Online exclusive
As well as Jennifer Bowden’s columns in the NZ Listener and here at listener.co.nz, subscribers can access her fortnightly Myth-busters column in which she explores food and nutrition myths. Here, she examines whether childhood ‘picky eating’ is simply just a phase.
Parents are often concerned about their child’s eating habits, and understandably so as early food choices shape lifelong dietary patterns. While many children go through phases of picky eating, some face more severe challenges such as Avoidant/Restrictive Food Intake Disorder (ARFID).
So, how can we tell if a child’s eating behaviours warrant intervention?
Food neophobia - the fear of trying new foods - is a normal developmental phase that peaks around age 2 in children and fades by age 4 to 6. It likely exists to protect toddlers from eating harmful substances as they begin exploring their environments. Most preschoolers exhibit some neophobia, especially toward fruit and vegetables.
For most children, exposure to a variety of foods, combined with a positive eating environment, helps them outgrow neophobia. However, genetic differences in taste sensitivity mean some children are more averse to bitter flavours. Nonetheless, parents can encourage acceptance of a varied diet through repeated opportunities to taste new foods and modelling positive eating behaviours.
Still, some children remain highly selective beyond this phase, developing into so-called picky eaters who reject many foods and prefer a limited diet. For example, a child may refuse entire food groups like vegetables or insist on eating only specific brands or textures.
In severe cases, picky eating can meet the diagnostic criteria for ARFID, which involves an “eating or feeding disturbance” that leads to nutritional deficiencies, weight loss (or failure to gain weight as expected), or interference with psychosocial functioning – for example, avoiding social occasions involving food, like family meals or birthday parties.
ARFID is a relatively new diagnostic term, introduced about 10 years ago to provide a clear diagnosis for a significant number of patients with restrictive eating behaviours that were not related to body image or weight concerns.
Instead of being grouped into a general eating disorder category, ARFID provides a precise, formal diagnosis that is more useful for guiding the care of these patients by their families and clinicians.
However, ARFID behaviours do vary. Some children lack interest in food, others avoid it due to sensory characteristics and a smaller group fears adverse consequences like choking, vomiting or allergic reactions. A 2023 review in Current Gastroenterology Reports noted that fewer patients present with fear of adverse consequences; instead, most ARFID patients present with a history of ongoing food restrictions and eat as few as 4-5 foods or up to 20-30 foods, often due to taste factors, but also for other sensory factors like smell and texture.
Notable red flags for ARFID include:
- Eating fewer than 20 foods, with an ever-shrinking list of acceptable foods.
- Refusing entire food categories (eg, all vegetables or all mixed-texture dishes).
- Stressful mealtimes with battles over food.
- Physical symptoms like abdominal pain, constipation or extreme fatigue from poor nutrition.
- Avoiding social activities involving food, such as eating at school or family gatherings.
Contributors to ARFID include a genetic predisposition, sensory sensitivities and psychological factors. Children with ARFID are often highly sensitive to bitter tastes or food textures. Anxiety or negative experiences with food can create a cycle of avoidance.
If certain parental behaviours, such as pressure to eat, are added, the aversions can worsen. Instead, fostering a calm and positive mealtime atmosphere can help children feel more comfortable around food.
Treating ARFID typically involves a multidisciplinary approach, including dietitians, occupational therapists and psychologists. They will use strategies like gradual exposure to new foods, sensory preparation and behavioural therapy to desensitise patients to specific food fears or aversions. This expert support is also invaluable for the parents of children with ARFID, as they often hold real concerns for their child’s wellbeing because of their limited food intake.
While picky eating and ARFID can feel overwhelming, support and persistence make a difference. If your child’s eating habits raise concerns, consult a healthcare professional. Keep a food diary for a few days, too, as this will provide invaluable insight into the issues faced.
Early intervention can prevent ARFID from escalating and improve your child’s relationship with food. Know too, though, that it’s never too late to guide a child - or adult - towards a more varied and nutritious diet.
