Picky Eating: when to get help?

[awkwardpenguin]

We have two kids - DD(8) and DS(6).  Both are picky eaters, but DS is much more extreme than DD.  He will not try any new foods, and eats the same thing over and over and over.  If he's presented with a situation where he doesn't like anything, he will simply not eat, even if he is hungry, and then gets hangry and ragey later because he hasn't eaten.

We have been "treating" this at home for about a year based on the book "Helping Your Child with Extreme Picky Eating" - doing strict division of responsibility in feeding and serving meals family style with a variety of foods and at least one acceptable food on the table.  He will eat only the acceptable food, and cry if he doesn't like what is being offered (even among acceptable foods he has preferences for certain ones).  He eats school lunch but school reports he doesn't eat much there either.  He has severe chronic constipation, which can make kids eat less, but also requires a diet with more fiber which is a no go right now since he won't eat high fiber foods (nor will he drink enough clear liquids to get his full Miralax dose).

He is growing and gaining weight appropriately, so the pediatrician just says "give him a multivitamin and keep trying".  He seems to get the bulk of his calories at breakfast where we allow more carby foods that he prefers.

He eats the following:
Carbs (bread, tortillas, plain pasta, pancakes, french toast sticks, specific kinds of crackers, specific kinds of breakfast cereal)
Protein (fried eggs, scrambled eggs, chicken nuggets, fish sticks)
Dairy (milk, vanilla yogurt, plain yogurt)
Condiments (butter, ketchup, strawberry jelly)
Fruit (strawberries, raspberries, peeled apples)
Vegetables (avocado)
Mixed up foods (strawberry smoothie, mac and cheese)
Misc (french fries, chocolate chips, gummy candy)

Ideas?  Thoughts?  I have mixed feelings about feeding therapy, but feel like we've been following all the recommendations and he's still eating 26 foods, so I'm kind of at a loss.  My concerns are mostly nutritional, but there's also the practicality of never being able to just cook one meal and all enjoy it.

[dcn]

My kids are picky too. Honestly my younger one eats less than you listed it feels like, but I haven’t made a list recently.

No matter what though, If you are feeling like you want or need help then it doesn’t hurt to reach out and have an evaluation done. Perhaps OT first to see if there’s something they could work on.

Hugs.

[waverly]

The list is not terrible and he is healthy according to the pediatrician.

So I think the only reasons you have to do feeding therapy are constipation and being able to make one dinner.  My concern with the constipation is not drinking enough fluids to take the Miralax.  

I will say DD ate a wide variety and still had constipation, but she did eventually outgrow it at an earlier age maybe around 4-5. The one dinner is going to take a while, for example mine eat it now at ages 13 and 10, but the 10 year old does still complain and there are times they both don't eat a ton, but are fine overall. So that might not be achievable at age 6 anyway.

So I think the feeding therapy works if it is convenient to your schedule and not too pricey for you. I've never done it, so I can't say anything about it. I tend to think therapies won't hurt, but you said you have mixed feelings, so perhaps you might think it might cause him to regress? Or if the level of frustration that you have hit is kind of telling you OK, I need to do this. Or you just feel it is beyond you, time to get an expert. I will say I have never regretted OT, PT, speech, or the tutor that we got. So I have never regretted services, but we didn't need to go to feeding therapy.

[awkwardpenguin]

Thanks dcn and waverly, those are both helpful perspectives.

I think my biggest concerns are 1) the ragey behavior when he won't eat anything and 2) not being able to follow the GI's recs for constipation because of his limited eating and drinking options. And my biggest hesitation about feeding therapy is that it will just be a big waste of time and effort.

[waverly]

awkwardpenguin, maybe give yourself that initial intake plus 3 sessions and see how it is going. If its a big waste of time and effort then you can a quit. But if you don't try you don't know if it will be helpful.

It might make it easier to say OK this is a sunk cost that I will spend 4 hours on this plus driving, but I am OK with that time commitment, and then I think it will be easier to say hey I like this or this isn't helping.

[orval]

My ds did OT for eating issues. It was worth it I think. Mine also ate less than yours and was about 9 or 10 when we started. They had me bring different food each week. She made him taste it and give his opinions -- texture, taste, spicy, sour etc. I think it helped him identify flavors he liked. Now at 16, he still has limited foods that he eats. But he does eat a lot more. Asian foods are some of his favorite. Sometimes he still only eats a few bites of dinner if he doesn't like it. I do try to make things he will definitely eat a couple times a week. If he doesn't eat much dinner, he grabs whatever snack he wants. His snacks are not "healthy" but that does not concern me. He is a carb man and that works for him.
ETA: I always have snacks on hand that he will eat.  Occasionally we still have the "hangry" there is nothing for him to eat scenario, but not often.  Again, I do not limit his food.  I will also sometimes make him something different if needed.  I also have helped him figure out what to order at restaurants.  Now he can usually pick his own meal, but for years I made suggestions for him.

[mrsGreeko]

Personally if he’s growing appropriately I’d let it lie. I would work on getting him to drink enough to get the Miralax in him (mix it in those strawberry smoothies he likes maybe?). Set boundaries about his behavior regarding not liking the foods. I have a picky eater who was picky to the point of becoming failure to thrive and not growing appropriately and needing an appetite stimulant on and off for several years. She used to make disparaging remarks about the food served for dinner. We set boundaries: if you make a nasty comment about the food I just cooked for you, you can go to your room. She stopped making comments about the food, ate what she could of what was offered and got a bedtime snack of preferred foods after to bulk her calorie count. It didn’t take long to correct that behavior.

If he throws a fit about the food, send him to his room. He doesn’t get to hold you hostage because of his food preferences.

ETA: I also had to let go of the control of what I considered “healthy” in favor of a calorie is a calorie is a calorie. We still sat down for dinner together and all ate one meal. Just sometimes she only ate the fruit or maybe took a bit or two. Then she had bedtime snack that was basically dinner. She’s a teenager now and still doesn’t eat a ton and is particular, but she does eat more of what’s served in general. Most of the time. We also never ever ever comment on what she is or is not eating and try to refrain from referring to foods as “junk” or “healthy” or whatever. Food is food and food is fuel for your body. Some foods fuel your body better than others, but all provide fuel.

[joy]

Does he bring a water bottle to school? Can you put the miralax in that water so he sips it all day? No other drink until he finishes?

My daughter is picky as hell. Her list is worse than this. I’m not sure what my line is for feeding therapy but I’ve also considered it. 😕

[noodleoo]

Commiseration. DD2 (age 5) is a picky eater too. Her list is actually pretty similar to yours, but I’ve always thought of her as a normal picky eater. DD1 has always been a more adventurous eater, but I knew she was not normal, so I just figured DD2 is more like regular kids.

I totally hear you on being frustrated and sick of making the same foods over and over again so that one kid will eat. In fact, I’m finally kind of giving up on it. I make bigger batches of things I know she will eat and then some days I make dinners that the rest of us want and she has leftovers. Or I plan to make chicken nuggets for the kids and a grown up meal for H and I. I’m just over it and I miss the food I like to eat. I try to get her to try things but she often says no and I don’t push it. If I make a meal and she won’t eat it, she can have cereal or yogurt instead. I’m still hoping she will outgrow it, but she may end up always being picky and if so, it is what it is.

Basically I can’t control her but I’m not going to always cater to her at the expense of everyone else.

Anyway, if you want help, I’d do a consult with a feeding specialist and see what they say. It can’t hurt and will either be reassuring that he’s normal or they’ll have a plan to address it. The downside is more mental load for you to manage. I think it depends on how much energy you are willing to put into it.

[VillainV]

Your DS eats about the same variety of foods as my kid. He’s eat pretty much any combo of carb + cheese (quesadilla, bagel with cream cheese, Mac and cheese, pizza) , but a limited variety of fruits and vegetables, and a limited variety of meats or other protein sources.

Honestly, it’s pretty similar to what I ate as a kid. Every year we add another few foods, and he’s getting there.

The big difference is that my kid doesn’t seem to have the same emotional reaction to food as yours does. He doesn’t get upset if a non-preferred food is on his plate…he just doesn’t eat it and moves on. This might be something worth exploring, either through OT or some other kind of therapy. I’m not implying that it’s wrong or bad for him to react this way, just that it may point to a different cause of the picky eating and it may point to a different way to treat it.

ETA: we also dealt with the constipation, and at age 9 are mostly through it. The only thing that really helped was strictly enforcing sitting on the toilet every evening before bed (preferably after a hot bath or shower).

[lynn07]

We have a range of eaters. The oldest eats a little of everything. The middle had extreme picky eating until about 5 (I could count on less than 2 hands the foods he would eat). His was found to be more of an oral motor/sensory issue. He would gag a lot and only ate foods that were easy to chew. He did feeding therapy until he aged out at 4, and I do think it helped. By 5, he was trying more things, and now at 13 he has a pretty good range of food while still having a few aversions. The youngest is 8, and doesn't have that different of a diet than what you described. It drives me crazy sometimes, but then he'll try something new out of nowhere and we try to praise him as much as possible. I also work in a school and see what other kids eat. All that to say, your kiddos diet doesn't seem that out of the usual to me. My biggest concern would be the emotional response - that was how DS2 reacted to non preferred foods when he was younger, and it had a lot to do with his sensory aversions (he also has ADHD).

[sparty04]

This is not helpful but I have 4 picky kids that wouldn't eat the majority of stuff on your list. My oldest is 11 and every once in awhile he might try a bite of something new (this is a new thing for him for probably the past year). He did food therapy when he was a toddler and while I wouldn't say it was a waste of time, it didn't change anything.

My kids are growing well and have no health concerns, so I've stopped worrying about it. It's super annoying and sometimes difficult to plan our meals around what they will eat, but it is what it is.

For the not eating at all, I always bring something I know they will eat. I almost always keep a pack or two of peanut butter crackers in my bag in case they refuse to eat anything else. Will he drink juice? I'm sure you've tried but just wanted to throw it out there.

[lolalolalola]

My kid has ARFID and at 18 still eats less variety that your kid- I am sure that’s not helpful but I want to let you know that you’re doing all you can! We did therapy and if didn’t help expand her palette. Most kids will eventually eat more variety. If you think there’s a need for therapy there’s really no harm in getting their opinion.

[sdlaura]

I have read that ages 5/6 are the peak of picky eating, and that has held true with my four kids. My now 11 year old and now 9 year old kids were also very picky at that age but have now branched out. I would say as long as growth and weight gain is normal and pediatrician is ok with it, I would see if they grown out of it.

A good friend of mine had her daughter in a full time camp for eating last summer, but her daughter was way underweight.

Totally anecdotal, but I was also a super picky eater as a kid and now will eat anything 🤷‍♀️

[al dente]

I could (and have) written your post and all the responses for my 5yr old. I'd say if it's causing so much stress to look into the various therapy options and see if it works for you. I've bought the Better Bites program from Kids Eat In Color, and on the Facebook page people often talk about feeding therapy with mixed results.

I debated this, but ended up just deciding if she's getting calories in it works for me. Dinner esp is not a great time for us, we had a major meltdown the other day because I made fettuccine noodles (pre-approved and eaten dry by my picky eater) instead of thin spaghetti noodles for dinner. I try and get calories in earlier in the day and do bedtime snack of some fairly boring but calorie dense. She's growing, her doctor has no concerns, so I also try not to.

If it helps your kid does eat more then mine. I also try and remember that until fairly recently people didn't have a huge variety of food available, which I personally feel is where a lot of pressure comes in that there's so much available and she eats such a small amount. But the human race has survived on less and she seems to be thriving despite all the stress it causes me lol.

[minzy]

My ten year old’s list is pretty similar except that she doesn’t do much in the way of protein and is a vegetarian (“that used to be an animal!”). She has an ADHD diagnosis and maybe because of all her movement has never had issues with constipation. She has for years remained on her own little 15% height and weight curve for her age. Her pediatrician is not concerned and has acknowledged she is very likely to just be petite. We did do feeding therapy a few years ago and it gave her the chance to try to people please strangers, so she would appease them a little, but back at home she made next to no gains. They were about to switch us to a fourth therapist over about a sixth month period (at a farther location at a really inconvenient time) so we stopped going. I did learn from her eval that she has an unusual swallowing pattern… but it’s not like we’ve done anything with that information. Still I do not regret trying it so would encourage you to consider it too. It most likely won’t hurt.

I try to hit grain-protein-fruit-veggie so her lunch is usually whole wheat crackers, two slices of cheese, strawberries, and cucumbers. Like so many other things in life, she just does it her own way and different isn’t always wrong.
Also I totally agree with the statement above that say even two or three hundred years ago there was not this extraordinary access to such a variety of food so maybe it shouldn’t be so unusual that someone wouldn’t want to eat every possible thing.

[trytobearunner34]

Fellow mama of a picky eater here who has suffered from chronic constipation. Her list of approved foods is more narrow BUT her water consumption, activity level and getting fiber in through very deliberate (and VERY repetitive food choices) seem to keep her regular.

For breakfast she eats 2 fiber gummies and a go go squeeze pouch (3-4 grams of fiber) along with her main dish (she is most adventurous at breakfast so this ranges from yogurt to a protein ball to Kodiak waffle or grape nuts cereal-the only cereal she will eat!).

Lunch fiber usually comes from nut butter, whole wheat bread and another go go squeeze pouch.

Dinner is an almond butter sandwich, pizza or pasta with a decent fiber content and butter of course served with a pouch🙄.

If she hasn’t had a bm after two days we add miralax to her morning water bottle and are back on track.

She’s healthy, active and now that we’ve gotten the constipation under control, not a battle I’m willing to fight at this point. If we are eating out or at a friends/family we feed her before we go 🤷‍♀️. We have never considered therapy.

Commiseration and hugs!

[ssmjlm]

Mine is somewhat picky, but I have never put together a list. When we had constipation issues she was on a daily prune. Maybe see if you can put them into the smooties or I had an apple/prune bar recipe when she was a toddler.


One thing I would focus on is that his response to non-preferred foods cannot be distracting/disrespectful, etc, or how you want to phrase it. He's old enough to be respectful of those that have cooked the meals and that just because HE doesn't like a food, doesn't mean there's anything wrong with that food.

I've tried really hard to make family dinner a thing, even if I'm accommodating her in some manner by ensuring she has something she likes. But we remember to respect the chef and everyone's palates. I mean, I don't like green beans, but DH and E do. I eat them and we all joke about me basically choking them down, but it's a nice sort of counter balance when she's not a fan of zucchini, but I am.

[wanderingback]

I think if you’re concerned then it wouldn’t hurt to get a professional opinion as a consult and then go from there.

However, looking at that list it isn’t horrible.
Even though I have never been a picky eater for breakfast and lunch I typically eat the same thing over and over for months to years, as I just find that easier. In high school I ate a peanut butter and jelly sandwich every day for lunch for 4 years (I don’t remember what I ate for breakfast). Even now I typically stick to the same breakfast for a year at a time. So I think it’s totally fine to eat the same things over and over.

I def understand it being frustrating to have to cook differently or not be able to go out to eat though. Can you offer a safe food in those instances so the hanger doesn’t happen?

[lilac05]

I generally think that when a parent asks, “When is it time to get help?” the answer is “now.”

Set up an evaluation, go in with your lists of preferred foods, observations, and questions, and let the professional tell you if they think that feeding therapy is appropriate.

Personally, I would not hesitate to make the appointment. Life could be so much more enjoyable for *everyone*, but you won’t know if you don’t try. It’s not just about not having to make extra meals, it sounds like they aren’t enjoying the meal experience as it is, either.

[osulori]

As a feeding therapist (SLP), the list you posted isn't too bad! I get that it's super frustrating that it puts limitations on going out to eat and requires that you're not making one meal that the whole family eats though. You're doing a lot of great things already, and he's growing well which thankfully takes a degree of stress out of things. Consulting with a feeding therapist has the potential to be helpful in working through other strategies to expand his diet based on his preferred foods, but can definitely be hit or miss until you find the right therapist match for you and your son.

Re: the constipation-I saw gummy candy on your list of preferred foods, has he tried fiber gummies? My daughter goes on and off the Lil Critters fiber gummy bears as needed if she gets stopped up and they've been great for her. I actually got the idea from one of my feeding therapy patients, and thank the patient's mom on a regular basis for telling me about them!

[jeaniebueller]

Does he have any diagnosis?  My DS was similar and we got an OCD diagnosis, he was just like that, would starve himself before he ate something he didn't like or that looked bad to him. The good news its that he had slowly gotten much better as he has gotten older. But the lists you provided are not bad at all, they are way longer than my son's list was when he was at his most restrictive. 

[purplepenguin7]

My daughter (5) is slightly picky, but with that list I think you are totally fine, especially if he is growing appropriately.

My daughter's dinner is usually chicken nuggets, a veggie (broccoli, cauliflower, carrots mostly), a carb (rotating through rice, pasta, mac n cheese). Sometimes we switch out the chicken nuggets for meatballs. Occasionally we do something like a grilled cheese, eggs for dinner or something. So yes, she does get a "special" meal most nights but I'm ok with it for now. We try and make her sides our sides for example if I make rice, we all have rice so really it's just the protein that gets swapped out.

I see a ton of meals and snacks I could make out of your kid's list.

Oh also, I just wanted to add.  It's finally fine to seek out therapy and help if you think it's needed but I also thinking that social media plays a huge part of this.  With BLW and "kids eat what you eat" and whatever other trends, you see tons of kids eating steak or super adventurous foods but its totally OK if that's not your kid (in my non professional opinion). 

[niq]

Nov 8, 2023 15:22:56 GMT -5 awkwardpenguin said:

Thanks dcn and waverly , those are both helpful perspectives.

I think my biggest concerns are 1) the ragey behavior when he won't eat anything

For whatever it's worth, O's behavior when she doesn't like what she's being served has waxed and waned a couple of times. She's not as picky as yours though.

I know you're okay with serving separate kid vs adult meals and/or following the book recs. Since he's gaining weight and healthy other than constipation/bedwetting I think KOKO might be reasonable, as much as it'd be nice not to be so constrained in cooking. Weed is legal in Illinois.

... only peeled apples??

[wanderingback]

Nov 9, 2023 12:54:36 GMT -5 niq said:

Nov 8, 2023 15:22:56 GMT -5 awkwardpenguin said:

Thanks dcn and waverly , those are both helpful perspectives.

I think my biggest concerns are 1) the ragey behavior when he won't eat anything

For whatever it's worth, O's behavior when she doesn't like what she's being served has waxed and waned a couple of times. She's not as picky as yours though.

I know you're okay with serving separate kid vs adult meals and/or following the book recs. Since he's gaining weight and healthy other than constipation/bedwetting I think KOKO might be reasonable, as much as it'd be nice not to be so constrained in cooking. Weed is legal in Illinois.

... only peeled apples??

I’m confused, what does weed have to do with this?

[loira]

I feel like these threads always have at least one poster who comes in and says "here's what we did for my kid who isn't really that picky so it's not at all the same situation and this will be of no help to you". But the weed thing is new! What the heck?

[waverly]

I'm assuming they mean that they take (smoke, edible?) weed when the child stresses them out? Maybe..., hopefully! I had to read it a few times before I came up with that conclusion.

[niq]

Nov 9, 2023 18:31:40 GMT -5 wanderingback said:

Nov 9, 2023 12:54:36 GMT -5 niq said:

For whatever it's worth, O's behavior when she doesn't like what she's being served has waxed and waned a couple of times. She's not as picky as yours though.

I know you're okay with serving separate kid vs adult meals and/or following the book recs. Since he's gaining weight and healthy other than constipation/bedwetting I think KOKO might be reasonable, as much as it'd be nice not to be so constrained in cooking. Weed is legal in Illinois.

... only peeled apples??

I’m confused, what does weed have to do with this?

[stoner voice] to help the parents mellow out, man.