Helping Your Selective Eater

Does your child have an extremely limited list of accepted foods? Do they snub their nose or tantrum when a new food is offered? Are they resistant to eating family meals at the table? If so, your child may be a selective eater. This article helps to define selective eater, discusses when to get outside help, and offers nutrition and feeding strategies to help your child thrive.

What’s The Difference? Selective Eater vs. Picky Eater vs. Fussy Eater vs. ARFID vs. Feeding Disorder

This is such a great and common question, and honestly there’s a lot of overlap between the definitions. 

Food Neophobia

To start, let’s talk about the most common form of picky eating, food neophobia. Most children will experience some degree of food neophobia, or reluctance to eat new foods during their childhood. This is thought to be an inborn safety mechanism, protecting kids from eating harmful substances. 

Because vegetables can be bitter, these tend to be some of the most commonly rejected foods. However, with positive feeding practices and continued food exposures, most kids outgrow food neophobia. 

Selective Eater

While there’s no formal medical definition or diagnosis for selective eating, a general definition is a child that refuses to try or eat a variety of foods. This can include both familiar and unfamiliar foods.

By definition, selective means highly specific in activity, giving a slightly positive undertone of being intentional. Some health professionals prefer “selective” over picky or fussy eating as it comes across a little friendlier. It can imply that something thoughtful or internal may be causing the food selectivity. 

Selective eating can be acute (<2 weeks) or chronic (>2 weeks). It’s often linked to a slower speed of eating and higher response to feeling full. Most studies find that selective eating begins between ages 2-6 and peaks around 3 years old. This corresponds with the natural slowing of children’s growth and appetite during that time.

Selective eating is common in children with autism, ADHD and other neurodivergent disorders. If not addressed properly, mild to moderate chronic selective eating can lead to nutrient deficiencies and chronic health or behavior problems. Selective eating can also overlap with Avoidant Restrictive Food Intake Disorder (ARFID) and Pediatric Feeding Disorder (PFD), requiring additional treatment strategies.

Picky (Fussy) Eater

Like selective eating, picky or fussy eaters tend to avoid both familiar and unfamiliar foods.

Picky and fussy, have a slightly different meaning of being very careful or too careful about choosing or accepting things. This definition can sound more negative when it comes to eating. Picky and fussy may give the connotation that a child is choosing their food limitations and in a sense, placing the blame on the child for their eating choices. 

Picky (fussy) eating can also lead to nutrient deficiencies and health problems over time if it’s not corrected. 

All that to say, selective eater, picky eater and fussy eater are 3 different ways of saying the same thing! You’ll even find these words used interchangeably throughout this article.

ARFID (Avoidant Restrictive Food Intake Disorder)

ARFID is an actual psychological diagnosis characterized by:

• Lack of interest in food
• Sensory sensitivity to food
• Fear of adverse events such as choking, vomiting or allergic reactions
• Weight loss/growth failure
• Significant nutritional deficiencies
• Interference with psychosocial function (i.e. difficulty eating in social environments such as a school cafeteria or friend’s house)
• Can have similarities to anorexia nervosa (AN), and in cases of severe malnutrition can coincide with AN
• Can have similarities to and can coincide with PANS (Pediatric Acute-Onset Neuropsychiatric Syndrome) 

Children with ARFID have a more severe form of food selectivity. Due to the psychological and nutrition concerns, they most often benefit from the combined help of a doctor, therapist and a registered dietitian. 

PFD (Pediatric Feeding Disorder)

PFD is an actual medical diagnosis defined as “impaired oral intake, not age appropriate, and associated with medical, nutritional, feeding skill and/or psychosocial dysfunction.”

It’s characterized by:

• Disturbance in oral intake of nutrients inappropriate for the child’s age, lasting at least 2 weeks and associated with 1 or more of the following:
  • Medical Dysfunction-cardio-respiratory compromise or aspiration during feeding
  • Nutrition Dysfunction-specific nutrient deficiency(s) or reliance on enteral (tube) feeds or oral supplements to sustain nutrition and hydration
  • Feeding Skill Dysfunction-requiring texture or feeding position modifications and strategies
  • Psychosocial Dysfunction-avoidance behaviors when being fed or inappropriate caregiver management of feeding; disruption of social function within the feeding context; disruption of child-caregiver relationship associated with feeding
• Not associated with other eating disorders or lack of access to food

PFD is also a more concerning form of selective eating. Since PFD is multifaceted, depending on your child’s symptoms and root cause, they will benefit from treatments by various specialists. This may include doctors, psychologists, dietitians, speech-language pathologists and occupational therapists. For more severe cases, feeding therapy by a group of trained specialists may be necessary.

To sum it up, selective eating by itself is not a medical diagnosis. But, when it’s accompanied by other symptoms of PFD or ARFID, it becomes a diagnosis.

Should I Be Concerned About My Selective Eater?

The fact that you’re reading this article says that you’re likely a little concerned about your child’s eating habits. But how concerned should you be?

Based on the above criteria, if your child has characteristics of ARFID or PFD, it would be wise to get a medical and/or psychological evaluation. While diagnoses can sometimes feel like a label, they can also pave the way for your child to get the treatments and services that they need.

If your child doesn’t fit either of these criteria, but you’re still concerned or frustrated, meeting with a registered dietitian (RD) for a nutrition evaluation is a great place to start! An RD can offer an extra set of eyes on your child’s diet variety and nutritional status. They can help to determine areas of concern and offer practical tips for improvements.

Side Effects of Chronic Selective Eating

Selective eating that doesn’t fit the criteria for a feeding or eating disorder can still be frustrating and concerning. Over time, chronic selective eating can cause:

• Nutrient Deficiencies-Kids that cut out entire food groups or rotate through the same few foods and brands can develop nutrient deficiencies. Common deficiencies in selective eaters include protein, potassium, magnesium, calcium, B vitamins, vitamins A, C, D, E, K, iron, zinc, fiber and essential fatty acids.
• Growth Concerns (under or over-nutrition)-Often selective eaters tend towards poor growth. Short term slowed weight gain or loss can be followed by longer term (and less forgiving) height stunting. On the flip side, selective eaters who prefer highly processed foods can become over-nourished, leading towards excessive weight gain.
• Fatigue-Deficiencies in B vitamins, Vitamin C, Vitamin D, iron, magnesium and zinc can contribute to physical and mental fatigue in children.
• Impaired Brain Development-Children need key nutrients including protein, iron, zinc, copper, essential fatty acids, iodine, choline, B12 and folate for proper brain development. Chronic deficiencies in these nutrients can lead to neurological changes (including behavior challenges) preventing normal brain growth and development.
• Gut Health Problems-Our gut houses 70-80% of our immune system. Chronically limited diets create an abnormal gut environment with limited strains of good bacteria. This can cause GI distress, poor nutrient absorption and poor immune function.
• Taste and Appetite Changes-Children who eat limited animal protein from meat, fish and poultry, may become zinc deficient. This can lower their appetite and cause food to taste differently, further limiting their food choices.
• Sleep Disturbances-Lack of iron, potassium and magnesium can cause sleep disruptions due to muscle cramping and restless legs.

Picky Eaters Quiz (Screening Questions)

Unfortunately, there’s no standardized diagnostic questionnaire for selective eaters. These screening questions are adapted from expert Kay Toomey (creator of the SOS approach to Feeding), various research questionnaires, and my experience in the field. They can help you decide if your child’s eating habits may be a problem:

1. Does my child have a very limited number (20-30) of accepted foods?
2. Has my child had a limited diet for more than a few weeks?
3. Does my child exclude 1 or more entire food group(s)?
4. Does my child have a preference for a certain flavor, color, or texture of foods?
5. Does my child have trouble chewing or swallowing certain foods?
6. Does my child complain about the way their food tastes?
7. Does my child struggle to sit at the table for family meals?
8. Does my child require the use of distractions (i.e. screens) during mealtimes?
9. Do mealtimes feel like a battle zone?
10. Do mealtimes last longer than 30 minutes?
11. Does my child have growth, gut health and/or behavior concerns?
12. Does my child have trouble sleeping?
13. Am I lacking in my knowledge and ability to feed my child?
14. Am I unsure of how to help my child expand their diet?

If you answered yes to 2 or more of the above questions, it’s probably time to get help! But, before we dive into where to get help, it’s important to understand what’s causing the selective eating.

Causes of Selective Eating

There are many causes of selective eating, some inborn and others developed. Getting to the root cause will help guide you to the best solution.

• Genetics (Nature)-Often selective kids have parents that were (or still are!) selective eaters too. This may be due to a taste, texture or appetite trait that gets passed down from parent to child. 
• Environmental (Nurture)-Other times parents can unintentionally pass on their limited food preferences to their kids based on their own food habits. This can even start in utero or during breastfeeding if the mom’s diet has limited foods and flavors.
• Personality-Some kids are naturally more eager to try new foods, while others are more hesitant. Some kids are more in tune with their hunger and fullness cues, while others aren’t.
• Age/Developmental Stage-Infants and young toddlers experience rapid growth (and big appetites) and are often more open to trying new foods. During early childhood, growth slows and picky eating often follows. Sometimes children are just too filled up from other foods during the day and aren’t hungry by dinner time.
• Parental Feeding Strategies-A short-term focus of “just getting your child to eat” can beget picky eating. Other less-than-ideal feeding strategies include controlling (force-feeding) or permissive (lack of structure and planning that leads to grazing and limited food variety).
• Food Availability-Children who have limited access to food due to finances or location are at risk for selective eating. 
• Neurodevelopmental Disorders-Disorders that impact the brain, like autism, ADHD, or PANS and PANDAS are highly associated with selective eating and can create a vicious cycle of food selectivity > nutrient deficiencies and growth concerns > poor brain development >more food selectivity 
• Sensory Processing Difficulties-Some kids enjoy a lot of sensory input from food (bright colors, crunchy foods, strong flavors), while others prefer minimal input (bland colors, soft foods, mild flavors). Some kids require a lot of sensory input in general and need extra physical activity prior to mealtime. Other sensory elements like mealtime lighting, music and seating comfort can impact mealtime behaviors too.
• Social Influence-Kids both young and old are influenced by people around them. If family or friends are eating (or not eating) certain foods, kids are more likely to eat (or not to eat them). Advertisements can cause even young kids to prefer highly processed foods, crowding out other essential foods like fruits and vegetables.

Strategies to Reduce Selective Eating

Determining the cause(s) of your child’s selective eating can help you to choose the best strategies to improve these habits. Because many children have more than one cause for their selective eating, they’ll often benefit from multiple solutions too!

1. Division of Responsibility– The parent determines “what,” “when” and “where” the child eats; and the child determines “whether” and “how much” to eat.
2. Mealtime Environment-Have your child seated at the table in a comfortable seat, able to see their plate, with their feet supported and their body squared with the table.
3. Table Talk-Focus on non-food topics when possible; encourage neutral food explorer questions when needed (i.e. “Does this food taste sweet or salty?”).
4. Parental Modeling-Model healthy, relaxed and balanced eating at mealtimes.
5. Sensory Appeal-Change the form, flavor or texture (roast, sauté, puree) ; cut into strips or use fun cookie cutter shapes; add favorite dip.
6. Food Chaining-Expand your child’s diet by linking preferred foods with similar, new foods (i.e. orange veggie stick > carrot stick).
7. Repeated Exposures-It can take kids an average of 10–25 exposures to new foods before they accept it, so keep trying!
8. Rotated Exposures-Because kids can tend to get “stuck” on favorite, familiar foods, offer a rotation of forms, brands and flavors over the course of a week to encourage variety.
9. Food Play-Try non-tasting experiences using food (i.e. painting with a celery stick).
10. Taste–Test-Create a fun, food experience outside of mealtime where a child is allowed to engage the 5 senses with a new food.
11. Opt for “Tasting” vs. “Eating”-Continue to create positive experiences around food that don’t involve swallowing, such as touching, smelling or licking.
12. Motivation/Incentives- Use with caution…offer praise about non-food behaviors at the table like good manners and sitting at the table. If needed, offer mild praise—no bribing, depriving or deceiving, and use non-food rewards when possible. In severe cases, it’s ideal to work with a behavior specialist to prevent a food/reward mindset.
13. Speech, Occupational and/or Behavioral Therapy-These therapies separately or in conjunction with each other can improve areas such as chewing, swallowing, feeding skills, texture desensitization and overall mealtime behavior issues.
14. Feeding Therapy- In-person therapy facilitated by speech and/or occupational therapists with hands-on feeding training can be utilized when the above methods have been exhausted.

Best Foods for Selective Eaters

Since each selective eater has their own preferences and avoidances, the “best foods” are very individualized. However, we do know that selective eaters often skimp on high protein foods and shy away from veggies.

High Protein Foods

Selective eater’s diets are often lacking in high protein foods and the vitamins and minerals that come with them. Protein is essential for childhood growth and development. High Protein Foods For Picky Eaters unpacks tricks and tips to increase protein in your child’s diet.

Veggies for Picky Eaters

Veggies are often the first food group to drop out of a selective diet. Their strong flavors and powerful smells can make them hard for kids to get excited about. Changing the shape or cooking method and adding dips are some of the best ways to increase acceptance.

Tips to add more veggies:

• Keep the Crunch-Kids who like crunchy foods are more likely to like raw or roasted veggies. They may even be apt to try the raw veggies as you’re slicing them up to cook. 
• Side Salads-Even selective eaters will often try salad, especially if it’s dressed up with croutons and a little ranch dressing. They’ll like it even better if it’s on your plate too!
• Dips-These can be great bridges to trying veggies. Ranch dressing, ketchup and melted cheese tend to be favorites. But even dips like applesauce, yogurt or BBQ sauce that might not “go” with the veggie de jour can still help to increase acceptance.
• Mix them in-If your child prefers softer textures, add in shredded carrots, zucchini, chopped mushrooms or onions to soups and meatballs. You can also toss spinach, kale or avocado into smoothies.
• Homemade Fries-French fries can get a bad rap, but making homemade oven-baked fries with regular or sweet potatoes can be a nutritious way to add in more veggies.
• Dress them up-Most kids get excited about food that looks fun…opt for ants on a log, veggie kabobs, or turn them into a silly face.
• Grow your own Garden-Whether you have space for a big garden or a small container, kids that see how food is grown are more likely to try it. You may even catch them sneaking a tomato or snap pea straight off the plant!

Lunch Box Ideas for Picky Eaters

Let’s face it…packing lunches can be tedious! It’s easy to fall into a rut of packing the same foods that you know your selective child will eat. Here are a few extra ideas to round out their lunchboxes and increase variety.

• Kid-Friendly Lunch Recipes
• Lunch Ideas for Picky Kids
• High Protein Meals for Picky Kids

One of the best ways to expand your child’s lunch box is by giving them both structure and autonomy. Download my free Lunch Packing Chart that fosters both! It includes a sample template and a blank template for you and your child to fill out together. 

Meal Prepping for Picky Eaters

Meal prepping for selective eaters doesn’t need to consist of chicken nuggets and macaroni and cheese on repeat, but it also doesn’t need to feel like a looming nightmare. Being intentional about what foods to add and repeating exposures to previously snubbed foods is key!

• Build balanced meals out of foods your child already enjoys. This may be as simple as adding roasted green beans to your chicken nugget and macaroni dinner.
• Create an intentional weekly plan that provides a blend of familiar and new foods, including foods from each food group. Check out Meal Planning for Busy Moms to help you get started.
• If your child’s diet is very limited and you don’t know where to begin, food chaining can be a helpful tool.
• When possible, offer 2 choices. Kid’s love autonomy, so instead of forcing them to try the broccoli, ask “would you rather have salad or broccoli?”
• Don’t be afraid to think outside the box! If your child loves crunchy foods, and won’t touch mashed potatoes, offer some raw, cubed (washed) potatoes instead.
• Offer colorful, nutrient-rich toppings! Kids love to add their own toppings and are more likely to eat something that they put on their plate. Turkey Taco Quinoa Skillet is a topping-friendly favorite. 
• Involve your kid(s) in meal planning and prepping! Invest in a kid’s cookbooks and let your kids choose and prep a recipe. Positive food experiences increase exposures to new foods and reduce selective eating over time.

Vitamins For Picky Eaters

Since chronic selective eating can lead to nutrient deficiencies, many children benefit from vitamin supplements. I most commonly recommend a high quality multivitamin and omega 3 supplement to support growth and brain development. Some children also benefit from fiber and probiotic supplements while they’re working on expanding their diet. There is no one-size-fits-all vitamin for selective eaters. This depends on their age, nutrient gaps and tolerated form (liquid, powder, chewable, capsule). 

Vitamin Cautions

When choosing vitamins or supplements for your child, keep the following cautions in mind:

• Gummies-Most children prefer gummies, but because they are sticky, I try to steer parents away from them. Any added sugars (even naturally occurring ones like honey) increase the risk of cavities.
• Mega Doses-Some vitamins contain very high amounts of B Vitamins, but keep in mind that more isn’t always better. Some children may experience side effects with high doses of B vitamins, so always monitor your child when starting a new supplement. High doses of fat soluble vitamins A, D, E and K can also be dangerous, and it’s best to avoid these unless supervised by a doctor or dietitian.
• Iron-Some children (especially those who eat a low animal protein diet) may have low iron stores. In these cases, it’s typically safe to offer a multivitamin that includes a low dose of iron (that doesn’t exceed the Recommended Dietary Allowance), but note that it can increase constipation and digestive distress. Avoid giving higher amounts of iron without proper testing, and be sure to store iron-containing supplements out of reach of children. Selective eaters that regularly include animal proteins likely don’t need iron.
• Third-Party Testing-Choose third-party tested supplements to ensure that they contain the nutrients specified on the label. This also ensures that they don’t contain contaminants like heavy metals.

Your registered dietitian can give you specific recommendations on the best supplements for your child.

Selective Eating in a Nutshell

So now you know the difference (or lack thereof) between fussy, picky and selective eaters! Don’t forget that ARFID and PFD are a little different and require more specialized treatment. Regardless of which category your selective eater falls into, remember this:

• Selective eating is very common. You can often treat it at home with intentional food parenting. But if it resembles ARFID or PFD or feels too overwhelming, it’s important to get outside help!
• There are many causes of selective eating. Understanding your child’s root cause(s) can help you create a better roadmap to success.
• Strategies to improve selective eating require an individualized rather than cookie cutter approach. Many children benefit from using a few different tactics.
• The most commonly snubbed foods are vegetables and high protein foods, and chronically avoiding these can lead to nutrient deficiencies. A dietitian can help you sort out the best foods and supplements for your child.
• Be realistic! Food neophobia is common in most children, so keep exposing your child(ren) to new foods, and don’t expect them like every food they try.

Need More Help?

Selective eating can be very draining and can impact the whole household. If you’ve tried a DIY approach and are still struggling, Food to Table Nutrition offers 1:1 services for selective eaters 🙂 

This is not a substitute for medical advice nor is it a suggested treatment plan. If your child has any medical conditions, please consult your medical provider before implementing these suggestions.