True confession: I used to roll my eyes at parents that fed their picky eaters Pediasure (a nutritional shake for kids) or gave in to their desires for comfort foods. But last month I broke down and bought a case of Pediasure for my 7-year-old extreme picky eater. I’m a pediatrician– I never thought I’d have a kid that just wouldn’t eat healthy food. But I do.
I always believed that if kids were hungry enough they would eat healthy food. I’ve preached that if you just limit sugar and junk food, kids will learn to eat well. I’ve advocated for family meals and written articles on how to get kids to eat well at school. And all this has worked for four of my five children. But my 7-year-old has humbled me.
I’ve been a pediatrician for more than a decade, but I had never heard of avoidant/restrictive food intake disorder (ARFID, also known as selective eating disorder or SED) until my own child developed it. Kids with ARFID are extreme picky eaters– the kind that will go months eating only a few favorite foods, or go 24 hours between meals to avoid things they don’t like. Many extreme picky eaters have other disorders such as autism, anxiety disorders or GI issues. Our son did have multiple food allergies as a toddler, but he has grown out of them all now. He is otherwise healthy, happy, and does well academically. Until he has to eat something other than pizza, sweets or sugary cereal… then the crying and whining starts.
When I first introduced solid foods to him as an infant, he refused vegetables but gobbled up fruit. When he was 2-years-old, he would cry through every family meal and refuse to eat anything other than a few comfort foods, usually high in carbohydrates, fat and sugar. “It’s a stage,” we thought. “He’ll grow out of it if we just keep offering healthy food, limiting sugar and modeling healthy eating habits.”
But he never grew out of it.
At age 7 he is still refusing rice, pasta, vegetables, lunch meats and most home-cooked meals. He won’t even eat macaroni and cheese. He eats tons of breakfast cereal in the morning and will go 24 hours without any more food just to avoid eating the family meals our other kids eat joyfully. By mid-afternoon he’s grumpy and angry. Discipline never fixes it. We knew the problem– he needed to eat. And so I finally broke down and bought him Pediasure. He drank a bottle and his attitude changed in minutes.
Finally, there is peace in our house. All it took was the humility to recognize that my child is sick with an eating disorder, not stubborn or spoiled.
ARFID is an eating disorder that, if untreated, can persist into adulthood. There are many options for treatment, but none includes using dessert to bribe kids to eat veggies, talking about starving kids in other countries, or insisting that a child try one bite of everything served.
If you have an extreme picky eater, it’s time to stop the mealtime battles and seek treatment. Start by speaking with your pediatrician, but if your pediatrician isn’t familiar with ARFID, make an appointment for a feeding evaluation by a team of health care providers that specialize in children’s eating disorders. At St. Louis Children’s Hospital, feeding evaluations are performed by a multidisciplinary team usually consisting of a speech-language pathologist and an occupational therapist. Evaluations may also include a consultation or referral to a dietitian, psychologist, lactation consultant, social worker, or other specialist. For more information on feeding evaluations at St. Louis Children’s Hospital, see this link.
I also recommend two websites with associated Facebook groups, where parents of kids with ARFID can find guidance. The first is Mealtime Hostage, a blog written by a mother of a child with ARFID. The second is Extreme Picky Eating, a website by a physician and a speech therapist who specialize in ARFID.
As for my son, he now has the option to drink Pediasure Sidekick at each meal to supplement the food he is willing to eat. It’s a slow journey, but now that the stress of eating is gone he’s already started to experiment with new foods.
We wish you success on your journey with your extreme picky eater.