Tips for Parents: Questions and Answers About Food Selectivity

What is food selectivity?

Food selectivity is the consumption of an abnormally limited variety of food. Technically, any child who eats fewer foods than normal and who avoids any foods could be called food selective. However, we usually reserve this term for children who avoid one or more entire food groups.

The four food groups are:

1. cereals, grains, and starches
2. protein foods (meats, eggs, cheese, legumes)
3. fruits and vegetables
4. dairy products

What is the difference between a "picky" eater and a "selective" eater?

Children who are labeled "picky" are described that way because they eat a limited number of foods from each food group. However, they usually do eat at least one food from each food group and do have more balanced diets than selective eaters. Children who are labeled "selective" have aversions to many more foods or have unusual aversions. For example, selective eaters may avoid all cereals, all meats, all cold foods, all foods with red color, all crunchy foods, all fruits and vegetables, etc. Many food selective children we see eat no more than a few foods. A typical food selective diet might include pizza, chicken nuggets, milk, and nothing else.

What causes food selectivity?

Some common causes of food selectivity are:

• Difficult medical history that affected interest in or ability to eat
• Tendency toward digestive problems such as reflux
• Chronic constipation
• Altered or heightened sensory perceptions of food
• Sensory integration problems
• Certain medical or genetic conditions--for example, autism
• Medications--some can alter sense of taste or texture
• Inadvertent history of parental reinforcement of food selectivity behaviors

Are there any good groups that can be avoided without compromising health?

The one food group that can be avoided without nutritional risk is dairy products. The nutrients found in dairy products can be found in foods in the other three food groups, and from sunlight (for adequate vitamin D). However, a child who does not eat dairy products must eat a good variety of foods from the other three food groups in order to make up for lack of dairy products. She/he must also have a good source for vitamin D, either regular exposure to sunlight, a vitamin supplement, or a vitamin D enriched milk substitute.

There is no other food group that can be avoided without compromising health, but there are individual foods that can be avoided without compromising health. Meats, for example, can be avoided as long as there are other good sources of protein present in the diet. A child who does not eat fruits but does eat many vegetables may still receive adequate nutrition. A child who avoids bread but eats other cereals, grains, or starchy foods may still meet his carbohydrate needs.

So if my child avoids only dairy products she is not at nutritional risk--right?

Not necessarily! Your child is at risk unless s/he eats a significant variety and amount of foods, to make up for the nutrients found in dairy products.

If my child avoids any other food group besides dairy products, is he definitely at nutritional risk?
YES!!

How do you help a food selective child overcome her selectivity?

Food selectivity can be overcome through behavioral psychology strategies. First, we determine what foods and nutrients are missing from the diet. Then we develop a list of foods we would like the child to start eating. Then our behavioral psychologist determines what family behaviors and interactions reinforce the food selectivity and what behaviors and interactions might discourage the selectivity and encourage more food acceptance. Next a new food to introduce to the child is selected. The psychologist demonstrates the behaviors and interactions designed to encourage acceptance of the new food and then helps the parents model the same behavioral techniques.

How do you help a picky eater overcome his "pickiness?"

It takes patience and repetition to help picky eaters be less picky. Continue to offer the food. Try different presentations and recipes (raw versus cooked, plain versus casserole, etc). However, don't expect a child to eat foods you don't eat!

What about "bad" diets and "pickiness" in older children and teenagers?

For older children and teenagers, continue to make healthy foods available and encourage your child to eat properly. While teens especially may eat a lot of "junk" foods, studies have shown that when parents continue to model good eating behavior and healthy diets, and continue to make an effort to provide their teenagers with healthy foods, those teens eat significantly more fruits and vegetables and other "good" foods than their peers.

Does Food Selectivity Lead to Eating Disorders?

No. Their underlying causes are quite different. Treatment is also different. Young people with eating disorders (Anorexia nervosa or Bulimia nervosa) are obsessed with appearance and losing weight. They require extensive psychological help to redefine their self-images more positively and to acquire a sense of control over their lives. These individuals do not have a history of food selectivity prior to their developing Anorexia or Bulimia. They do not avoid food groups for any other reason than to reduce the calories or fat in their diets. They are "food selective" only in order to lose weight.

Weight and appearance have nothing to do with "true" food selectivity. Motivations for true food selectivity includes factors such as dislike or fear of certain foods or textures, and altered or heightened oral hypersensitivities. Food selectivity and food aversions usually start much earlier in life, when awareness of body image and appearance are not yet present. Thus treatment of food selectivity, as already mentioned, includes strategies to retrain children to respond to foods differently. Addressing issues of self-esteem, appearance, and body image in these children would not be effective.

Would you describe vegetarians as food selective?

Probably not but it would depend on the individual. An individual, who used to eat from all the food groups but now makes a philosophical decision to eliminate meat from his/her diet, is not food selective. A person who has always had an aversion to meat and becomes a vegetarian because of that might well be considered food selective. Would someone like this require treatment? Not unless she/he wanted to overcome his/her aversion.