Almost 10 year old very selective eating

My son is almost 10 and has been very selective with his eating since he started eating. He eats enough food and variety that he is healthy, but he seems to almost have a fear of trying new foods. His preferences are so specific that he needs a food item to be from a specific restaurant or has to be an exact variety or he won't eat it. For instance there are a few items from Trader Joes that have been on the list of foods he'll eat, but then TJ changed their supplier on those items and now they are different and that becomes two fewer food choices we have for our son because it is so hard to get him to add anything new to his diet.  Sometimes I feel hopeful because he's open to trying almost any candy item. That shows to me a willingness to try new foods and that he is not completely closed off, but of course I don't want to let him eat much candy.  He sometimes actually gags on food he is uncomfortable with if he does somehow try it. He seems very sensitive to food textures, although I don't see that sensitivity in other areas like clothing etc. He does not seem to have any food allergies.  It is very difficult to travel with him as he often cannot find a single thing he is willing to try from a restaurant menu.  He does not like to go to a friend's house over a meal time.  When he was younger I thought he would grow out of this pattern, but it seems to have stayed the same or gotten worse if anything and I fear what may happen as he goes into adolescence if nothing changes. He is open to therapy in this area.  I'm looking for recommendations for therapists who specialize in this kind of thing who people have had success with. I'm also wondering if anyone has a child like this who grew out of it or if you did something that helped the child.  Thank you. 

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If he is willing, there is a great book "First Bite: How We Learn to Eat" by Bee Wilson about this subject. it is written for adults but may be good to read and chat with him about. in terms of the mechanics of learning to tolerate and then like new food, I think that the classic is Kay Toomey's 32 steps to eating, example at: https://www.ieccwa.org/uploads/IECC2015/HANDOUTS/KEY_2874632/StepsToEati.... It does take work and persistence but there is good potential for change in almost anyone willing to look at the problem. My child who refused for many many years to even try many many different types of food now eats almost everything (after many years of persistently and gently offering on the plate every day/week). 

We had a very similar-sounding experience with our older daughter, now 20.  Not just that her diet also was very selective, but the gagging and sensitivity to food textures and the limitations on eating other places than home.  (She also seems to have a very keen sense of smell; she would freak out if someone peeled an orange in her general vicinity.)  We didn't do any therapy around eating, though we talked about it.

Things finally changed -- significantly -- when she went away to college.  I don't know exactly what did it, but she came home with a notably (shockingly, to those who know her well) expanded dietary range.  She's still not as well-rounded as the rest of the family, food-wise, but we have a lot more options in what we can cook and where we can eat out.  She even managed to find sufficient sustenance to survive a summer in Moscow.  If your son remains healthy, and patience is an option for you, waiting it out may pay off.

Have you ever heard of ARFID? (Avoidant/Restrictive Food Intake Disorder). Children are often picky eaters but it does sound like you are concerned about how your son limits what he’s willing to eat. It might be helpful to have him assessed for that. ARFID is something that a person experiences as physical and psychological discomfort over smells, textures and tastes. I just was reading about this recently and I think it might be helpful for you to explore it. Obviously your child isn’t doing this intentionally and it is causing him distress. There definitely are things that can be helpful if this is the case. I don’t know the resources in this area. You could start by talking to his pediatrician and asking for a referral. Hopefully another parent on this forum has some experience with this. Good luck.

I wonder if he's a super taster? I've met people that have this, and most foods are overwhelmingly flavored. I think it has to do with the number of taste buds on your tongue, and could be something you inspect at home or in a pediatrician's office. It's an innate trait, so not something you can change, but understanding if there is a physical source for his food preferences could possibly help you and your son navigate things in a more informed way. Unfortunately, if you or your Dr. has judgements about the situation, however you try to hide them from him, it could be making things unintentionally worse. Janet Lansbury talks a lot about this kind of thing for infants/toddlers/preschoolers, but many of her RIE approaches apply to older children as well. Also, this is not therapy, but a possible idea... Have you heard of the book French Kids Eat Everything? The author had a lot of fear of foods, and so did her kids, until they moved to France where her husband is from. It seems they had a pretty drastic and unpleasant transition to eating everything, but the author is humorous about it, and it's an entertaining and light read. 

My heart goes out you, this is indeed a challenging situation. My son is now 20 years old and continues to be so selective that it is difficult for him to eat outside of the home. The impacts on his social life and self-esteem are significant. In adolescence, his eating became so selective and restrictive that it began to impact his physical health (primarily chronically underweight with related problems and insufficient nutrient profile). I had noticed impacts on his behaviors related to his eating habits starting in preschool.

A number of years ago, my son was diagnosed by the Stanford Eating Disorders clinic with Avoidant Restrictive Food Intake Disorder (AFRID). This is a little understood disorder that is very different from other eating disorders (for example, body image is not an issue and it often begins in childhood). It was added to the DSM latest addition. It is believed to be related to anxiety. Unlike typical picky eating in childhood, it does not go away. Rather it increases in intensity as the person ages. 

I wish I had professionals to refer you to, but I do not. Nothing and no-one we tried has been effective. That said, perhaps more is known about ARFID now and you will get better results than I have. I'm grateful you're taking the situation seriously. Talk about it with your son's pediatrician and proceed with calm and compassion. The biggest mistake I made was allowing mealtimes to become unbearably stressful for everyone in the family when even simple things like serving the wrong brand of pasta (Who knew ARFID kids can tell the difference in brands of plain old white pasta?) could result in anger and frustration.

I wish you a circle of support and compassion. Take care.

If you haven't already checked out his site, I recommend you (and your son, other family members) take a look.  If there's another parent in the picture, be sure you're all on the same page.   https://yourkidstable.com/my-teenager-refuses-to-eat-what-i-cook/

Please read about ARFID; there are a lot of ARFID cases that sound like what you describe--such narrow food choices that if one tiny bit is different, then the possibilities get even fewer. Also try looking at aroundthedinnertable.org, which is an online parent forum for kids with eating disorders. A lot of parents on that forum will have kids who are in much worse shape, but there are some ARFID parents there who can give great advice. Also UCSF has a program for eating disorders, and Stanford too. ARFID is different, though, than most EDs, so it is worth getting specialized care.

My daughter is younger but very similar issues. We got a referral from our pediatrician for in-person feeding therapy at Oakland Children's hospital (we chose it bc it was covered by insurance, there are other options available including ppl who can come to your home). We only had 3 appointments before the pandemic hit (our last appt. was on March 10, 2020), but even just that was incredibly helpful. I could not recommend it more, it was an incredible source of stress for our family. The therapist had us bring "safe" and new foods and worked together with my kid. The appointments gave us tools to use at home and also helped to rule out physical issues. I am sure its' a bit different for an older child but if he is showing willingness to do therapy that is absolutely fantastic. I would recommend therapy and not waiting to see if they grow out of it -- I don't think my daughter would have (to be sure, she is still very picky but willing to try new stuff and no longer goes into full stress mode at the sight of new food. It is a work in progress and we may return to therapy at some point. 

I can sympathize, our 14 y/o is very similar. He only likes miso soup from ONE restaurant, will only eat a certain variety of mango, etc. Like your son, he will also try any kind of candy or sweet, doesn't each much at friends and is reluctant at restaurants.

His sibling is the complete opposite and will taste and eat most everything. I don't know the answer, I assume he will grow out of it too, just not yet. Ours will drink green juice and eat some veggies, though is not a fan of meat in general. I'm curious to hear other responses but wanted you to know you are not alone! As long as they are getting a diet rich in fruits and vegetables with protein thrown in I don't worry too much.

Hi, I've been there with my child, now 18 and dxd with ASD at 18. Does your child have any other sensory sensitivities? Sounds, smells, crowds etc? My child did and does but the food issues were the most prominent. If it's a phobia then CBT therapy should help. If it doesn't or he has other issues I'd recommend a neuropsych to find out what the whole picture is. I really wish we had done that when my son was much younger. Now that we know he is autistic we accommodate his food preferences. He has gotten better about trying a few new things but mostly sticks to the things he likes from restaurants he likes or that we can make at home. When traveling we do have to find restaurants with things he will eat. It used to drive me bonkers but now I realize it is part of who he is and not something I can change. My neurotypical kid was also somewhat picky when younger, though not to this extent and he outgrew it. Good luck and it's good he eats a range of healthy foods. 

I'm not really tackling picky eating right now, although it's still an issue. Somethings I've learned while attending to it: Sensory issues are a big part of picky eating and you don't need to be sensorily reactive in other areas to have it orally. But the cool thing is sensory actvities in other areas can help with the sensory aspect of picky eating. So rice and bean bins, essential oil sniffing, play dough, texture experimentation are going to be contextually helpful. There is a facebook group for parents of picky eaters run by OTs called "Real Help for Picky Eaters" with access to free and also paid webinars and parent support and helpful infographics and links. Because tongue tie is one of our issues, I know that an under recognized cause of picky eating (texture, gag, swallow) is posterior tongue tie. Virginia Downing, an Oakland Oral Myofunctional Therapist evaluates for ties, as do pediatric dentists. The Bay Area is a little short on those who work with older children, Downing will have a current list.

Hi! Sorry you are dealing with this. I’m an SLP and feeding specialist and I know how challenging picky eating can be!! I am not practicing with patients right now, but would love to give you some resources. 
 

I’d recommend the book Helping Your Child with Extreme Picky eating by Jenny Mcglothlin and Katja Rowell, as well as any info from the Ellyn Satter Institute (ellynsatterinstitute.org).
 

When looking for a feeding therapist, you’d probably want to find someone who is SOS (Sequential Oral Sensory) trained - could be speech therapist or occupational therapist feeding specialist. I believe they have some providers listed on their website as well as further info about sensory feeding issues (sosapproachtofeeding.com) - that is Kay Toomey’s method mentioned by another poster.

My son is about to turn 9, and we are in an identical situation. We are also embarking on thinking about therapy for him, although our son sounds less willing than yours to go to therapy, which is an issue in itself. We are actually really struggling to find a therapist. Those that know of or specialize in ARFID are either full or don't treat children as young as our son. But we are continuing our search. Please get in touch with me if you just want someone to chat with who is in the same boat.

I want to add that I was also an extremely choosy eater throughout my childhood - not as extreme as my son, but still pretty limited in what I ate. I am now a person who eats pretty much anything and everything. Things changed for me when, at age 23, I lived by myself for the first time and chose/prepared my own food. I slowly learned that I actually do like many foods that I had been averse to as a child. In hindsight, I can see that the thing that set me back, literally for decades, was all the attention my food choices got. It is so toxic and so awful the way so many people think they are entitled to comment on others' food preferences. ("You don't like pizza?! Are you crazy?" "Why don't you want ketchup on your French fries?" "You've never had sushi??") I got so, so much negative attention from peers, adults, and family members throughout my entire childhood. When I was very young, it felt totally nonsensical to me, because my food aversions did not at all feel like something I was in control of. Asking me why I didn't like pizza was like asking me why my eyes were brown. That's just the way things were. It wasn't a choice. So here's my PSA for anyone reading this: stop commenting on what children eat. Just leave them to it.

I suggest getting him evaluated by an ENT specialist. The son of a good friend was very much like your son, even around the same age. Ends up there was something physical that caused him to have an extremely sensitive gag reflex. I do not recall exactly what was suggested, it might of been removing his unusually large adenoids but I do recall the other option was to wait and see if he grew in to them. They did the later and as he went through growth spurts in middle school became less and less picky about food. The ENT doctor they saw was at Children's Hospital and he said that the difference after removing the adenoids was remarkable. 

I know how stressful these situations can be! I don't have therapy suggestions, but I found this dietitian on instagram (https://kidseatincolor.com/), she has very approachable tips, and I registered for her "Better Bites" program, an online workshop that aims to help kids broaden their diet (My 5 yo is a moderately picky eater, with some sensory issues). I've found the workshop helpful so far with lots of tips-- enough that you can adopt the things that might work for YOUR kid and family. It has also been helpful to ME, as I realize the focus and stress I've placed placed on eating, which is not helping things. It has also connected me with a facebook group of compassionate families in similar situations, which is comforting and helpful, with lots of ideas are shared there. Best of luck to you! 

My 16yo son has recently been diagnosed with ARFID. My son went from very picky eater around your son's age to alarmingly picky around the beginning of shelter in place. From my research, what doctor's know about ARFID is that there are several different types. My son has a natural low interest in food, compounded by ADD and also severe food allergies, which has caused his brain to send danger signals around food. Stressful times in life, i.e. pandemic, my cancer diagnosis (cancer-free now!) have sent his restrictive eating off the deep end. Kind of like a PTSD around eating which is magnified during anxiety producing times. Due to the pandemic, it has been very difficult to find therapy and we are still looking for a therapist. However, knowing the diagnosis and having language to talk about the issue has helped us immensely. Good luck!

I highly recommend Nikki at Child's Play in Lafayette. We saw her with my 9-yo daughter recently and after just a few sessions we came away with such useful tips. We've been seeing lots of different child specialists for a variety of different issues lately, and out of everyone we've met/worked with so far Nikki was far and away my favorite. She takes a really great approach to working with the sensory experience of food - I can't say enough good things about how she approaches all of this; she shared that she's highly trained with eating OT and it shows. Also just want to say I think you're doing the right thing by getting help now - my sister had similar challenges growing up, and back then there wasn't the same awareness or access to resources - the doctors always just told my mom she was "picky" and would grow out of it, and it's been much harder addressing it as an adult. Now is the time and you're on the right track. It could be useful to work with a therapist for a bit (maybe DBT/CBT) to deal with the anxiety piece too.

Seriously Nikki is awesome - if our schedule weren't already so full with other treatments I would take my daughter to her weekly, but we got some useful info in a short time and may go back later when our schedule allows. She's got a great personality, and very easy to work with. Wishing you and your son all the best!

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