Picky Eater

1. Epidemiology
   1. Incidence: Up to 50% of those under 2 years
2. Physiology
   1. Aversion to trying new foods is part of normal development
      1. One of many signs that child is exercising their autonomy
   2. Significantly restricted diet (limited to a few foods) may however result in adverse effects
      1. High carbohydrate, highly sweetened foods may replace more nutritionally adequate diet
      2. Galloway (2003) J Am Diet Assoc 103(6): 692-8 [PubMed]
3. Risk Factors
   1. Autism Spectrum Disorders
4. Management
   1. Review growth charts to confirm no Growth Delay
      1. Typically the normal growth charts are reassuring to parents
      2. Supplements and Vitamins are not needed and risk Overdose
   2. Children are wary of new foods
      1. May take exposure to a food up to 10 times before they accept it
      2. Avoid punishment or reward as this may exacerbate the problem
         1. Birch (2001) Pediatr Clin North Am 48(4): 893-907 [PubMed]
      3. Offer a wide variety of healthy foods at each meal
         1. Child decides which foods and how much to eat
         2. Those items not eaten may be re-served as leftovers
      4. Older siblings who eat a broader variety of foods may be a good influence (modeling)
      5. Combine foods in fun ways
      6. Limit milk to 24 ounces daily in toddlers
      7. Limit juice to 6 ounces per day
5. References
   1. Cathey (2004) Pediatr Nurs 30(2): 101-7 [PubMed]
   2. Nasir (2015) Am Fam Physician 92(4): 274-8 [PubMed]