio of arm circumference to head circumference) serves as a useful measure. A value below 0.31 indicates the need for specialist evaluation. And obviously, a balanced diet with diverse foods is key for proper nutrition. If this isn’t met, continuing the toddler formula beyond age 3 can help prevent deficiencies in iron and calcium.
When eating difficulties are discovered, health care providers should look for and investigate underlying organic, digestive, or extra-digestive diseases (neurologic, cardiac, renal, etc.), but with caution, because misdiagnosing can complicate the case more than help it sometimes.
Not to mention, Avoidant/Restrictive Food Intake Disorder (ARFID), that is characterized by low interest in eating and avoidance of foods due to sensory aspects. It is commonly seen in children with anxiety and is diagnosed in about 20% of those with autism spectrum disorder, where picky eating is widespread. This condition can affect a child’s growth and development, often requiring nutritional supplements to address deficiencies.
Picky eaters can be classified in 3 categories:
- The small eater: those children are very active, and they are near the lower growth curve limits. Parents should encourage psychomotor activities, discourage snacks outside of mealtimes, and consider fun family picnics on the floor, offering a mezze-style variety of foods.
- The child with a history of trauma: Children with trauma (from intubation, nasogastric tubes, severe vomiting, forced feeding, or choking) may develop aversions requiring behavioral intervention.
- The child with high sensory sensitivity: This child tends to avoid getting their hands dirty, dislikes mouthing objects, and may resist certain textures like grass or sand. Gradual behavioral strategies, including sensory play and introducing visually appealing foods, can be effective. Encouraging self-directed food exploration, such as baby-led weaning, may also be helpful. However, ensuring adequate dairy intake is often necessary to prevent nutritional deficiencies during this phase.
Finally, gastroesophageal reflux disease or constipation can cause appetite loss in many children, and many studies have shown that treating them, can help a lot improve appetite in children.
