When is Picky Eating Too Picky?

09 16 14 Little Girl with Strawberry Milk_reducedBailey is an active 20-month-old toddler who ate well until two months ago when she became a “picky eater.” As a parent, you have provided balance and variety in her diet since you introduced her to solid foods, but now she’s refusing certain foods.

What if Bailey refuses anything new that is offered?

At this stage, toddlers are developing food preferences and exerting independence. It’s common for toddlers to refuse certain foods, especially the first time they are offered. A new food may need to be offered more than 20 times before it’s accepted. For parents, perseverance is essential.

 What if Bailey refuses carrots?

Fruits and vegetables provide fiber, vitamins, and other nutrients. Often toddlers will refuse certain foods from a group, but may eat others. Try reintroducing carrots down the line, but in the meantime focus on vegetables the child will eat. Toddlers need at least a cup of fruit and vegetables daily. 

What if Bailey refuses meats?

The protein group includes meats, fish, poultry, legumes, nuts, dairy and egg products. Becoming accustomed to meat textures is developmental and may vary in toddlers. Toddlers require 13-15 grams of protein daily. Toddlers who drink real dairy milk receive 8 grams of quality protein per glass, plus other nutrients such as calcium for optimal muscle and bone growth. If meat is a struggle, remember, yogurt, cheese, eggs and beans offer quality protein.

When should I get worried about Bailey?

Our goal is appropriate growth and development. Inadequate nutrition and selective eating can lead to malnutrition as well as over-nutrition. Abnormal changes in growth parameters, developmental lags, or abnormal lab values indicating nutritional disorders (such as iron deficiency or anemia) are all red flags.

Refusing to eat certain textures may be a developmental issue, but if it persists, it may signal problems with chewing or swallowing that require further investigation. Other eating patterns such as eating only foods of a specific color may indicate personal preferences, but can signal underlying behavioral problems and/or eating disorders and may require additional assessment and management. 

Parents eagerly anticipate the next developmental milestone or the next stage, whether it’s the first smile or the “terrific twos.” Remember that eating behavior typically follows patterns. If you have concerns about lagging growth or development, “picky eating” persists past toddlerhood, your child accepts fewer and fewer foods, or your toddler becomes anxious or fearful at mealtime, consider an evaluation with your child’s pediatrician.

Gerri A. Cannon-Smith MD, MPH, FAAP is a pediatrician with more than 25 years of practice and administrative experience. As the Public Health Committee Chair of the American Academy of Pediatrics, Mississippi Chapter, Cannon-Smith served as team lead for the chapter’s Be Our Voice Obesity Prevention Advocacy project.