The 'Whats' & 'Whys' of Selective and Picky Eaters & Tips to Overcome It

Strategies that can be reviewed and individualized during my picky eating consultations can help parents of children along the continuum of food selectivity; from passively-avoidant picky eaters to children who display challenging behaviors at mealtime.

The following is a brief overview of how food selectivity may present in children, as well as some resources that may be helpful in your search to support your child…

Children develop a pattern of selective eating  over the course of weeks, months, and years

• • Selective eating can be the result of genetic, psychological, and triggering events (e.g., choking)
  • Even if a child seems to be more sensitive to taste, visual presentation, smell, texture or other sensory aspects, most children can learn to eat a wide variety of foods

What is selective eating? Thing to know: It occurs on a broad continuum!

• • From a parent(s) perspective, probably something like…
    • “My child won’t try anything new!”, “My child hardly eats anything!”
    • Limited diet
    • Specific Food preferences – placement, closeness of foods to one another, temperature, eats foods in specific form 
  • ARFID – Avoidant/restrictive food intake disorder. Fairly new – children who are extremely picky eaters may get diagnosed with ARFID by a medical practitioner. ARFID may lead to poor growth and nutrition. Behavioral intervention strategies may be helpful in increasing eating behaviors in those diagnosed with ARFID, however, parents/caregivers should consult with a medical practitioner first

How did my child become a selective eater?

• Medical issues – this should always be ruled out before seeking behavioral consultation for selective eating 

• Patterns of eating that become increasingly restricted over time – when coming from a behavior analytic perspective, keep in mind what is known about behavior and the history of reinforcement (positive and negative). If access to specific foods, attention, and routines were provided/removed over time (and functioned as a reinforcer for behaviors), then selective/restrictive eating behaviors were learned and reinforced over time

• Problems with sleep – evokes irritability and lower threshold for variation and novelty when it comes to eating for some

• Conditioned taste aversions – association of certain foods with symptoms of being sick or other aversive effects in environment (e.g., smells, sounds, visuals)

How and When to Work on Selective Eating Behaviors

• Impacts day-to-day functioning and the ability to participate in family/social routines without additional preparation and/or modifications

• Nutrient intake

• Evoking novel challenging and interfering behaviors

What are the most effective interventions for selective eating behaviors?

• • Most food selectivity interventions include multiple treatment components, such as: 
    • Positive reinforcement (e.g., reward system, behavior contracts, praise)
    • Incremental changes
    • Support from multidisciplinary providers (e.g., dietician, therapist, etc.)(Freeman & Piazza, 1998; Anderson & McMillan, 2001; Najdowski et al., 2003; McCartney et al., 2005; Ahearn et al., 2001; Ahearn, 2002)
  • A heavy focus on proactive strategies (setting up for success!), such as:
    • Timing – Select a time of day when trying something new is most likely to be successful
    • Location – maybe away from the usual meal-time location as to not contaminate the target location
    • Visual Supports
      • Review a story with a preferred character who is eating different foods, different ways, in different places
      • Reward chart outlining expectations
    • Pairing of Preferred Activities with Meals – music, TV, iPad (if socially valid for the family/child)
    • Food – type and amount
      • Type – similar shape, texture, and color to other preferred foods in the child’s repertoire (e.g., if square cheese crackers such as Cheeze-Its are preferred, maybe the next new food is a Goldfish cracker)
      • Size – it matters! Think about only placing the amount the child is expected to eat on the plate/table

• Script and Instructions – plan out what will be said and shown to the child ahead of time
• Build in choice – if the function of the child’s eating behavior is access to tangibles and/or attention in the form of control around choices related to food, proactively build in choice while setting clear boundaries paired with a reward for making a choice – pick choices the family and providers are comfortable with!
  • Examples: If rice and pasta are new targeted foods, can say: “Do you want rice or pasta as your side for dinner? When you make a choice and eat it, you can get ice cream for dessert” OR If the target for eating behavior is to increase the amount of food consumed, can present something like: “We are having meatballs with dinner – do you want 1 ½ or 2 with your dinner? When you eat most of the amount you picked out, you can have some dessert when dinner is done”

Resources for Parents

These books present behavioral interventions to successfully expand children’s diet variety and preferences

• Broccoli Boot Camp: Basic Training for Parents of Selective Eaters 
• Helping Your Child with Extreme Picky Eating: A Step-by-Step Guide for Overcoming Selective Eating, Food Aversion, and Feeding Disorders