What if it’s Not Just Picky Eating? Selective Eating Disorder in Children

Little girl toddler picking her food, making faces
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Between 25-35 percent of typically developing children in the U.S. have feeding disorders, and up to 40 to 70 percent with chronic medical problems are struggling with issues related to feeding and nutrition. RDs working in private practice, community and clinical settings have to learn to evaluate and treat or refer pediatric patients with extremely picky eating, often referred to as selective eating disorder (SED).

SED is a condition present since earliest childhood where a child whose linear growth is normal eats only a very narrow range of foods and refuses all others. Although a whole medical and eating history needs to be taken into account before diagnosing such children, some of the signs of selective eating include accepting 15 foods or fewer, omitting whole food groups, persistent gagging, tantrums at mealtimes and frequent food jags. Over a period of years, children with SED may develop an avoidance-reinforced anxiety associated with new foods. There may be anticipatory nausea (with sight or smell triggers), fear of vomiting (textures) or a fear of choking.

In 2013, SED was officially added to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), and renamed Avoidant/Restrictive Food Intake Disorder (ARFID).

Does selective eating exist in adults?

While little data on SED or ARFID has been published, it appears that it usually presents in infancy or childhood, but it can also persist into adulthood. In children and adults, ARFID may be associated with impaired social functioning and affect family functioning, especially if there is great stress surrounding mealtimes. A Duke University study currently underway has received a much greater response from adult selective eaters than researchers originally anticipated.

Is selective eating related to how parents feed their children?

Internationally recognized feeding expert Ellyn Satter states that the parent-child feeding relationship plays a great factor in the precipitation of food disorders, including ARFID. According to Satter, “severe feeding problems must be considered in the context of feeding strategies as well as in the context of the child’s medical and developmental history. Even when children contribute to ‘food intake disorders’ by being irritable, having medical and/or oral-motor problems, developing atypically, or showing extreme food regulation patterns (e.g. don’t eat much or eat a great deal), the parent-child feeding relationship is paramount.”

How RDs can help selective eaters

1. Understand the signs of underlying issues such as GI disorders, food allergies, sensory sensitivities, oral-motor delays and refer to specialists as needed in order to provide more comprehensive support. For example, Melanie Potock, MA, CCC-SLP, lists the following signs that may signal a need to work with an occupational therapist or speech language pathologist who specializes in feeding:

  • strong dislike of messy hands or face
  • gagging on specific textures on a daily basis
  • preference for “squish and swallow” foods
  • unable to keep food or liquid in mouth
  • extreme fussiness at mealtimes

2. Minimize counterproductive feeding strategies such as forcing food and catering to demands, and work with parents to reduce stress at mealtimes by following the principles of the Division of Responsibility in Feeding. Help establish structure in meals and snacks and incorporate at least one food a child can eat in each meal and snack.

3. Encourage parents to trust the child to eat the amount and types of food he or she needs within the structure and choices provided.

4. Educate parents about food chaining — an individualized, non-threatening, home-based feeding program designed to expand food repertoire by emphasizing similar features between accepted and targeted food items. Limited research suggests that food Chaining may be an effective treatment for SED.

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Natalia Stasenko
Natalia Stasenko, MS, RD, is a U.S.-credentialed pediatric dietitian based in London and New York and the owner of Feeding Bytes. She blogs at feedingbytes.com. Follow her on Twitter and Facebook.