Picky Eating: Causes, Strategies, and When to Seek Support

Picky eating is common in toddlers and preschoolers and usually improves with time. Repeated, low-pressure exposure to new foods works better than pressure or rewards. A smaller group of children have something more — feeding difficulties with sensory, medical or anxiety-related causes — and those children need individualized help.

Wariness of new foods peaks in early childhood. Genetics, temperament, early feeding experiences and the way food is offered at home all play a part (Taylor & Emmett, 2019). Most picky eaters grow normally, although their diets often include fewer vegetables (Taylor & Emmett, 2019). Knowing that this is a normal phase can take some of the tension out of mealtimes — and less tension helps.

• Repeat, without pressure. In a randomized trial, children who tasted an unfamiliar vegetable every day for eight days came to like it and eat more of it; offering a reward did no better than simple repeated tasting (Wardle et al., 2003). Many children need numerous tries before they accept a new food.
• Divide the jobs. Parents decide what, when and where food is served; children decide whether and how much to eat from what is offered.
• Include a “safe” food your child usually accepts alongside anything new.
• Eat together, and let children see you enjoying a range of foods.
• Keep portions small, and let children serve themselves when they can.
• Avoid pressure, bribes and “one more bite” negotiations, which tend to make children more resistant (Taylor & Emmett, 2019).
• Involve children in shopping, washing and preparing food.
• Limit grazing and drinks of milk or juice between meals, so children come to the table hungry.

Some children have avoidant/restrictive food intake disorder (ARFID). In ARFID, avoiding food — because of sensitivity to textures, tastes or smells, a lack of interest in eating, or fear of choking or vomiting — leads to weight loss or poor growth, nutritional deficiencies, dependence on supplements or formula, or serious interference with daily life (Zimmerman & Fisher, 2017). Feeding difficulties are also more common in children with autism, reflux, constipation, food allergies, or a history of medical procedures involving the mouth or throat.

We start by checking that growth and development are on track — reassuring for most families — and then look at the whole feeding picture: the textures a child accepts, mealtime routines, constipation or reflux, sensory patterns and family stress. We give practical, step-by-step strategies, look for likely nutrient gaps such as iron or vitamin D, and refer to a feeding therapist, a pediatric dietitian or a psychologist when ARFID or a medical cause is suspected.

• Picky eating is common and usually temporary.
• Offer new foods often, in small amounts, without pressure or rewards.
• Keep a familiar food on the plate, and eat together.
• Poor growth, very few accepted foods, or choking and gagging need a professional evaluation.