“Ok, what should I make the kids for dinner tonight? Chicken nuggets or nachos (cheese and tortilla chips)? Because that is all they will eat. I can’t win.”

That Thread – from a user named therealchriscavs – pretty neatly sums up the way many parents feel about their kids’ eating habits. Picky eating is such a common frustration that we devoted an entire chapter of our book, Eat, Laugh, Talk: The Family Dinner Playbook to addressing it. Up to 20% of parents of preschoolers report that their child is often or always highly selective about food, but if listening to parents online and in real life is any indication, many more of us have dealt with the highs and lows of picky eating.

Fortunately, most of the time, pickiness is a developmentally normal phase that will pass, even if it comes back in a few different forms over the years before finally resolving itself for good. But what if the picky eating doesn’t go away? What if it’s more than just rejecting green vegetables, seeming to live on goldfish crackers and dino nuggets for weeks at a time, or only eating strawberries if they’re served in the yellow bowl, not the blue one?

For some kids, what parents may initially think of as “picky” behavior is something more. We recently sat down for a conversation with Dr. Evelyna Kambanis, a fellow at the Eating Disorders Clinical and Research Program at Massachusetts General Hospital, whose research focuses on Avoidant Restrictive Food Intake Disorder (ARFID). During our talk, Evelyna shared some signs that picky eating has tipped over into a potentially significant feeding problem:

• Not eating enough volume or variety of foods. A child who isn’t taking in enough calories and nutrients is at risk of malnutrition. Due to sensory sensitivities, fear of choking or vomiting, or a chronically low appetite and lack of pleasure in eating, kids may avoid most foods altogether or severely restrict the type or amount of food they eat. Over time, a child who eats too little in volume, variety, or both may lose weight or fail to gain weight appropriately, show signs of nutritional imbalances, or even require supplemental feeding (such as tube feeding) to keep them healthy.
• Social issues around food. Evelyna points out that if a child exhibits “picky eating” to the degree that it disturbs their ability to eat a meal with others in certain settings, it’s a potential cause for concern. For example, there might be constant battles at the family dinner table, inability to eat out at certain restaurants, rigidity around eating only specific “kids’ menu” items, or avoidance of social eating altogether.
• What about weight? According to Evelyna, ARFID occurs independent of body image and weight issues – in other words, unlike other more widely known eating disorders, children with ARFID aren’t restricting their eating habits because they’re worried about the way their bodies look. However, in the course of our conversation, we also asked for her input on what red flags parents may see in the development of other eating disorders like anorexia nervosa or bulimia, where issues with weight and body image are more common triggers. Because eating disorders like anorexia may at first look like the development of picky or selective eating habits, it’s important for parents to understand what to look for whenever a child seems to be restricting or avoiding certain foods.

Listen to the latest episode of The Family Dinner Project Podcast to hear our full conversation about the differences between developmentally normal “picky eating” and the red flags for ARFID and other eating disorders. We learned so much from our discussion with Evelyna, and we know you will, too.

Food, Fun, and Conversation

In recognition of July 4th and the Civic Season, we’ve teamed up with our friends at Made by Us, Challah Back Girls, Thomas Jefferson’s Monticello, and New American History to offer this Civic Season Family Picnic! Enjoy Rainbow Crunch Challah Ice Cream Sandwiches, a roundup of family-friendly movies, thought-provoking conversation starters, and more.

A Civic Season Family Picnic