By Jeanette Bradley 

 Medically reviewed by Jonathan Purtell, RDN

Your son will only eat crunchy foods. Your daughter loves vegetables but refuses to eat fruit. Your toddler gags on anything that is not pureed. Your tween will only eat pizza and chicken nuggets. Grandma says he’s spoiled and you just need to be firm with him.

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Grandpa suggests paying her a dollar if she cleans her plate. Friends tell you the secret to getting kids to eat anything, anything, is ketchup. Or ranch dressing. Or maybe honey mustard? You’ve tried everything, but nothing seems to work. Is your child a picky eater? Or could he have a hidden medical problem?

Yes, There Could Be A Problem

Eating disorders are surprisingly common in early childhood—one study found that anywhere from nearly one-quarter to a startling one-half of young children suffer from an eating disorder (the wide range is due to different definitions of "eating disorder" that are used).1

Of course, not all picky eaters are the same, and the medical issues that can underlie picky eating may show themselves in different ways. Ask yourself these questions about your child's eating, and then read more about possible medical causes and solutions:

  • Children With Texture Aversions: Does your child refuse foods with a certain texture (wet, crunchy, gelatinous?

  • Children Who Only Eat One or Two Foods: Does your child rigidly limit her diet to just a handful of foods?

  • Children Who Gag on Solid Foods: Does your child gag or choke on food that is not pureed or liquid?

  • Children Who Don’t Want to Eat Anything: Does your child refuse all food, or only manage to choke down food when begged or coerced?

  • Children Who Won’t Eat [Insert Food]: Does your child refuse to eat a particular food?

Diagnose Any Medical Issues Early

Yes, picky eating can just be a phase. But it's important to work with your pediatrician to diagnose any eating problems that extend beyond simple toddler-inspired (and short-lived) power struggles. A recent study found that even moderate levels of so-called "selective eating" are associated with symptoms of anxiety and depression, even in very young children.2

That study, which looked at more than 900 children ages 24 months to almost six years old, found that children who practice selective eating are more likely to suffer from anxiety, depression and attention deficit hyperactivity disorder (ADHD).

The worse the selective eating, the higher risk for psychological problems, the researchers noted. In addition, children's selective eating negatively affected their families' dynamics.

The study concluded that pediatricians should take steps to correct the problem even if the child in question has only a "moderate" selective eating problem. This could be accomplished through dietary counseling and behavioral therapy.

2 Sources

Green RJ, Samy G, Miqdady MS, et al. How to Improve Eating Behaviour during Early Childhood. Pediatr Gastroenterol Hepatol Nutr. 2015;18(1):1-9. doi:10.5223/pghn.2015.18.1.1

Zucker N, Copeland W, Franz L, et al. Psychological and Psychosocial Impairment in Preschoolers With Selective Eating. Pediatrics. 2015;136(3):e582-90. doi:10.1542/peds.2014-2386

Additional Reading

North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition. Hepatitis B Vaccine. Accessed online 1/14/2011. http://www.naspghan.org/user-assets/Documents/pdf/diseaseInfo/2008%20Revisions/Hepatitis%20B%20-%20Reviewed%20August%202008.pdf

  • Ernsperger, Lori, Ph.D. and Tania Stegen-Hanson, OTR/L. Just Take a Bite: Easy, Effective Answers to Food Aversions and Eating Challenges. Future Horizons, Arlington, TX.

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By Jeanette Bradley
Jeanette Bradley is a noted food allergy advocate and author of the cookbook, "Food Allergy Kitchen Wizardry: 125 Recipes for People with Allergies"