Is It Picky Eating Or Is It A Selective Eating Disorder?

Reviewed by Heather Cashell, LCSW

Published 07/14/2022

Most people have not heard of Selective Eating Disorder or Avoidant / Restrictive Food Intake Disorder (ARFID). The reason for this is that most children grow out of the picky eating stage by age 6. While the name is self-explanatory, the disorder was only added to the DSM Manual in 2013. Even still, few healthcare providers come across enough cases to tackle them successfully.

However, we see an increasing amount of advocacy and awareness being drawn to the issue by individuals who have dealt with this condition firsthand. Selective Eating Disorder is now being discussed on social media, blogs, specialized care center websites, and more. As far as this disorder is concerned, it is ok for your child to be a picky eater, but it's not ok to be “extremely picky at eating.”

What Determines If Your Child Has Selective Eating Disorder? 

Most parents have to deal with their children's idiosyncrasies concerning food. It's normal for children, as adults, to have a few different food preferences: a dislike of vegetables, preferring sweets and snacks, and or even something tart. Likewise, it's also normal for parents to feel guilty indulging their children.

But here are two signs you may want to watch out for as a parent:

  1. If your child's growth starts to hamper as a result of food preferences.
  2. If you sense your child starting to get anxious at social events around food, particularly in the company of their friends or peers.

What Are Eating Disorders?

In very simple terms, the Selective Eating Disorder (or the Picky Eating Disorder) refers to an extreme form of picky eating. However, there is a psychological element to the situation. Children as young as six or seven years old may experience high anxiety levels, get personally affronted, argumentative, and even tearful if what they were expecting is not found on the dinner table. This may also occur if they are forced to eat something good for them but not what they wanted.

When it comes to Selective Eating Disorder, there are a few commonly observed symptoms or signs to look out for, some of which may simply be caused by malnutrition. These symptoms include:

  • Refusal to a long list of food items.
  • Preference for food that has a similar texture or a similar color that they may like. For example, some children would prefer to only eat crunchy food.
  • Being stuck in a specific food preparation methodology.
  • Not wanting to eat vegetables in general, as well as protein sources or even fruit. It is as if children know exactly the foods they need to eat and stay away. 
  • Food that has once been eliminated will never be integrated back into their accepted diet.
  • Malnutrition, and in particular deficiency in vitamins A and C, as well as Iron.
  • Being opposed to entire food groups at once.
  • Aversion to trying anything new.
  • Unhealthy or irregular eating habits or being disinterested in food.
  • Stunted growth, being underweight.
  • Experiencing growth disturbances.
  • Continuous and persistent weight loss and nutrient deficiencies.
  • Anxiety around certain food items.
  • Tendency toward and dependence upon supplements.
  • Sensitivity toward food texture or another food characteristic.
  • Impairment in psychosocial functioning as a result of the eating habit.

Children afflicted with this disorder usually have an underlying condition or personal history as reasons behind indulging in the behavior.  For example, they may have had their food refusal dismissed in the past and may have created negative eating associations. Negative associations may have included gagging, vomiting, choking, or being forced to eat food against their wishes. Other examples include food allergies discovered late, gastro issues that may result in the child experiencing bloating, constipation, etc. Some children may also have comorbidities, including autism or other mental disorders such as attention deficit hyperactivity, which may trigger texture-based sensitivity.

Parents also must watch out for physiological issues. For instance, your child may be dealing with enlarged tonsils. These adenoids may be inhibiting eating habits, or even sensitivities around the various characteristics of food such as the smell, appearance, texture, or flavor.

Basically, when it comes to eating disorders, including Selective Eating Disorder, there is an emotional  component involved. Typically, children are not intent upon or interested in losing weight but rather have other underlying conditions that need to be addressed.

Food Parenting And Selective Eating Disorder 

Parents are important role models for their children when it comes to developing good eating habits . These habits are referred to as your food parenting style. Selective Eating Disorder is often in direct conflict with food parenting. In fact, unless the precise reasons behind your child's bad food behaviors are discovered, this conflict is likely to continue, resulting in chaos. Many parents find themselves driven to desperation due to the challenges of having a picky eater in the house. It can convert full time working parents into short-order cooks. However, this stress and desperation could also lead to the child resisting new food and developing negative associations. Even tactics like bribery are only going to end up encouraging bad food. There is no winning in this case. In the end, the nutritional status of the child is going to be in jeopardy.

When Should You Take Your Child To The Doctor?

The first step would be to determine if you have a problem with your hands. This means looking for red flags that indicate that you need to intervene. Professionals often advise that the picky eating phase should be allowed to end no earlier than four or five years of age. If you continue to experience difficulties after that, it may be time for an intervention. If you feel like you are not getting anywhere, you may want to consider having a professional intervene. This is also a good time to carefully observe, analyze, and note all the eating habits and associations your child has made around food.

When you enlist a professional's help, they will primarily work to help you address sensitivities to food. The physical regimen of chewing and swallowing aside, the child may need to be taught coping skills to help them deal with anxiety, which is often a component of Selective Eating Disorder.

The Link Between Anxiety And Selective Eating Disorder

One of the most prominent risks in a Selective Eating Disorder comes from the underlying anxiety. In fact, research shows that 1 out of 5 kids with Selective Eating Disorder will have anxiety as well. Furthermore, as many as 58% of kids experiencing Selective Eating Disorder will also have some type of anxiety disorder.

Doctors have singled out this anxiety as being behind these kids' inability to try something new at the table. It takes real courage to try something new when you're already stressed about it. At the dinner table, the food may become just as distressing as perhaps a negative family dynamic. Eventually, food starts to get identified as a trigger for angst. Children may also experience embarrassment around the food that they are observed eating in scenarios with their peers.

Treatments For A Selective Eating Disorder

Treatments and success rates are still in their infancy because the disorder has only been classified recently. As hard as it is to believe, therapists did not know how to recognize, let alone treat, Selective Eating Disorder before 2013. At the same time, children, as a patient group, are very different from one another. Successful treatment for one could vary drastically for another. This means that treatment methodologies may need to be changed from case to case.

For children lashing out due to anxiety, treatment would be more centered around teaching them coping skills.  More attention needs to be paid in social settings for such children, and the emphasis should be on building confidence and food exposure therapy. Slowly, this challenge should be taken to new food.

On the other hand, for children where a parental dynamic was involved (i.e., they were punished, pressured, bribed, etc.), positive feeding education is needed. This education can be mixed with other treatment approaches depending upon the original problem.

It’s important to recognize that most of the children experiencing Selective Eating Disorder are nutritionally compromised. Therefore, nutrition therapy is likely necessary for every child going through this disorder.

Treatment could be any of these single methodologies or a combination. Likewise, you may work with a single healthcare provider or an entire team specializing in treating children with Selective Eating Disorder. It depends on what is available near you and the severity of the case.

Steps You Can Take As A Parent

As a concerned parent, alongside professional help, there are additional steps you can take to help your child. Perhaps the most important thing you can do is to educate yourself on the condition. This can be done by reading best-selling books on the topic, reading other parent experiences on forums and blogs, etc. These same resources could also help give in new ideas to introduce your child to new foods.

Additionally, you could look for a therapist in your area or online. Try working with a couple of them to see who the best fit is for both you and your child. It’s not a one size fits all approach. It is important to find the right therapist that both of you are comfortable with. The same is true with working with a dietician or nutritionist as well.

If you think that your child’s picky eating habits could be something more, this free test can help you take a closer look at your child’s symptoms so that you can determine if it is time to make an appointment with your child’s doctor.