Understanding "Picky Eating": Developmental Phases and What to Do

Picky eating is a common phase for many children, but when should you worry? Picky eating is a form of typical child development however, understanding the signs of something more extreme requires professional evaluation and intervention. Experts like Dr. Ellyn Satter, Dr. Kay Toomey, and other researchers in the field of pediatric feeding challenges provide essential insights into distinguishing between normal picky eating and more concerning feeding difficulties, such as Pediatric Feeding Disorder (PFD) and Avoidant/Restrictive Food Intake Disorder (ARFID). Below is some information to help you determine whether seeking out professional insight and support is the next best step.

The Spectrum of "Picky Eating" to Problem Feeding

Dr. Kay Toomey, the creator of the Sequential Oral Sensory (SOS) Approach to Feeding, categorizes "picky eating" on a continuum from “typical” to “problematic.” Normal picky eating includes behaviors like:

• Preferring familiar foods but still accepting some variety

• Eating at least 30 different foods across various food groups

• Occasionally refusing foods but willing to retry them over time

• Growing and gaining weight appropriately

In contrast, more severe cases exhibit:

• Swallowing or chewing challenges leading to frequent coughing or gagging on foods and/or liquids

• Eating fewer than 20 foods with extreme resistance to trying new ones

• Strong emotional distress at mealtime (e.g., crying, gagging, tantrums)

• A tendency to drop foods from their diet without replacing them

• A preference for specific textures, colors, or brands of food

• Growth concerns, nutritional deficiencies, or weight stagnation

When Does Picky Eating Become a Concern?

There is no single definition of when picky eating becomes a concern, as each family's needs and expectations differ. Some families may find that even if their child does not meet the criteria for a severe feeding disorder, mealtime struggles are impacting their daily lives, creating stress, frustration, or power struggles. If feeding challenges are disrupting family dynamics, causing distress, or leading to avoidance of mealtimes, parents are encouraged to seek support—regardless of whether their child meets strict clinical criteria for intervention.

According to the American Speech-Language-Hearing Association (ASHA), red flags indicating the need for direct professional intervention with your infant/child include:

• Difficulty chewing, swallowing, or gagging on purees/foods/liquids

• Food refusal that persists for 2 years beyond the toddler years

• Anxiety or distress related to eating

• Strong sensory aversions to food textures, smells, or temperatures

• Dependence on specific preparation methods or brand-specific foods

• Falling below expected growth curves or experiencing weight loss, malnutrition

However, families do not need to wait until challenges become severe before seeking help. Early intervention can make a significant difference, preventing mealtime struggles from escalating into larger feeding difficulties. Consulting a feeding professional can provide reassurance, personalized strategies, and support to create a more peaceful and successful mealtime experience for the entire family. Investing in help early can be worthwhile in reducing long-term stress and frustration for both the child and their caregivers. To get support now, schedule a free 15-minute consulation with NEST’s feeding therapist now.

DISCLAIMER!!!! If your infant/toddler/child experiences persistent coughing or gagging when consuming any amount of liquids and/or solid foods (including purees) you should reach out to your pediatrician or specialist immediately and stop providing the problem food(s) to the child until an evaluation can be completed.

Moving Away from the "Picky Eater" Label

As a neuro-affirming practice, we would be remiss in not discussing the stigma around children and adults who experience challenges with eating and feeding. Thus, we feel it is essential to shift away from using judgement labels on children that include describing them as "picky", "stubborn," "manipulative," or "difficult" - words often associated with picky eating - and instead focus on understanding the underlying needs and challenges they face. Dr. Ross Greene’s philosophy—"Kids do well if they can"—highlights that children struggling with feeding challenges are not refusing food out of pure defiance but due to underlying challenges and potential gaps in their developmental abilities. Many children with feeding difficulties experience sensory processing challenges, oral-motor delays, anxiety, or negative past experiences with food that make eating an overwhelming task. By focusing on skill-building, reducing pressure, and providing a supportive and fun feeding environment, caregivers can foster a more positive and developmentally appropriate approach to eating.

Supporting Picky Eaters and Preventing Escalation

1. Follow the Division of Responsibility – Parents should focus on providing a variety of foods in a no-pressure environment while allowing the child to decide what and how much to eat.

2. Encourage Food Exploration – Let children engage with new foods through touch, smell, and play before expecting them to eat.

3. Limit Short-Order Cooking – Offer the same meal to the family with minor modifications to accommodate preferences while maintaining variety. Ensure there is at least one "safe food" on the table at all mealtimes.

4. Seek Professional Help When Needed – If feeding difficulties are persistent, a professional (speech-language pathologist, occupational therapist, dietitian, and/or psychologist) can provide family coaching and tailored strategies.

Final Thoughts

Picky eating is often a normal part of development, but for some children, it's persistence and severity can indicate a deeper issue requiring direct professional support. Consulting with a professional who specializes in pediatric feeding disorder can be a great starting point in understanding your child's specific needs and differences, your family dynamics, and whether or not moving forward with coaching or direct support for your child is warranted. To learn more or connect with one of NEST's pediatric feeding therapists, click here to set up a free 15-minute consultation.