What is the Difference Between a Picky Eater and a Problem Eater?

Picky eaters have a wide selection of foods (30 or greater) that they choose to eat, although they may be resistant when it comes to particular foods.  They may temporarily stop eating an accepted food, but after some time they will add that food back into their diet. Picky eaters do not usually have complicated medical conditions, but they may have reflux or mild sensory issues that contribute to their eating habits. 

Problem eaters have 20 or fewer foods in their diet.  Presenting problem eaters with new foods may lead to vomiting, gagging, or temper tantrums.  Children who are true problem eaters may not be able to tolerate the smell, sight, or feel of a new food without an adverse response.  They may reject entire food groups, refuse a food they have accepted for a long period of time, or have trouble accepting a once accepted food again.

While both picky eaters and problem eaters may cause stress for their parents and caregivers, problem eaters often have other health issues and diagnoses.  A team approach is the best course of action to rule out physiological variables that maybe causing food refusal.

Registered Dietitians are trained to evaluate whether your child is getting the right nutrition in his or her diet and a Gastrointerologist will determine if there are structural or allergen causes for food refusal.  Once physical reasons for food refusal have been ruled out, a consult with an Occupational Therapist or a Speech and Language Pathologist is the next step.  Occupational Therapists work with children to improve texture and oral motor issues, while Speech and Language Pathologists work with children to improve the oral motor, sensory sensitivities, and swallowing issues – all of which can lead to picky and problem eating.  In some instances, a psychology evaluation may also be needed to evaluate behaviors related to feeding.

In conclusion, food refusal issues in children can be complex with many different causative factors, but they can get better with proper attention and hard work.  If there is concern about your child’s eating habits, contact your child’s pediatrician to start the process in answering the question, “Is my child a picky eater or a problem eater?”