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Practical strategies to help the picky eater

At the 2022 AAP National Conference & Exhibition, a look at picky eating among adolescents, and reviewing key behavioral and nutritional strategies for improving eating behaviors.

As Jennifer Carlson, MD, Stanford University School of Medicine, division of Adolescent Medicine, Palo Alto, California, explained, “There is a spectrum of eating disorders,” including the DSM-5 list of anorexia nervosa; unspecified/other specified feeding and eating disorders; and avoidant restrictive food intake disorder (ARFID). For all these disorders, there are practical solutions to help transition the adolescent into more healthful eating behaviors.

Why do adolescents and teenagers develop eating disorders? Carlson explained that the intense fear of gaining weight, even when the child is already at a significantly low weight, and body image distortion (disturbance in self-perceived weight or shape, and persistent lack of recognition of the seriousness of current low body weight) often lead to the restriction of food intake. With ARFID, the failure to meet nutritional/energy needs is often associated with significant weight loss and nutritional deficiency, dependence on enteral feeding or oral nutritional supplements, and marked interference with psychosocial functioning.

Assessments are key here to determine the patient’s diagnosis:
--Is there an underlying organic disease? (Consider inflammatory bowel disease, thyroid disease, cancer)

--Are there already serious medical complications (Consider vital sign instability, electrolyte abnormalities, nutritional deficiencies

--Is it safe to continue evaluation in an outpatient setting or is immediate hospitalization required?

In addition, the clinician should take a thorough growth and eating history as well as family, social, and psychiatric history, along with a comprehensive physical exam and lab tests.

Management of picky eating and adolescents with ARFID include bringing in a dietician to “feed the patient the best that we can,” by increasing, normalizing and diversifying food intake, and help guide parents on presenting food with sufficient nutrition for every meal and snack. Additionally occupational therapists can evaluate normal eating and functional activity, and can collaborate on a feeding plan, while also developing a behavior modification plan.

A back-up nutrition plan should also be in place (ie, liquid supplements, homemade milkshakes), and organic strategies to help with nausea and fullness include acupressure points, aromatherapy and abdominal breathing.

Reference
Carlson J. Making sense of sensitive tastebuds: practical approaches to picky eaters. 2022 AAP National Conference & Exhibition. October 11, 2022. Anaheim, California.