Picky Eating

Picky Eating

But did the ketchup touch the nuggets?

Maybe you’ve seen this at your house?

It’s dinner time. One child wants chicken nuggets. Wants isn’t the right word. She will only eat chicken nuggets. She might be persuaded to have a couple of tots as long as they don’t touch the nuggets. Your other child is a little more eclectic in her eating habits. She’ll eat maybe a dozen foods but with so many rules that it’s hard to know what to cook. So you count through a boring litany one more time. Nuggets? Pasta? A waffle? Cereal? By the time you’re done, both kids are eating different foods at different times and you’ve grabbed an emergency frozen dinner for yourself that tastes like cardboard with sauce.

This is not what you envision for the family meal.

The story above is the story at my home about four nights a week. It’s frustrating for my wife and I and for the girls. Dinner becomes a boring refuel or a fight. Family time is lost and my wife and I wait until the kids are done and then eat by ourselves. Truth is, I’ve never bothered much with my kid’s eating habits. I’ve taken a firm stance to never take a firm stance. Most children grow up to be normally eating adults and I have never understood why you force the kids to eat what is placed before them. Kids will eat when they are hungry and I simply refuse to fight about it. While my feelings are entirely anecdotal, Dr. Nancy Zucker, of Duke University, has recently published research (here) that argues that I’m missing an important nuance. While she generally upholds my sense that picky eating is normal, she finds that, for a small group of children, picky or selective eating (SE) can lead to more serious behavioral concerns.

Selective Eaters

Zucker defines selective eaters as people who:

Restrict eating to certain foods
Have strong food preferences
Are unwilling to try new foods
Eat a limited amount

If you think this describes you or your child then you’ve noted one question I have about her approach. The definition is too broad. She amplifies her terms and adds that selective eaters can have difficulty eating with others. In more extreme cases, selective eaters find it difficult to remain at the table with certain foods, so strong is their repulsion.

For here assessment, she uses a group of just over 900 children, aged 24-71 months, screened out of a population of about 4,500 who attend the Duke Children’s Pediatric Primary Care Clinics. Once selected, a questionnaire for each child is completed. Then a face-to-face interview follows with the child’s parents at their home. Children were scored according to their level of ‘voluntary selective eating.’ Children with no restricted intake other than foods like broccoli that almost all children hate, were coded with a “0”. Those who only ate foods ‘within the range of his/her preferred foods’ scored a “1”. And those for whom ‘eating with others was difficult because of the extreme limited range’ [of food preference] were scored a “2”. “0” correlates to normal, “1” to having moderate SE, and “2” to severe SE. This seems artificially restrictive to me: I’ve met about three kids in my life who didn’t care about what they ate. What Zucker calls moderate SE seems much more normal to me. If not normal then certainly more common.

About 20% of the children screened exhibited moderate SE. Only 3% showed severe SE. Parental behaviors gleaned through interviews were noted as well: mothers of children with moderate SE were more likely to have sought psychiatric treatment for themselves than mothers of children with severe SE. Both moderate and severe SE children had mothers with ‘high maternal anxiety’. Children with moderate SE were more likely to have mothers with a history of drug use and children with severe SE were more likely to be female. Children exhibiting either moderate or severe SE had a higher correlation with depression, anxiety, and ADHD than normal eaters. There is statistical evidence that many kids with moderate or severe SE will grow out of it as part of normal eating and growth patterns.

Are You Being Played?

Picky EatingParents whose children exhibit moderate or extreme SE are often accused by friends and even by health officials of being overly accommodating to their children’s petulant demands. But Zucker argues that this isn’t a power play on the part of the child. She writes that it’s possible that there is a correlation between a heightened food or taste awareness and a heightened awareness of surroundings causing anxiety. This anxiety about surroundings could exhibit in a child’s desire to control the sameness of their environment to the extent that they are possible. Follow-up studies show that children with moderate or severe SE are 1.7 times likely to exhibit anxiety disorders as they age. Zucker suggests that we should drop the dismissive label of a child as a picky eater and recognize that food avoidance can be a true physiological disorder.

I have my normal concerns over this research just as I do about anything from the social sciences¹. The numbers tend to be fuzzy. The results would be difficult to reproduce and generally impossible to falsify. The old research saw that if humans are involved then you’ve got problem is an added concern. But Zucker makes a strong case and the statistics reveal that something is different between the groups. She is not investigating causal mechanisms but, per the paper’s abstract, is hoping to understand SE enough ‘to guide health care providers to recognize when SE is a problem worthy of intervention’. She argues well that further investigation can be warranted for both child and family when food choices block normal development and normal interactions.

Some Bases for Picky Eating

There is nothing new about picky eating. I have a boy who ate nothing but spaghetti and wore the same Atlanta Braves shirt for about three years. I’m not making it up when I say that we would actually take the shirt off while he was sleeping to wash it and then put it back on while he was in bed. No doubt he will be able to blame me for something in his future. So other than food aversion or a need to control your environment, here are other, more broad reasons, that your child might not want to taste the fois gras:

  • Nature. Your genes largely control how sensitive you are to tastes. In fact, some people are called super-tasters by nutrition scientists. These are people with an abundance of taste buds. More taste buds bring a greater ability to experience the tastes of foods. Alternately, some people, called non-tasters, have fewer taste buds than normal. As you would guess, food is bland and boring to these folks. Most people fall between the two. It’s possible that your picky eater has heightened tastes.  So, while you see the evening’s wrestling match as an affront to your parenting and cooking skills, your three-year-old might wonder how any human could eat such stuff.
  • Picky Eating

    I’ll take the fillet but is that just my culture speaking?

    Nurture. I lived in Alaska for a while fishing for crabs. We were stationed on one of the Aleutian Islands and I still remember how surprised I was the first time one of the islanders hauled in a catch of salmon. All the island kids came running the to beach and popped out the fish’s eyes and ate them like candy. I saw a similar thing when a seal was caught and people carved off pieces of raw skin and fat to eat. It’s a gross thought to me but I wasn’t raised this way. Even something closer to home, like putting cheese on apple pie, sounds gross to me. It just wasn’t what I was raised eating.

  • Nature and Nature. There is very likely a mix of the two. Certainly a component of a child’s picky eating can come from their parent’s picky eating? Even if they are a super-taster, they will model some of their behavior after your habits.
  • You are feeding your child wrong. (You knew it would be your fault at some point!) Many nutritionists and health advocates argue that parents overfeed their children with high-calorie drinks and snacks. When the time comes for a meal, they just aren’t’ hungry enough to dive into foods that the may or may not like.


Picky Eating

Nancy Zucker, Duke University

So, should you force your kids to eat those tomatoes? No. The number of children who exhibit real SE is low – three percent of those observed in this study. Your kids will learn to eat tomatoes one day. They will likely grow out of picky behaviors as they grow up, hang out with friends, are inundated with advertising, and change physically. But, as the research here argues, there are a few children for whom eating is a true challenge. If this describes your child then some kind of behavioral intervention might very well be helpful. If your four year-old can’t even be in the same room as a sliced tomato then it might be time to consider talking to someone.

What do you think? Do you have experience with picky eaters? Do you have hint to help other parents cope?


See more of my posts about food here:

8 Benefits of Cooking At Home
5 Reasons Nutritional Advice is Contradictory
9 Keys for Healthy Eating

More information about picky eaters:

Note 1: NYT: Many Psychology Findings Not As Strong As Claimed
Super-tasters and non-tasters here at Live Science.
Zucker’s Paper: Psychological and Psychosocial Impairment in Preschoolers with Selective Eating, Pediatrics
Need some help? Here is some sane advice from the Mayo Clinic.
An easy home experiment to see who has more taste buds from Scientific American.

I’m of a strong opinion that for virtually all children these things work themselves out with age. But here are a couple of resources that can help along the way.