When is it time to get your picky eater specialist help?

‘Picky’, ‘finicky’ or ‘fussy’ eating is a thorny area because, as those words imply, it may just be an insignificant phase that needn’t be a major cause for concern or  it may be a huge source of stress within a family, with complex underlying factors.

A child’s eating issues can be extreme enough to have an enormous impact on family life and for some children, there may be something physiological causing the feeding problems  (issues with chewing or swallowing, allergies, digestive problems etc.) that requires specialist diagnosis and treatment.

The majority of cases of ‘picky eating’ are straightforward and most children described by their parents as ‘picky’ are healthy, of a normal weight and are adequately nourished. But it’s very important that you can feel confident that you know where your child’s issues sit on this continuum.

Sometimes children with feeding problems have sensory processing issues and/or may be on the autism spectrum but if this is true for your child, it’s highly unlikely that eating will be the only area where you have noticed challenges. When you are considering seeking help, I recommend asking yourself these five questions :

Five things you need to ask yourself about your child’s eating:

• Have you had their weight and growth checked by a health professional?

This is vital because if there are concerns in this area, you will need  further professional advice.

• Have you investigated any other unusual or worrying behaviours or traits that you have noticed in your child?

If not, it’s always worth checking these things out, even if it is only to learn that what you are seeing is developmentally normal.

• Have you got reason to be concerned about your child’s  health?

If they are low in energy, having problems with their digestion, sleeping excessively or badly, feeling constantly irritable or looking pale or unwell, get them checked out by the doctor. In fact, if you have an intuition that they are ‘just not right’ – listen to this.

• Is your child genuinely anxious around food?  

You will have a gut-feeling about whether your child reacts anxiously to food, and if you sense this may be a problem, get it checked out. A little anxiety can still fall within the realm of ‘normal’ but it could point to psychological issues that need specialist assessment and treatment.

• Are mealtimes consistently stressful for you or your child?

We all have the odd stressful meal with our children – anyone who wants to argue to the contrary is lying. But do you or your child dread meals? Do you often find yourself getting  very anxious, angry or frustrated at the table? Does your child frequently cry or have tantrums during mealtimes? If you recognise this, it’s time to get some specialist support.

• Is your child missing out on an entire food group and/or only has a very small number of accepted foods?

Very extreme ‘picky eating’ may indicate a need for an assessment for Avoidant Restrictive Food Intake Disorder (ARFID). And even if your child does not quite merit an ARFID diagnosis, some input from a dietitian could be a great idea.

What does specialist support look like?

This is a really hard question to answer because it really varies from country to country. In the UK, if your child is under five, the Health Visitor is a great resource and can sign-post you to further support if required. If your child is over five, it’s worth having a chat to the SENDCo at their school, the school nurse or the GP.

Feeding consultants like me (and dietitians who specialise in paediatric feeding) can be a life-line but are few and far between; you will usually have to pay and they may have long waiting lists. It is possible to access a dietitian on the NHS, via your GP, but they are not all experts in the psychological aspects of food and feeding and many focus heavily on the nutritional side of feeding problems. Valuable, but not necessarily the whole picture . In some cases your child may need feeding therapy or other forms of specialist psychological input, but to get this on the NHS, they will need to have quite severe difficulties.

In the US, it’s often Speech and Language Pathologists (SLPs) who work with child feeding problems (and here in the UK, they can also offer valuable support with physiological issues around feeding) . Your child’s pediatrician or the school nurse will be your first port of call.

If your child’s eating issues are underpinned by sensory processing challenges, they may need help from an Occupational Therapist (OT) with the right training and expertise.

My message is this:  TRUST YOUR INTUITION.

As a parent, you know best if you need extra help. You will have a small (or sometimes loud and obnoxious!) voice, telling you that all is not well with your child. Your first attempt to get your child the right help may not work out, but harness your inner maternal (or paternal) tiger and don’t give up.

Equally, if your child’s weight and growth are fine; they are well in themselves; eating across the food groups; you have no concerns about them generally and mealtimes are mostly okay, maybe you need to understand their eating as a normal phase that you just have to ride out.

And if you are just not sure where you and your child are with all of this – ask for help, there’s nothing to lose. There is no shame in being told that you have nothing to worry about and you will at the very least come away with some useful strategies for supporting your child. If it turns out that there is a problem, early intervention can make all the difference.