Pathologising picky eating

Now I’m not normally one for the reactive blog post – I’m more of a ‘sleep on it and see how it reads in the morning’ kind of girl. BUT I’ve just read an article entitled  Is Picky Eating the Newest Eating Disorder? by Marcia Herrin and I couldn’t hold back…

What Dr Herrin is referring to is ARFID (avoidant / restrictive  food intake disorder). This is a diagnosis that can be found in the DSM-5, the manual that is used by clinicians to diagnose psychiatric disorders. If a child is diagnosed with ARFID, he will restrict his food intake to the extent that he suffers from a significant loss of weight and nutritional deficiency. Now I’m not questioning the existence of ARFID or the usefulness of this diagnosis. What am I suggesting is that it’s very unhelpful to suggest that picky eating in a healthy child should merit a psychiatric diagnosis.


Research shows that the majority of children whose parents consider that they have an eating problem will suffer no adverse consequences in terms of growth[i]. With EAF, the message to parents is clear – check your child’s weight and growth with a health professional. Once you have established that it’s normal, you can begin to relax a little. This is often the first step towards improving your child’s relationship with food.

In her article, Dr Herrin describes a little boy, Ben, whose paediatrician has advised that he is healthy and his growth is normal. However, Ben is very picky and mealtimes are stressful. Dr Herrin writes: ” It is possible that Ben has the newest eating disorder, Avoidant / Restrictive Food Intake Disorder (ARFID)”.

Locating the problem in the child

There is so much wrong with deciding that the child needs labelling, that  the problem is somehow innate, located in him alone. EAF is a systemic approach, in other words, the whole family is  involved in tackling picky eating because it  is a complex emotional and behavioural phenomenon. If you can understand that how parents react to picky eating is part of the problem, you can also see that parents are a valuable part of the solution. Yes, there are genetic differences in the way in which children react to food, but parents can make an enormous difference by understanding the emotional side of the issue. In Ben’s case, I would imagine that supporting his mother in working through her stress and anxiety at the table would be extremely helpful. Recommending that she “get[s] up to speed on ARFID” as Dr Herrin says she would probably do, will do little for Ben’s mother’s stress levels.

Picky eating is normal

Picky eating is a normal phase that many children go through. For some it’s more pronounced than for others and for a rare few, it is so extreme that their growth will become affected. For this minority, support from a medical professional will be vital. Confusing picky eating with these rare extremes is to medicalise a developmentally normal phenomenon.


EAF is all about checking your child is healthy then staying calm and understanding the emotional and behavioural side of picky eating. I would argue that suggesting healthy children merit psychiatric diagnoses provokes even more anxiety in parents. This could understandably drive them to put even more pressure on their children to eat, making picky eating worse.
So in answer to the question  ” Is picky eating the newest eating disorder?”  It’s a resounding “No!”

[i] C. Wright, K. Parkinson, D. Shipton & R. Drewett ( 2007) How Do Toddler Eating Problems Relate to Their Eating Behavior, Food Preferences, and Growth? Pediatrics, Vol. 120, No. 4, pp. 1069-1075

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