Expert Why Children Go Through a Selective Food Phase

My son was a really picky eater, so finding favourites was always a time for celebration and warranted a trip to the supermarket to stock up. He would eat these foods with gusto for a week, and then, just like that, refuse to touch them again. Papino stands out as a good example. He ate it as a snack for a week at the age of two and I don’t think he ate it again until he was five years old.

Although this can be extremely frustrating for parents, please keep in mind that it is usually part of normal development, which we would call developmental food selectivity. This is very different to a clinical feeding difficulty. Let’s take a look at what is common for most children and when you should worry.

Developmental food selectivity:

Between 18 months and around four years old, it is very common for children to go through food selectivity, and there are well-recognised reasons for this. Your child is not being difficult; he or she is learning:

1. To test boundaries – You will see this in relation to clothing as well. He or she is making sense of the world and wanting to take control. Food and dressing are spaces where a child can experience independence and decision-making. While the negotiations can be exhausting, some level of choice is great for developing your child’s skills.
2. Food jags – This sounds a little like a rock band, but actually refers to a stage where a child fixates on a particular food, wants it at every meal, and then suddenly refuses it altogether. It can last for a few days or even weeks. This typically occurs because a child has a need for sensory consistency, is adjusting to different textures of food or wants to control what they eat. Much like my papino example.
3. Neophobia – Since children in our age group, 18-months to 4 years, are learning about the world, becoming aware of stranger danger and figuring out what is scary and what is safe, they naturally turn this wariness towards food. Familiar and unfamiliar foods may be rejected. It is part of evolution and is intended to protect a child from ingesting potentially dangerous substances. Of course, you are not feeding your child poisonous food, but their little instincts are telling them otherwise when they are suspicious of the items on their plate.

Clinical feeding difficulty

By clinical, we mean that it is not just a phase, but rather a situation which may require intervention. You may need to consult a healthcare professional.  

Clinical feeding difficulties look different to developmental selectivity. Here are some of the things that are important to understand when considering a clinical/medical concern around food:

1. The child has always had a limited variety of food, but this is now getting smaller. Your child should eat a minimum of twenty foods by 18 months. In fact, the ideal is 100 foods by 1 year. If the list is getting shorter, then you need to have this assessed. It may be a sensory issue or a feeding disorder.
2. Ongoing distress around mealtimes is not improving. Here, we are not referring to a simple dislike or refusal of food but real stress at the dinner table. The child may gag at the sight of food and display signs of anxiety. This cannot be ignored as it will definitely impact the child’s nutritional and mental wellbeing.
3. If a child has entire food groups missing. Every food group, including protein, grains, dairy, vegetables and fruit, plays a vital role in the health of a child. If one of these groups is omitted, there will be a lack of nutrients. Even if your child appears to eat enough food, getting this food from each food group is essential for normal growth and development.
4. The child’s weight or height is dropping across the percentiles on the growth chart. Each time a child goes for a check-up, the healthcare provider will weigh and measure the child and plot the growth in the child’s road-to-health book. If there is a downward trend over a period of time, your child needs to be investigated. Issues such as a failure to thrive, reflux, allergies or chronic illnesses need to be excluded.
5. A child who does not improve their eating over time. There are a number of skills required for eating. This includes chewing and swallowing. If a child is struggling to move from smooth food to lumps or to eat independently, he or she may need help to move to the next phase. Eating is part of development. A child who can’t chew and swallow may not be using their tongue correctly. This will affect speech. Do you see the trend? Your child may have a mechanical problem. Eating is a milestone, much like speaking and walking. It is important that this milestone is also achieved.

How do I handle these selective food phases?

If your child is developing normally, following a normal growth curve and eating a balanced diet over a period of 5 days, then I would suggest the following to help your child move through this phase:

1. Be patient and follow regular routines.
2. Offer a variety of foods with different textures, colours and smells.
3. If your child doesn’t want to eat what is on the plate, try to get them to at least touch or smell it.
4. Model eating a variety of fruit, vegetables, proteins and grains yourself.
5. Make sure mealtimes are a positive, social event.
6. Monitor your anxiety. A child will associate the food with your anxiety rather than their behaviour. If Mom or Dad get irritated every time a plate of food comes out, then the child will see the food as the problem.
7. Don’t force the child to eat. This can be extremely traumatic for them.
8. Don’t keep offering multiple options. Offer what is for dinner. Include all the elements on the plate. Allow the child to pick and choose after smelling and touching, but don’t keep inventing alternatives. The child will learn that this is a game and that they can command the entire family. Remember “testing the boundaries”?

Conclusion

When I discuss the introduction of solids with parents, I do explain that it is a major step for both parents and child. We talk about allowing the child to experience the food. This would include watching other people eat, smelling food, squishing and squashing it and then putting it in the mouth even before they learn to chew and swallow. In reality, eating involves 30 coordinated steps. If some of the steps go wrong or are omitted, the child may struggle with eating. Seek help if you are concerned. Being conscious of the skills needed for eating will help you to establish whether your child is just in a phase or if you have a real problem. You need to remain calm and make your child feel safe enough to learn about new foods, textures, colours and temperatures. I know it is hard and extremely frustrating when you just want them to try.  Pick your battles. Perhaps get your child just to touch or smell the food. Next time, they may be willing to give it a lick and so we proceed. Just as with any new skill, the idea is for you to get your child to master eating and for your family to enjoy mealtimes. It is likely a phase; if not, help is available to you.

References:

• https://pmc.ncbi.nlm.nih.gov/articles/PMC12736178/
• https://pmc.ncbi.nlm.nih.gov/articles/PMC3474391/
• https://pmc.ncbi.nlm.nih.gov/articles/PMC9002550/
• https://equip.health/articles/understanding-eds/equip-academy-picky-eating-arfid-selective-eating
• https://pmc.ncbi.nlm.nih.gov/articles/PMC11547883/