In my clinical practice, I specialize in treating children with selective eating disorder (aka Avoidant/Restrictive Food Intake Disorder). In a recent post, I addressed the question of whether picky eating is harmful. The short answer was "yes:" prolonged picky eating compromises a child's nutrition, inhibits their ability to eat like their peers at social and school events, and generally makes mealtimes a battleground (harmful to family harmony, not to mention parental sanity).
The following are my recommendations to help your picky eater. They are probably most appropriate for kids aged 5 to 10, the age group that I generally treat. The list assumes that you have already seen a physician to rule out any medical cause for the picky eating, such as swallowing difficulties or gastro-intestinal problems.
Believe that your child is capable of eating just about any food. That extreme distress he displays whenever there's pressure to try a new or nonpreferred food? It is not the result of a physical or psychological incapability. Rather, it is the result of years of avoidance. A basic rule of the brain is this: The longer something is avoided, the more distressing and impossible it seems. This goes for just about anything, from completing a big homework assignment, to starting a complicated project at work, to calling someone up and asking for a date. It's also true for a food.
What's needed, then, is repeated exposure to foods until your child habituates to them. Habituation is just a fancy word for "learned safety" or "the brain gets used to it." Research has shown that young children need an average of 8 to 15 exposures to habituate to and accept a new food. Unfortunately, how many times do most parents offer a food before deciding their child will never like it? Just 3-5.
For the picky eater, exposure means tasting and swallowing the food. It does not, in this case, mean merely having the food on the plate, looking at it, touching it, or smelling it.
Establish a consistent pattern, such as requiring your child to taste and swallow a new or nonpreferred food each night at dinner. Start with very small bites and then work up to larger and larger amounts as your child gets over the initial days of distress and comes to accept that a nightly "challenge food" is just another dreary fact of daily life.
Many desperate parents have tried telling their children that they can't leave the table until they have eaten a nonpreferred food. In my experience, this leads to a child who sits at the table for hours, whining loudly and often. My recommendation is to require that he eats that nightly challenge food within the first 5 minutes of a meal. Go ahead and set a timer. The 5-minute rule means he gets it over with right at the start of the meal and then everybody can relax.
Reward successes and mostly ignore failures. He eats the nightly challenge food = lots of praise and access to rewards/privileges. He doesn't = "No screentime for the rest of the night, but I know you can do it tomorrow" said once, with sincerity and optimism.
Don't worry about rewarding or restricting privileges based on eating: There are no credible, converging lines of scientific evidence that doing so causes eating disorders or self-esteem problems. Think about it: parents require their children do things they don't want to do for their own good all the time (teeth brushing, taking a bath, getting homework done). That's called good parenting. Why should it be any different when it comes to insisting your child eat a varied and healthful diet?
Remember, this will not happen overnight. It will not happen over many nights. It will happen over many months – so be patient. With enough successful exposures, your child will eventually habituate to enough foods that his diet is greatly expanded and mealtimes are a peaceful experience for everyone.