Picky, Picky, Picky


Why do toddlers play with their food?

Is it simply an annoying — and frustrating — rite of passage for a child? Or does it have deeper implications?

Recent headlines in Europe and a major study in Israel show that quirky early eating habits may have some serious roots with international ramifications.

Britain's Daily Mail reported recently that a child of 3 was among 600 pre-teens hospitalized for eating disorders since 2009 while the German magazine Der Spiegelreported on the complex case of a 3-year-old girl named Klara who weighs under 18 pounds and only eats in the presence of her grandmother.

Sabine Rohde, a consultant in child and adolescent psychiatry at the University Hospital Munich Schwabing, has been quoted as saying that diagnosing an eating disorder in a young child is "not so rare" and that children as young as 3 are being hospitalized with eating disorders.

Indeed, a recent study by researchers at Tel Aviv University suggests that food hypersensitivity in children — picky eating — could be an "early warning sign" of their developing an obsessive-compulsive disorder in adulthood.

In that study's findings, children who are hypersensitive to certain smells or sensations, but too young to be able to articulate what is bothering them, may develop ritualistic behaviors to "manage" their responses to their sensory discomfort.

This, in turn, could have adverse affects with how their nervous system processes sensory information.

Current research and accounts like the above are not only shifting unwarranted blame from parents, but also suggest there may be ways parents can proactively work with their children and well-chosen physicians and experts to find explanations and solutions.

Minneapolis psychologist and addiction specialist Brenda Schaeffer (www.brendaschaeffer.com) details several signs parents should look for beyond changes in eating habits themselves: Is there anything happening in a child's life that is different? Is the child seeking attention for some reason? Are the parents and child in a power struggle over food?

She also says any illness or diagnosis should be taken into account. "There are many ways to find the source of changes like this with minimal conflict," affirms Schaeffer. "Besides avoiding power struggles over food with your child, you should be inquisitive in your approach rather than angry."

From there, she advises consulting experts. Start with a thorough physical exam with a pediatrician knowledgeable in behavioral disorders. Next, check out hearing and vision.

If a physical cause is ruled out, she recommends a visit to a child psychologist to help rule out OCD, anxiety disorders, sexual or physical abuse, Asperger's, behavioral problems or the presence of family problems.

She also advises looking at outside relationships with babysitters, neighbors and extended family members

Dr. Ruth Frank of Philadelphia's Renfrew Center, one of the nation's first residential eating disorder treatment facilities, agrees a pediatrician is a good place for parents to start. However, once triggers of eating habits are pinpointed, she says a "team approach" for the family is an effective way to address the problem's many dimensions.

The team can include nutritionists and child psychologists as well as pediatricians and family therapists.

"Blame is counterproductive in any context, when a parent is exploring preventive intervention and proactive action," stresses Frank. "Taking responsibility is better than accepting the blame. Effective parenting involves maintaining an observing eye."

Schaeffer of Minneapolis further explains that if a physical or psychological problem is diagnosed, examining the family history to establish a biological basis for a problem can provide valuable insight.

If there is a trauma or emotional problem established, family therapy is recommended, she says. "If parents are in conflict, they should be mindful that the child is likely to be sensitive to it," Schaeffer adds.

"Have a conversation letting the child know that healthy conflict is OK, and that the child is in no way responsible for the parents' conflict."

"The tendency to figure out who's to blame is misguided," concurs Frank. "Children highlighted in the Tel Aviv study and European media accounts" may have other "problems that may not have been fully examined."

Bucks County's Barry Ginsberg, an applied developmental psychologist with more than 40 years of practice, questions the viability of assessing eating disorders for toddlers. "You may not want to make such a definitive diagnosis" for a patient that young "as you want to see how a child's personality and relationships with parents and other adults will grow and develop over time," he says.


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