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Why Picky Eating is Not Only About the Food: Consider an Underlying Diagnosis

I often have pediatric patients whose parents bring them for picky eating. Many times, the picky eating is described as a behavior that interferes with the family. Often, the child does not have a diagnosis at the time that encompasses the picky eating. Parents, and sometimes the children, want the picky eating to improve.

a child who does not want to eat

The parents will describe how their child has aversions to certain categories of foods, textures, temperatures, colors, or tastes. For some children, their pickiness is distressing to them. That distress is more prominent as children get older and their food aversions impact them socially. Other children do not articulate distress from their pickiness.

Some children come with food avoidances that do not seem to stem from typical pickiness. They might avoid foods because they are afraid of choking, they think a certain food is unsafe or contaminated, or they fear it is bad for their health. Often these children feel that their food avoidances are good for them and the right thing to do. They are often not at all interested in becoming less food-avoidant. In fact, they are often more than willing to pick up more foods to avoid for similar reasons to their already avoided foods.

In both cases, the presenting problem is unlikely to be simply picky eating. More likely, the picky eating is a symptom of an underlying pattern or problem. Many children with picky eating also have other rigid behaviors that impact their life. In some cases, the picky eating was the fist behavior that the parents thought necessitated treatment, so that is what they identify as the problem. Discuss with your pediatrician or dietitian if your child may need a more in depth behavioral or psychiatric evaluation to better understand their picky eating and othe behaviors.

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