Picky eating is a very common concern for parents. As many as 1 in 3 parents seek support from their doctor or paediatrician regarding their child’s picky eating patterns and some studies show that more than 50% of mothers report that at least one of their children eats ‘poorly’.
Picky eating can lead to significantly increased stress levels for both parents and the child, as every mealtime begins to feels more like a battlefield than it does an opportunity to nourish your children or spend quality time together. This stress can leave even the most composed of parents desperate for support and answers to their child’s picky eating behaviours.
When is picky eating a problem?
It is important to note that feeding challenges in children present on a spectrum of severity and not all issues require treatment or intervention. On one end there are the transient fussy eating behaviours that fall within the realm of normal development, while on the other end are the more serious feeding difficulties, with varying degrees of challenges in between.
The severity of the problem is usually defined by the number of foods the child will regularly eat, the child’s reaction to certain foods, and their behaviour at mealtimes. A useful definition is the ‘picky eaters’ versus ‘problem feeders’ distinction, as described by Kaye Toomey’s SOS Approach To Feeding program. While picky eaters usually need some strategies to help at home, is the ‘problem feeders’ that usually require a more thorough assessment for underlying causes.
What causes picky eating?
Many people are quick (and usually wrong) to assume that picky eating is a purely behavioural problem, with these children often described as ‘fussy’, ‘difficult’, ‘defiant’, or worse. But, in fact, it is extremely rare to see picky eating patterns emerge from behavioural factors alone. Instead, we know that there are a whole host of other possible causes as to why a child may develop or display selective eating patterns. As paediatric feeding specialist Cheri Fraker says, “children refuse for a reason, always” and as parents and health professionals, it is our job to figure out why.
Historically speaking, it is thought that picky eating in early childhood may have had evolutionary benefits for the child by reducing their risk of consuming toxic or poisonous foods. As any parent will know, young children are highly suspicious of new foods – something known as neophobia (fear or rejection of new foods). Most children will overcome neophobia with repeated exposure to the foods, meaning that for a majority of children picky eating of this nature is transient.
But for those children with more persistent or pronounced picky eating, or who demonstrate a loss of eating skills that aren’t regained, other possible underlying factors should be considered. These might include sensory processing problems, discomfort or pain, nutritional factors, delayed oral-motor and swallowing skills, learning problems, or developmental transitions. Another important consideration should be their gut health.
Gut health & picky eating
Digestive troubles can be a major factor leading to a series of events that eventually results in picky eating behaviours. Some research estimates that around 42% of oral aversion cases could be gastrointestinal in nature. Underlying issues with gut health can quickly trigger a learned avoidance of food and eating in children due to the pain and discomfort they experience during the meal or during digestion of foods.
In particular, the digestive issues most likely to be involved in feeding problems include:
- • GORD – gastroesophageal reflux disease, which can often be ‘silent’ (i.e. no obvious signs or symptoms reflux)
- • Eosinophilic oesophagitis
- • Constipation
- • Food allergies or intolerances – especially cows milk protein, but also the other major allergen culprits – soy, egg, wheat, nuts, fish, seafood
- • Coeliac disease or non-coeliac gluten sensitivity
- • Gastroparesis
- • Bacterial overgrowth
The consequences of these gut problems and food avoidance may include:
- • Food refusal
- • Oral hypersensitivity
- • Choking or gagging
- • Reduced self-regulation of appetite
- • Delayed oral motor skills
- • Distorted feeding relationships
Is it the chicken or the egg?
Once picky eating behaviours develop and mealtimes become increasingly tense, a vicious cycle can arise between eating and gut health. For a child, the stress of a mealtime can trigger increased levels of our stress-response hormones, such as cortisol and adrenalin. These hormones push our body into fight-or-flight mode, which switches off our digestive system and reduces our appetite. This response may perpetuate their existing gut health problems.
Alternatively, even if a child’s picky eating behaviours did not stem directly from digestive issues, their restrictive food intake certainly has the potential to impact gut health. With highly selective eaters there is concern about their intake of essential nutrients, many of which are needed for optimal digestion of foods. These children also typically have a low fibre intake and we need specific fibres to feed our good gut bacteria in the large intestines.
The result can be improper breakdown of foods leading to bloating and gas, and/or altered bowel motions resulting in loose stools or constipation (or sometimes a mix of both). In the long run, these issues only serve to worsen food avoidance behaviours due to the discomfort.
What can you do?
Ultimately, the first step in addressing picky eating behaviours is to identify and treat the underlying cause. Without this step, other strategies such as oral-motor skill development, food chaining, or desensitisation approaches may be ineffective.
Children with pronounced feeding challenges often require multidisciplinary assessment to get to the root cause and a naturopath can play an important role in this process. They can assess gut health, evaluate the presence of food allergies or intolerances, and monitor the nutritional status of your child. To add, a naturopath can provide support for gut problems in the form of herbal and nutritional medicines, ensuring that the underlying cause is not only identified, but also treated effectively.
Get in touch with our team if you would like to find out more about how one of our naturopaths can support your child’s gut health and get them on the path to becoming a confident and capable eater.
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