Written by Doctor G

Extreme Picky Eater!

Dear Dr. G.,
I have a 7 year old son, who is an extremely picky eater. When I say “extreme”, I mean really extreme. He has never had fruits, vegetables, meat, or many of the regular food choices kids love. I’m concerned for his health. I’m embarrassed by this issue, because I know some of it is a result of poor consistency in our parenting when it comes to meals. But, I also think there is a bigger issue here. I’m desperate for advice on how I can turn this around. I know part of the problem stems from allowing him choices early on, but he also seems to have a legitimately anxious relationship with food. As a toddler, he would only eat things that were soft, and now his relationship with food is odd. He’s very interested in learning about different foods, cooking, and actually wants to be a chef when he grows up. I get him in the kitchen with me all the time, and it’s one of his favorite things to do. Yet, he barely eats anything. Most of his diet consists of pasta, ramen noodles, and rice. (I shudder) It’s not that I don’t offer him healthy choices, but he will not eat them, and I give in because I want him to have something in his system. He was drinking milk on regular basis until he was about 5. We allowed him to drink out of a sippy cup until then, but once we took that away, he stopped drinking milk. He literally gags when he tries new foods, and he seems like he really wants to eat other choices, but it’s almost as if he can’t. I’m frustrated and feel defeated. Can you offer any advice? I know that in order for him to build up a taste for fruits and vegetables, he has to try them. Some parents would say to let him starve until he eats his vegetables. Is this a recommended technique for something this extreme? How can I break through to him?
Thank you for your advice.

Adrienne, in (state not provided)

This is an important issue to address. I understand your struggle, and the obstacles that seem unconquerable. However, he can’t keep eating like this for years and be the healthy, fit kid and adult you want him to be.

Since it is your job to guide him and keep him healthy, I’m glad you’ve decided to try something new. What you’ve done so far is all reasonable but doesn’t seem to be working.

The main question is this: Is his picky eating behavioral, or evidence of true anxiety, or a combination?

Let me answer your last question first. “Some parents would say to let him starve… is this a recommended technique?” Starvation is of course not a good punishment (Children and Youth Services especially frowns on this!). However, for run-of-the-mill picky eating I do recommend this:

  1. Plate your son’s food: ½ the plate vegetables, ¼ protein, ¼ starch.
  2. He does not have to finish anything, but if he wants second helping of the starch, he needs to eat (or in this case, try) each of the other foods.
  3. If he doesn’t eat the other foods, no seconds on the one he ate.

However (and it’s a big however), there is the real possibility that your son is not able, or believes he is not able, to eat a new food. He may not be able to voice the reason for this. This can be a sign of OCD (obsessive compulsive disorder), but that is unlikely considering that he likes to touch and cook these foods, just not eat them. He may have general anxiety, or a specific phobia. Or, he may just not want to eat anything but starch and he’s getting away with it so far!

Out of respect for your son, I think it is time to seek some outside evaluation and help.

For the evaluation, the easiest would be to contact your nearest children’s hospital. Most have a great department for evaluating kids with feeding difficulties. If this is not an option for you do to living rurally, you have 2 choices. Call the nearest city and make the appointments you need and make a trip (this should only be a one time deal, since you need an answer but can probably find treatment closer to home). Or, call the phone number on the back of your son’s medical insurance card and ask them who provides specialty care in your area for children with feeding difficulties.

As far as treatment goes, there are many possible resources, depending on the focus of the issue.

If he has trouble with the taste and textures of a lot of foods, an occupational therapist can help. He may have trouble with chewing and managing foods with any fiber, and so a speech therapist at a children’s hospital may be of great help. If he has anxiety, he may need cognitive behavioral therapy to help him find ways to overcome it. These are only a few of the possibilities.

The take home point here, Adrienne, is that there is a lot you can do for your son. Find out what the problem is, and you will be well on your way to solving it. And the guilt that you are feeling will, I hope, dissolve.

I hope you’ll let us know how it goes!


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6 thoughts on “Extreme Picky Eater!”

  1. I’m not at all surprised that you’ve mentioned OCD. My oldest has severe OCD, and I’ve wondered if some of these issues are related. You have given me some excellent advice and options to consider.

    I recently took him in to the PCP for his physical, and she just basically tells me to keep trying. Although, I know I must do this, I’m also discouraged. So I really like the direction you’ve given me.

    I will definitley look into some of the resources our insurance will cover. Thank you so much!

    I also really like the plating portion control. That helps!

    1. With OCD in the family, it could be that he is copying behavior a little, or be that he has a real need for intervention. Either way, an evaluation can’t hurt. Best of luck, this is tough for sure.

  2. Actually, there appears to be many sensory integration issues, however, I highly recommend to start with a feeding specialist – a Speech/Language Pathologist who specializes in feeding issues. It’s way beyond a picky eater, you child is now a “problem feeder” and no matter what you put on that plate will be rejected.

    It stems from the basis of central nervous system… and development issues from within.
    I am sure that if you find a good SLP, then he will be on his ways to identifying the cause,
    and that may mean working with an OT. A behavioralist should not be needed b/c the other two professionals are fully capable of working within the means. Did your child crawl for at least 4 months?– well, there are many questions to go here, but let the professionals ask.

    It’s not about just to keep trying… even if your insurance does not cover it. —

    My title: Not a doctor, not a therapist…but spent a great deal of time with therapy teams to know that this is beyond being a picky eater or behavioral. It’s a sensory defensiveness…and if your child only eats: browns, whites and yellows, well, then there are several other issues. — BE YOUR CHILD’s ADVOCATE… you are the only one he can count on! —

    1. Lulu, I thank you for your input. I’m not certain at all that there are “many sensory integration issues.” This mom is clearly working to be her child’s advocate. As you and I both agree, getting some professional help to check in with all these possibilities is a great idea!

  3. Hi Im 16 and I am an extreme picky eater. I can’t have my foods touch, took or smell a certain way and most things make me gag. I can’t eat chews on a pizza, only a bagel. And I only eat about maybe 20 things. When I try things, anything I literally gag and choke. For example I tried real chicken as opposed to fast food and I almost threw up. I wanna be able to eat foods because its extremely embarrassing especially when the only good I can eat at a restraunght is chicken and fries, but I literally can’t. Is there anything I can do because it’s physically hard to put things in my mouth. What do you suggest?
    Thank You
    Sincerely, Brigit

    1. Brigit, It sounds like you need a speech and swallow therapist. Your doctor should be able to help you find someone in your area who does this work, and medical insurance would cover it. If you live in the US and you were born in the US, you can get medical insurance if you don’t have it. I hope this helps.

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