Is It Picky Eating or Something More?

November 13, 2013
Kennedy Krieger’s Pediatric Feeding Disorders Program helps children overcome feeding problems.

Catering to a child who is a picky eater is like being a short-order cook: chaotic. Dinnertime becomes a war zone, leading to hopeless battles fought over vegetables and macaroni and cheese.

Picky eating is as normal as potty-training, a rite of passage in childhood development. Taste buds evolve and food preferences expand in these early years. Even the best of parents can have a difficult time getting their child to eat. In fact, picky eating is one of the most common occurrences in children, often outgrown as the child reaches adolescence. But if eating behavior inhibits normal developmental and physical growth processes, it could be something much more severe—a pediatric feeding disorder.

Baby eating “The difference between a fussy eater and a child with a feeding disorder is the impact the eating behavior has on a child’s physical and mental health,” says Peter Girolami, PhD, clinical director of the Pediatric Feeding Disorders Program at Kennedy Krieger—a leading program that was one of the first of its kind in the United States and the largest in the world to treat pediatric feeding disorders.

Pediatric feeding disorders are more common than most think, afflicting up to 10 percent of all infants and children, according to published literature. Children classified as having a feeding disorder do not consume enough calories and nutrients to promote healthy growth and development. It is important to differentiate between a picky eater, who may consume a restricted but still nourishing diet, from a child who consumes, for example, only three to four types of foods, eliminating entire food groups and compromising healthy growth.

Feeding disorders are not all created equal. Some children can have aversions to food groups or certain textures and colors, while others lack the skills to self-feed or refuse to eat any food at all. The assortment of behaviors that constitute a feeding problem vary from child to child and include food refusal (e.g., crying, head turning, spitting out food, throwing utensils, packing or holding food in mouth, aggression, and getting out of the seat), coughing/gagging, and vomiting. Many children with feeding disorders also suffer from a serious medical, behavioral, or psychological condition that can contribute to the onset of the feeding disorder—30 percent of children with developmental delays have difficulty feeding at some point during their childhood. Other common medical conditions that are associated with feeding disorders include gastroesophageal reflux disease (GERD), food allergies, cancer, and complications from premature birth. Children who undergo surgeries unrelated to food may also develop feeding problems, as feeding tubes can throw them off track. 

Early diagnosis and treatment are extremely important when it comes to a feeding disorder. The longer it is left untreated, the more complex it can become—in extreme cases, children may need a feeding tube. Feeding disorders can also lead to serious complications from nutritional deficiencies, such as anemia. Undernourished children are also at risk for developmental delays, including the inability to crawl, walk, and talk, which could lead to oral, motor, and sensory problems.

Since there is no common cause or symptom that is characteristic of all pediatric feeding disorders, each case is unique with varying challenges to effective treatment. Both biological and social interactions need to be individually addressed for each child during diagnosis and when developing an appropriate treatment program. Kennedy Krieger’s Pediatric Feeding Disorders Program takes an interdisciplinary approach. A team of professionals with expertise in many specialties—from leaders in pediatrics to behavioral psychology and speech pathology—works together to help each child modify behavior, build motor skills, and treat associated medical conditions.

Common symptoms of a pediatric feeding disorder:

  • An abrupt change in eating habits lasting longer than 30 days
  • Delayed development of the skill set necessary to self-feed or consume higher textures
  • Unexplained fatigue, loss of energy
  • Weight loss or failure to gain appropriate weight
  • Choking/coughing during meals
  • Disruptive behavior during mealtime

“It’s not a one-size-fits-all model,” explains Dr. Girolami. “Our team of leading professionals addresses the many causes of feeding disorders and their associated complications so we can give the child and family the best care available.”

Part of the child’s care involves training for the family by every member of the child’s treatment team. “The goal is that when the family leaves, they’re self-sufficient to do the meals and introduce new foods, and to trouble-shoot any problems that may come up,” says the medical director of the program, Eric Levey, MD. “I’d say 80 to 90 percent of the time, families continue to make progress without any additional help on a regular basis.”

For the many families whose children have emerged from the program no longer saddled by feeding disorders, the program has made a profound difference in their daily lives. “Every parent wants their child to be able to sit at a table and eat a meal together as a family,” says Dr. Levey. And thanks to the feeding disorders program, many more families will be able to do just that this Thanksgiving.

Video: The Pediatric Feeding Disorders Program at Kennedy Krieger Institute helps four-year-old Isabella learn to eat by mouth for the first time.

Parents.com: Feeding “picky eaters” over the holidays

Parents.com features an interview with Dr. Peter Girolami on the differences between a child who is a “picky eater” and a child who has a feeding disorder. Dr. Girolami also shares strategies for dealing with “picky eaters”. Read more.