When Picky Eating Becomes a Health Problem

When a temporary or long-term picky eating habit occurs, parents have two major concerns:

• Is my child getting enough calories?

• Is she getting adequate nutrition?

Generally, unless your child has stopped gaining weight for several months or is losing weight, she’s getting enough calories. In fact, old caloric estimates were about 15 percent higher than children actually needed, according to Susan Roberts, author of Feeding Your Child for Lifelong Health. Parents are often worried because appetite seems to decline so much after the baby’s first birthday. This is because the rate of growth slows considerably, Roberts says, pointing out that if a child continued to grow at the same pace as he did in his first year, he would weigh 400 pounds and be 21 feet tall by his 18th birthday.

If you are worried that your child’s limited preferences are not meeting his nutritional needs, make a list of what the child actually does like. It’s usually longer than the parents first think, Roberts says.

From this list, you can then work out what is missing and determine what foods could be added to bridge the shortfall – “foods that are similar to things your child already likes,” Roberts notes. She recommends that all toddlers and preschoolers be given a daily age-appropriate vitamin/mineral supplement to prevent deficiencies, particularly for iron, calcium, zinc, B-vitamins and anti-oxidant vitamins A, C and E.

Red Flags

Both Roberts and Cynthia Lair, a professor at Bastyr University’s School of Natural Medicine, have a list of “red flags” indicating that a picky eater may actually be endangering his health and needs to see a doctor:

• loss of weight or no weight gain for two to six months
• lack of energy
• behavioral problems
• refusal to eat any solid foods
• frequent colds or infections (one or two a month)
• skin problems or dark circles under the eyes, which may indicate a food allergy or deficit.

If a child is eating much less food than he normally does, it often means he is coming down with an infection, Roberts adds. If it goes on for a long time, it could indicate a serious illness.

Monica Andis, M.S., a registered dietician and program manager of Nutrition and Dietary Services at the West Virginia Center for Excellence in Disabilities, also distinguishes between picky eaters and selective eaters.

• Picky eaters eat foods from the four major food groups – dairy, grain and cereal, meat and protein, and fruit and vegetable – and have a basically balanced diet.

• Selective eaters eat an abnormally limited variety of food, often avoiding one or more whole food groups. Selective eaters may also have unusual aversions, such as avoiding all cold, crunchy or red foods. This selectivity may be due to difficult medical history (such as procedures that made eating painful or unpleasant), digestive problems, altered or heightened sensory perceptions, medical/genetic conditions, such as autism, or medications that interfere with taste. Some children suffer from gastro-esophageal reflux – the muscles between the stomach and the esophagus are weak and do not close tightly, so that food and acid from the stomach back up into the esophagus, causing burning and discomfort. Selective eaters are often missing vital nutrients and should be seen by a doctor and a nutritional counselor or dietician, Andis says.

Related Reading

Can’t Eat, Won’t Eat: Dietary Difficulties and the Autism Spectrum, by Brenda Legge, Jessica Kingsley Publications, 2001. Features tips for dealing with picky eating and food refusal.

Feeding the Whole Family: Whole Foods Recipes for Babies, Young Children and Their Families, by Cynthia Lair, Moon Smile Press, 1998. Offers down-to-earth recipes the whole family can enjoy.

Feeding Your Child for Lifelong Health, by Susan B. Roberts, Ph.D., and Melvin B. Heyman, M.D., Bantam Books, 1999. Helps parents teach their kids to like healthy foods. The book is heavy on science, but includes plenty of recipes.