Dr. Bernadette C. Benitez - Picky Eater – A Pediatrician’s Point of View

Although there is no universally accepted definition,¹ a ‘picky eater’ is generally characterised as a child who eats slowly, eats very little and/or a limited number of foods, shows a lack of interest in eating, exhibits strong food preferences, and demonstrates food neophobia – a strong dislike of new foods.²

Picky eating is a common feeding behaviour among toddlers and young children. In the US, a study has reported that 50% of toddlers (aged 19‒24 months) were perceived by their caregivers as picky eaters.³ Likewise, in Singapore, picky eating appears to be commonly reported: 49.2% of children (aged 1‒10 years) were reported by their caregivers to exhibit picky eating behaviours “all the time” or “sometimes”.⁴
 

Risks associated with picky eating

Children with picky eating behaviours are at risk of having inadequate dietary intake of essential micronutrients because they generally consume insufficient servings of important food groups, particularly fruits and vegetables as well as meat and meat alternatives.⁵ Picky eaters tend to have lower consumption of total fat, energy and protein,⁵ and are twice as likely to be underweight compared with children who were never reported to have picky eating behaviours [Figure 1].² Apart from its effect on physical development, picky eating behaviours may also impact cognitive development; children who were picky eaters or had infantile anorexia were found to have statistically significantly lower mental development index scores compared with healthy eaters [Figure 2].⁶
 

Figure 1. Increased risk of underweight (BMI below 10th percentile on US CDC growth charts) among children with picky eating behaviours.² Adapted from Dubois L, et al. (2007).

Figure 2. Picky eating behaviours may contribute to lower mental development index scores.⁶ Adapted from Chatoor I, et al. (2004).
 

Approaches to managing picky eating

When managing a child with feeding difficulties, it is paramount to identify ‘red flags’ indicative of serious threats to the child, screen for oral motor dysfunction, eliminate aversive feeding practices and stabilize the child’s nutrient intake.⁷ The child should be closely monitored for growth faltering, and if eating behaviours do not improve, strategies that target specific eating behaviours and parental feeding styles should be recommended. In severe or resistant cases, referral to specialists or interdisciplinary feeding teams is advised.⁷

In the management of picky eating, behaviour modification/nutrition counselling goes hand-in-hand with nutritional supplementation to improve the nutrient intake, dietary habits and nutritional status of the child. Nutrition counselling helps shape positive feeding practices and healthful food choices, while nutritional supplementation helps fill in nutritional gaps in picky eaters’ diets while the picky eating behaviour is being corrected. Apart from helping provide a more balanced foundation, nutritional supplementation provides a good source of essential vitamins and minerals, as well as calories and macronutrients, such as fats and proteins, which are especially important for children who demonstrate growth faltering.
 

Summary

Picky eaters tend to have inadequate nutrient intakes, which may potentially lead to dietary insufficiencies, growth faltering and suboptimal mental development. In combination with nutritional counselling, nutritional supplementation can help fill in nutritional gaps in picky eaters’ diets.
 

References

1. Taylor CM, et al. Nutrients. 2019 Apr;11(4):807.
2. Dubois L, et al. Int J Behav Nutr Phys Act. 2007 Apr 4;4:9.
3. Carruth BR, et al. J Am Diet Assoc. 2004 Jan;104(1 Suppl 1):s57-64.
4. Goh DY, Jacob A. Asia Pac Fam Med. 2012 Jul 20;11(1):5.
5. Dubois L, et al. Eur J Clin Nutr. 2007 Aug;61(7):846-55.
6. Chatoor I, et al. Pediatrics. 2004 May;113(5):e440-7.
7. Milano K, et al. Curr Gastroenterol Rep. 2019 Aug 23;21(10):51.