Is it picky eating or an eating disorder?

Lots of young children refuse to eat anything beyond chicken nuggets and buttered noodles. Try to sneak a stalk of broccoli or a scoop of peas into their pasta and they might fall apart. But while this behavior may be common for toddlers, not all kids outgrow their picky eating.

According to the American Academy of Pediatrics, picky eating is a normal development stage for toddlers. As they leave infancy, toddlers’ growth rate and appetites slow and they begin to develop — and emphatically express — food preferences.

Experts recommend offering lots of healthy food choices and avoiding battles over food to help your children outgrow picky behaviors at mealtimes. Eating meals as a family and involving kids in meal planning and preparation can also help.

However, children who don’t outgrow picky eating or who are severely picky about what they eat are at risk of developing avoidant restrictive food intake disorder (ARFID), previously known as selective eating disorder. Like anorexia, ARFID is an eating disorder marked by limitations in what and how much a person will eat. But unlike anorexia, ARFID doesn’t include distress around body shape or size.

“Picky eating is very normal in toddlers, and parents should try not to worry about young children who may want to eat just a few foods,” says Dr. Linda Santangelo, lead clinical psychologist with the Sharp Mesa Vista Hospital Eating Disorders Program. “However, it can become an issue if not addressed early or if limitations in what they will eat increase over time.”

Health risks of ARFID
The National Eating Disorders Association reports that a person with ARFID severely limits the types and amounts of food they will eat. This can be because of the sensory characteristics of food, such as taste, color and texture; concern about potential negative consequences of eating, such as gagging or vomiting; or a general lack of interest in eating or food.

Such limitations often mean a child with ARFID doesn’t consume enough calories to properly grow, develop and maintain body function. ARFID can also lead to difficulties in school due to a lack of nutrition, which can interfere with emotions and cognition, and challenges eating with others.

Additional health risks of ARFID include:

• A lack of calories leads the body to break down its own tissue to use for fuel. Pulse and blood pressure can drop as the heart has less fuel to pump blood and fewer cells to pump with, increasing the risk for heart failure.

• Poor nutrition can lead to slowed digestion, constipation and other gastrointestinal problems.

• Decreased caloric intake can lead to difficulty concentrating, inability to fall or stay asleep, and fainting and dizziness.

• Lack of enough fat and calories in the diet can cause levels of hormones to fall and increase bone loss and the risk of bone fractures.

• Low calorie and fat consumption can cause dry skin and loss of hair; increase the risk of anemia, leading to fatigue and weakness; and negatively affect the immune system.

“If a child’s extreme restriction of foods goes untreated, it can lead to severe illness, hospitalization and in extreme cases, death,” Dr. Santangelo says. “Just like we see in patients with anorexia or other eating disorders, when the body is denied essential nutrients, every organ system can be affected, resulting in serious medical consequences.”

Signs of ARFID
Dr. Santangelo suggests parents watch for signs their child’s picky eating may be something more serious. Along with severe rigidity about what they will eat and delayed weight gain and growth, warning signs and symptoms of ARFID include:

• Complaints of constipation, abdominal pain, feeling full or other stomach issues

• Cold intolerance or often feeling cold

• Fatigue

• Difficulty concentrating

• Anxiety at mealtimes

• Fears of choking or vomiting

• Lack of appetite or interest in food

• Dizziness or fainting

• Sleep problems

• Dry skin and brittle nails and hair

• Muscle weakness

• Poor wound healing

• Impaired immunity

• Growth of fine hair on the body (lanugo)

• Late development or loss of menstrual period in adolescent females

“Parents know their children best and can recognize when behaviors become problematic or when their growth or development stalls,” Dr. Santangelo says. “Talk with your child’s doctor if you have concerns. There are effective treatments available that can help a child get their growth on track, become medically stable, and overcome their fears and challenges related to eating.”

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