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When you’re the parent of a toddler, mealtime can be an uncertain time. Will they eat what you made? Will they eat anything? Is a meltdown coming? Yep, picking eating has entered the chat. But is it always picky eating at play, or could there be something else going on with your little one?
What exactly is picky eating?
Picky eating is an umbrella term that includes a wide variety of eating difficulties, from the typical to the more extreme. “When we think about the typical phase of picky eating that many children go through,” says feeding specialist Melanie Potock, MA, CCC-SLP, “it usually starts at about 18 months and begins to get better at about the third birthday.” The rapid growth period a baby experiences in their first year begins to slow down after the first birthday, which impacts appetite.
Additionally, toddlers have so many exciting distractions, which can equal less interest in sitting for extended periods to focus on eating. The cognitive and language development kids are experiencing at this age usually includes new words and phrases like “no” and “don’t like it,” which are both highly popular and highly powerful for kids at this age.
If parents continue to offer small samples of new foods (with no pressure to eat it) at each meal and expose their children to fun food activities, children will often outgrow the picky eating stage.
How to Differentiate Typical Picky Eating From an Underlying Issue
| Typical | May Indicate an Underlying Issue |
| Tolerates new foods on their plate, but often won’t eat them. | Emotional outbursts if new foods are on their plate and cannot settle down until food is removed. |
| Occasionally has trouble sitting in their chair for mealtimes. | Consistently becomes upset if asked to sit in their chair for mealtimes. |
| Rarely gags when eating. | Consistently gags at mealtimes and/or may vomit. |
| Preference for favorite foods, but may occasionally try a new food on their own, when it’s offered on their plate. |
Very rigid food preferences that may include insisting on certain packaging, specific brands, or eating only in certain settings. |
| An eager eater for at least one meal per day, although they may not be as enthusiastic about other meals. | Hesitant to engage in mealtimes unless eating in front of a screen, riding in the car and snacking, or other means of distraction. |
| Growth and appetite naturally slow down in the toddler years. | Falling off the typical growth curve or demonstrating a significant drop in appetite. |
| Coughs or sputters occasionally, but recovers quickly with no upset. |
Coughs often when eating and may resist certain foods, like thin liquids, where they are likely to have a coughing episode. |
| Likes to choose the color of their plate, pick out their choice of cup, etc. May occasionally become upset when their choice is not available, but most often can be redirected to enjoy the meal. | Rigid behaviors around food where a child cannot eat unless they have a specific plate, cup, seating arrangement, TV show or other highly preferred environmental settings. |
| No more than one choking incident or none at all. Choking is not gagging. Choking means the child could not breathe and needed immediate help from the adult. | Multiple choking episodes where food is lodged and the child cannot breathe that require immediate intervention by an adult. |
Underlying Issues That May Present Like Picky Eating
Sometimes an issue—whether physical, developmental, or emotional—can impact your child’s willingness to eat in a typical way. These include gastrointestinal discomfort, sensory challenges, oral motor difficulties, and anxiety.
Gastrointestinal Issues
Gastrointestinal discomfort due to constipation, gastroesophageal reflux, severe teething pain, and large tonsils or adenoid tissue. “Once the physical discomfort is resolved with medical intervention,” Potock says, “the anxiety around new foods often remains, and also must be addressed.”
Sensory Challenges
Children with sensory challenges may have strong food preferences, which present as picky eating tendencies. Like a child who only wants crunchy, processed foods, or will only eat smooth foods like purées. “Some children may be diagnosed with Sensory Processing Disorder, and may require occupational therapy to learn to regulate their bodies and manage their reactions to certain stimuli,” says Potock.
“One out of four typically developing children will develop a pediatric feeding disorder (PFD) where physical, sensory, or motor challenges impact their ability to eat a variety of foods,” Potock shares. If anxiety is the cause, preschoolers and older children may be diagnosed with Avoidant Restrictive Food Intake Disorder (ARFID). “Both PFD and ARFID require a professional assessment and intervention and these children will not ‘just grow out of it’ like more typical picky eating.”
Oral Motor Difficulties
Oral motor difficulties can impact a child’s ability to try new foods as they may not feel safe managing the food in their mouth. “For example,” she says, “ankyloglossia or ‘tongue tie’ may hinder a child’s ability to move their tongue and/or swallow appropriately and they may insist on only eating foods that feel safe in their mouth.” Other kids may not have the strength or stability in their mouth to chew or swallow properly. “It’s not uncommon for those kids to maintain rigid choices and food preferences because trying to chew and swallow a new food doesn’t feel safe,” says Potock. Working with a speech pathologist or other OT can be helpful in these cases.
Anxiety
Anxiety in preschool aged kids can be associated with picky eating. “When kids feel anxious,” Potock shares, “they often have negative predictions about eating, especially eating unfamiliar foods.” Eating the same, familiar foods can help them feel less anxious. Along with feeding specialists, working with a psychologist or social worker can be a great support for children and families experiencing this.
When Picky Eating Becomes a Concern
If your child is showing consistent, emotional or physical discomfort at mealtimes, you should contact your pediatrician. Their age is not the concern here; rather, it is the ongoing discomfort that could signal a concern. “Children learn very quickly to either stop eating or eat minimal amounts in order to avoid the pain or discomfort easily associated with food,” says Potock. Within their second month of life, babies learn to turn away from the breast or bottle if eating hurts.
“Likewise,” she adds, “when babies start solids, they will be fussy and avoid eating if they experience consistent discomfort over a few days.” While toddlers having picky eating tendencies is normal, if the behavior worsens or persists, it’s best to speak with your pediatrician.
When to Seek Help for Picking Eating or Related Concerns
The number one reason to seek help is if your child’s food preferences are causing them, you, or the family as a whole, continued stress at mealtimes. Some other important reasons to seek support include:
- Concerns about your child’s nutritional health.
- Concerns about your child’s growth and development.
- Concerns that your child does not participate in social or school activities due to their limited eating style.
- Repetitive or frequent coughing, gagging, vomiting, or periods of GI distress.
- Any choking episode. This needs to be brought to the attention of your child’s doctor.
- Rigid behaviors around food, including but not limited to your child only eating in certain environments, unable to eat with others present, insisting on eating from the same type of plate at every meal, requiring toys or distractions in order to consume enough volume, and crying or becoming upset frequently over the presence of new foods.
At the end of the day, you know your child best, and you are their best advocate. Trust your gut and speak to your pediatrician if you have any concerns related to their eating. Whether they assure you it’s run-of-the-mill picky eating that will pass, or perhaps something else, you will have the information to make a plan and continue to set your child up for success—at mealtimes and beyond.