What to Expect, When to Worry, What to Try
By Liz Regalia
If the sight of anything colorful on your kid’s plate has ever sparked a full-on meltdown, you’re in good company. Picky eating is one of the most common worries parents bring to pediatricians, and research published in Frontiers in Pediatrics estimates that roughly 20% to 50% of young children show picky-eating behaviors that concern their parents.
Picky Eating and Mealtime Concerns
Still, picky eating is widely misunderstood, explains pediatrician Dr. Jenny Nordby, MD, of MUSC Children’s Health on Daniel Island.
“The biggest thing that parents get wrong about picky eating is that it’s abnormal,” she says. “It’s often very age-appropriate, especially after year one when they usually have a decrease in appetite.”
So, when is picky eating just a phase, and when is it time to call the doctor? Here’s how to tell, plus tips for getting more nourishing food on your child’s plate.
UNDERSTANDING PICKY EATING
Picky eating usually involves strong food preferences, a small appetite or an unwillingness to try new foods. There’s no formal medical definition, but the behavior often peaks in toddlerhood and preschool for a few reasons.
Around 18 months, growth slows, and appetite naturally dips, Dr. Nordby explains. At the same time, toddlers constantly encounter new textures, sights, and sounds.
“We actually don’t appreciate how much toddlers have to assimilate on a daily basis,” she says. “Some kids will simply say ‘no’ to new foods because they are taking in more than they are ready for.” Cue the cravings for comfort foods like crackers, pasta and chicken nuggets. Some research also suggests that avoiding new foods is a built-in survival instinct. A cautious toddler is less likely to eat something unfamiliar or unsafe. “We want toddlers to learn discernment and to stay away from new things that could be dangerous,” Dr. Nordby says.
It’s also normal for kids to suddenly reject foods they once loved, said Dr. Kelli E. Johnston, DO, founder of Angel Oak Pediatrics on Johns Island. “Children’s preferences change as they become more aware of tastes, textures, and their ability to make choices.”
The good news: for most kids, pickiness is a phase.
“By school age, many children gradually become more flexible, particularly with repeated exposure and opportunities to try foods in different settings,” Dr. Johnston says.
SIGNS IT’S MORE THAN A PHASE
If your child gags, chokes, or has difficulty swallowing while eating, especially when a particular texture triggers it, schedule an appointment with your child’s primary care doctor as soon as possible. They can assess issues like sensory integration, weight loss, dehydration, and nutritional deficiencies.
“I start by looking at the child’s growth pattern over time, reviewing a typical day or several days of eating, and asking about which foods they accept and refuse,” Dr. Johnston says.
She also asks about avoided textures, colors, or food groups, any history of choking or painful eating, and what mealtimes look like at home.
When it comes to deficiencies, her biggest concern is iron, especially for kids who eat little meat or other iron-rich foods. But she doesn’t recommend extensive bloodwork for every picky eater. “Some children benefit from a basic multivitamin, while others need more targeted supplementation or evaluation,” she says.
And while sensory sensitivities can contribute to food avoidance, not every picky eater has a sensory processing problem.
“It’s important to understand why a child is avoiding foods before deciding which intervention will be most helpful,” Dr. Johnston says.
TIPS FOR NOURISHING PICKY EATERS
According to the Mayo Clinic, kids need the same nutrients adults do, including vitamins, minerals, carbohydrates, protein, and fat, just in different amounts. So, it’s understandable to worry when your child refuses nutrient-rich foods.
Start by rethinking what a balanced diet means. Dr. Johnston suggests looking at what your child eats over a week rather than a single day.
“Our goal isn’t to make every meal nutritionally perfect. It’s to help children develop a healthy relationship with food over time,” she said.
Repeated exposure to food helps, and it doesn’t always mean eating. Letting kids wash vegetables, stir ingredients, or simply see something new on the table can all count.
At meals, Dr. Nordby recommends pairing an average-size portion of a food your child accepts with a small amount of something new.
“They’re less likely to throw the unwanted food across the room or push the plate away if they see something they want alongside it,” she said.
Dr. Nordby also encourages parents to model the behavior they want to see by eating together and serving everyone the same meal.
“A lot of times people will assume a child won’t like things like salmon or Brussels sprouts, but that’s not always the case,” she says.
Above all, don’t read a temporary refusal as a permanent dislike. Keep offering the food occasionally, without pressure or “clean-plate” rules.
“Remember that feeding is a relationship, not a battle,” Dr. Johnston says. “Children are much more likely to develop curiosity and confidence around food when mealtimes feel safe, predictable, and enjoyable.”
The Mayo Clinic suggests snack time combine carbohydrate, fat and protein. Some examples include:
• Crackers and peanut butter.
• An apple and a cheese stick.
• Yogurt with fruit.
• A trail mix of nuts and dried fruit.
Tip: If you can, have children sit at the table or a designated spot when they have a snack or meal. This helps make eating more intentional.
