The Basics - Lesson 2

Terminology and Why It Happens

I describe food refusal and picky eating as two separate things. Although you may hear similar strategies, picky eating or selective eating can be harder to manage. In food refusal phases, a child who is eating more may all of a sudden eat less. You may feel that they are picky, but they just truly aren’t hungry. This is very common as food intake needs change from infancy through the toddler years. At the 12 month visit, I often get families tell me how their child will eat ANYTHING and everything and I celebrate and encourage this. But, I also like to remind parents that around this very time; it is not unusual to see periods of food refusal or desires change. 

A child who has food refusal still eats various things when we look at the big picture, but they may be eating less than normal while still being content. They may refuse a food one day that they liked the other but may eventually come back to it.

After 14 months and closer to 2 years, toddlers can start to eat much less than they were as infants. “But Dr. they’re so active. How are they not hungry?” Their needs change and the toddler body’s growth trajectory slows down and thus they don’t need as many calories. As they move through the toddler years (18 months to around 4 years), you will see many periods of food refusal. We can also see volume fluctuations with other developmental surges. Sometimes when a child is learning new motor skills, their volume can fluctuate OR when they are taking in more vocabulary, we can see fluctuations. FLUCTUATIONS IN FOOD VOLUME ARE NORMAL.

We also can see periods of food refusal coincide with illness or teething where they refuse food or eat much less, which is common as well. It is during these phases that we do not want to create crutches that can lead to permanent behavioral issues with feeding; such as bribes, pressure, or becoming a short order cook. More to come about these. 

Another reason we may see food refusal that starts to borderline on picky or selective eating is a change in preferences and behavior. It may seem like overnight they are refusing foods they love. Remember, their taste buds and preferences are changing! They could have loved meat, but all of a sudden the texture makes them uneasy. They also may want to show control more, desire more autonomy, and are testing more boundaries to show what they want. 

Picky eating is when those periods of food refusal are more long term. A food refusal phase can last maybe 1-2 weeks, but then a child goes back to eating variety again. Think about it like this… Imagine your child refused eggs for a week, you stopped exposing for a bit, and then reintroduced it and they went back to eating it. Picky eating is different, a more long term issue where a child is refusing entire types of food, there are long-term battles at meal-times, they are unwilling to try much of any new food, and in more severe cases they are experiencing sensory issues or physical refusal of food such as a toddler who is gagging and vomiting.

I tend to like to stay away from the phrase picky eating when I discuss the issue with families (especially with a child present) because the term has created stigma. The stigma and label can create body-image issues and actually make picky eating worse. And it can become a self-fulfilling prophecy when parents label their children as picky: “OH he’s so picky. He won’t try it.” Kids will act how they hear us talk about them. So if we want to help our picky eaters, we want to avoid the stigmatizing terminology and instead say “He’s a curious eater” or “He’s figuring out what he likes and doesn’t like.” 

Although picky eating and food refusal can be a very normal phase, make sure to read my VERY  important handout on WHEN PICKY EATING IS A CONCERN in the resource library.