Where Does Picky Eating End and Disordered Eating Begin?

At some time or another, all mothers have been there—we spend hours slaving over a lovely meal (or after a busy day, we defrost some tasty leftovers) and we lovingly place the plate in front of our child. Our efforts to feed them a delicious, balanced meal is met with screaming, crying, throwing, spitting, the silent treatment, demands for different food or an exasperating combination of these refusal behaviors.

Some mothers deal with the frustration of a picky eater every now and then, while others endure this scenario at every meal. Picky eating in children is not uncommon. As kids grow, they develop preferences and test boundaries. In general, children usually outgrow selective eating, and eventually consume a wider range of foods including the fruits, vegetables, grains and proteins that comprise a balanced diet.

However, picky eating can be prolonged, severe or affect a child’s emotional or medical status. In these instances, it’s important to consider the wider implications of picky eating behaviors, most notably:

Where does picky eating end and disordered eating begin?
The answer to this question isn’t always clear, but understanding the difference between disordered eating and an eating disorder can be a helpful starting point.

“Disordered eating” refers to a wide range of irregular eating behaviors that do not warrant a diagnosis of a specific eating disorder. Most picky eating among children falls under mild to moderate disordered eating, and will resolve over time, at times with the support of an outpatient dietitian, therapist or pediatrician.

An “eating disorder” is a mental illness characterized by abnormal eating habits (that may involve restriction, bingeing and purging) to the detriment of a person’s health alongside an unhealthy preoccupation with food, weight, shape or body image. Anorexia nervosa, bulimia nervosa, binge eating disorder and eating disorder not otherwise specified (EDNOS) have a specific set of diagnostic criteria outlined in the Diagnostic and Statistical Manual (DSM, now in its fifth addition), which is widely used by clinicians to diagnose mental illnesses.

Even though 95 percent of eating disorders develop between the ages of 12 and 25—after most childhood picky eating resolves—eating disorders can and do affect younger children. In fact, specialized treatment is available for young children and families suffering from these deadly mental illnesses.  

In addition to this foundational understanding of disordered eating and eating disorders, parents dealing with a picky eater can consider three additional strategies if they are concerned about their child’s eating patterns:

Explore the thoughts and attitudes behind picky eating.
Have a conversation with your child about their food preferences to determine whether there are concerning motivations related to dieting, weight or shape. Even young children are exposed to our society’s dieting mania through the popular media, attitudes and behaviors of parents or older siblings, and even school programs that weigh children and issue “fat letters” to parents. Arbitrary, rudimentary rationales for picky eating like “I don’t like yellow foods” or “Vegetables taste yucky” are less concerning than beliefs like “Yellow foods are bad for you” or “I like vegetables because they make me skinny.”

Consult a dietitian or pediatrician, preferably one with eating disorder experience
These experts can help evaluate whether the child’s nutritional status is compromised by their limited food intake, and shed light on whether the patterns of food restriction indicate an eating disorder or disordered eating. Eating disorder experts can help parents understand the diagnostic criteria for an eating disorder and make eating disorder treatment referrals for children and families accordingly. Don’t delay seeking an expert opinion—if an eating disorder has developed or if the child’s risk of developing the illness is heightened by family history, temperament or another factor, early intervention is critical to recovery and prevention.

If you think your child’s picky eating has evolved from a periodic mealtime frustration to an ongoing syndrome that is adversely affecting their dietary, emotional or medical status, trust your instincts and seek help.

Trust yourself.
Parent intuition, or our “gut feelings” related to our children’s health and well-being, is usually accurate. Parents have instinctually been alerted to issues in their children for centuries, even before we could hop online and consult WebMD or shoot our pediatrician friend a quick text.

Even with abundant resources for information and support, our intuitive nature should be acknowledged and nurtured to keep our kids healthy and safe.

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