What is Picky Eating?

Written by Erin Kresmery, MS, OTR/L

As a parent or caregiver of a child who refuses food or has a restricted diet, you may experience feelings of frustration, anger, and disappointment. Feeding your child is a fundamental aspect of parenting, and ensuring they receive all the necessary nutrients for healthy development can be challenging, especially in a world of over-processed foods and misleading “healthy” or “unhealthy” social media myths. 

What happens when you’ve carefully chosen nutritious food for your child, only to have them reject it? You might go through a series of emotional stages similar to the five stages of grief.

First, you may enter denial: “What do you mean you don’t like chicken?”

Then comes anger: “Well, this is what’s for dinner!”

After that, you might try bargaining: “If you eat your chicken, you can have an extra dessert.”

This can lead to feelings of depression: “I worked hard to prepare this dinner for our family.”

Finally, you reach the stage of acceptance (of their preferences): “I have the mac and cheese you like. Do you want me to make that for you instead?” 

What is Picky Eating?

“Picky eating” or “fussy eating” are terms you may have heard when talking about a friend, family member, or even yourself. But what exactly is picky eating? Picky eating refers to the rejection of a large proportion of both familiar and new foods, which leads to a low-variety diet. The definition of “picky” or “fussy” eating behaviors can vary across different studies. These behaviors may include: limiting the intake of vegetables, having strong food preferences, requesting meals that differ from what caregivers provide, needing specific methods of food preparation, consuming inadequate amounts of food, and causing disruptions in daily routines that can negatively impact the child, parent, or the parent-child relationship. 

Recent studies provide various definitions of “picky” or “fussy” eating, but there is a consensus on the ages when this behavior commonly emerges. Research indicates that picky eating is a typical developmental phase in preschool-age children, usually starting between the ages of 2 and 3, and typically peaking around the age of 3. This behavior tends to decline between 4.5 and 5.5 years, reaching its lowest prevalence by age 6. This decline is partly due to a child’s growing autonomy and desire for greater control over their choices. This stage of development also builds on the child’s oral exploration during infancy and toddlerhood, where they often investigate both edible and non-edible items using their mouths. It could be a cause for concern if your child has significant picky eating beyond this stage of development. 

As humans evolve, children reach a developmental stage where they become mobile and begin exploring the world with their mouths. During this phase, they rely on evolutionary instincts to avoid potentially poisonous plants. While modern children may not face the same threats from poisonous plants, they often avoid common and safe foods, such as vegetables, due to their bitter flavors.

In addition to this evolutionary “safety mechanism,” children frequently depend on their vision to determine whether a food is “safe” to eat. This is why some children tend to reject foods that don’t look familiar or visually appealing. A term used to describe this behavior is food neophobia, which refers to the reluctance to eat or the avoidance of new foods. This can limit a child’s food repertoire, as their initial instinct is to reject unfamiliar foods. 

Children with food neophobia may exhibit a fear or avoidance response to new foods. They are more likely to try foods that resemble items they have previously tasted. For instance, if you describe a food to a child using only verbal cues, they are more likely to reject it compared to if they can see the food and make visual connections to their past experiences. 

How to Address Your Child’s Picky Eating

As a parent, you can support your child’s picky eating in several ways. From an occupational therapy perspective, you can help your child with sensory regulation by using sensory strategies that facilitate smoother transitions during mealtimes. These strategies can include providing your child with increased proprioceptive input to support their regulation through deep pressure such as engaging in resistive putty or providing a theraband on the bottom of their chair at the dinner table. 

Establishing clear expectations about what is for dinner can also be helpful. Involving your child in selecting and preparing meals allows them to see exactly what they will be eating, which can help them become more tolerant of different textures and smells. This engagement not only promotes familiarity with various foods but also fosters a positive association by allowing quality time with a parent or caregiver during the preparation process. Although it can be difficult to address “picky eating”, it is important to continue to expose the child to foods that they don’t particularly like in order to foster flexibility. Research says it takes at least eight to ten times to introduce a new food before your child will accept it. The food can be on the child’s plate next to their preferred foods or on another plate close by. Without this exposure to non-preferred foods, the child no longer has the opportunity to engage in that food even if they want to. 

Exposure also does not only mean meal-time exposure. Encouraging messy play with non-preferred foods is a great way to create positive associations with these foods without the pressure of putting the foods in their mouth. This can be using noodles to make noodle art, making balloons stuffed with fruit, or making an animal feeder using vegetables. As the parent or caregiver, you can also find children’s books about food and eating to support flexible thinking from the child’s perspective and use the opportunity to talk about feared foods. 

In addition to participating in meal planning and preparation, family mealtimes are important. By modeling healthy eating behaviors and discussing food openly, you can encourage your child to engage with food in a more positive way. As the parent participating in the meal, you can describe how the food looks to you, what you smell, what you expect the taste and the texture to be, and if it reminds you of any other meals you’ve had in the past.

If you have a concern about your child’s picky eating, it is recommended to discuss this with your child’s pediatrician who may suggest connecting with an occupational therapist, nutritionist, cognitive behavioral therapist, eating therapist, or speech-language pathologist. 

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References

Bryant-Waugh, R. (2020). ARFID Avoidant Restrictive Food Intake Disorder: A Guide for Parents and Carers. Routledge. 

Dovey, T. M., Staples, P. A., Gibson, E. L., & Halford, J. C. G. (2008). Food neophobia and ‘picky/fussy’ eating in children: A Review. Appetite, 50(2–3), 181–193. https://doi.org/10.1016/j.appet.2007.09.009 

Taylor, C., & Emmett, P. (2018, November). Picky eating in children: Causes and consequences. The Proceedings of the Nutrition Society. https://pmc.ncbi.nlm.nih.gov/articles/PMC6398579/ 

Wolstenholme, H., Kelly, C., Hennessy, M., & Heary, C. (2020). Childhood fussy/picky eating behaviours: A systematic review and synthesis of qualitative studies. International Journal of Behavioral Nutrition and Physical Activity, 17(1). https://doi.org/10.1186/s12966-019-0899-x