There are many causes of picky (or selective) eating, ranging from it being a 'just a phase' that need not be a major concern, to a symptom of complex psychiatric issues needing long term specialist support and medical intervention. Between these two extremes there are so many other factors which can affect a child's relationship with food, for example: parenting approaches; how a child responds to sensory stimuli; personality and temperament. However, when problems are worrisome enough to persuade parents to come to my feeding clinic, one of the key characteristics which I see over and over again is anxiety.
In my experience, children who are anxious at meals are also anxious in other contexts. They are often naturally cautious and unsure about new experiences. Very anxious children often seem more emotionally sensitive than their peers, too. It makes sense to me that a child who clings to familiarity would be wary of new foods. It also makes sense that children who are emotionally sensitive may be more affected by social pressure to eat, or pressure from the adults around them.
Recent research at Duke University found that levels of anxiety were significantly higher in children who are selective eaters. So is this about cause or effect? One of the researchers explained ( in an interview for healthline) that this is not something they are ready to answer yet as they did not know quite enough to claim either that eating issues made anxiety worse, or that anxiety caused eating issues.
"We don't know if it's cause and effect. We're relatively certain there's a link" (Dr William Copeland, Duke University)
Other research (Harris & Booth, 1992) suggests that eating problems may be both caused by and cause anxiety, in a kind of vicious cycle.
When we experience anxiety, although it is an emotion, there are lots of things going on in our bodies making anxiety a very physical experience. Our hearts beats faster, our mouths go dry, we get butterflies in our stomach. These sensations are caused by the chemical processes associated with anxiety and they interrupt appetite. This makes sense if we consider that by sending us into anxiety mode, our bodies are preparing to run or fight; when you're escaping danger, having something to eat is the last thing your body wants.
Imagine if mealtimes send your child into a 'fight or flight ' anxious state. Eating will be really hard for them. I help parents manage this by giving them lots of tools and techniques to use. I've summarised some of the most effective tips for helping children who experience mealtime anxiety in a free guide (see below). The guide is split into things you can do before a meal, things you can do during the meal and things you can do away from the table. Most parents find that not only do these techniques help with food-related anxiety, they also help children more generally; as children grow in confidence and resilience, this spills over into other areas of life. Equally, as your child becomes less anxious at the table and learns to tolerate unfamiliar foods, this teaches them that going out of their comfort zone may not be catastrophic in other areas.
To help your child become less anxious in response to food, the first step is empathy. It can be hard to imagine why your little one gets into such a state at the thought of eating a small piece of carrot... but anxiety is very real; trying to imagine meals from your child's perspective lays the foundation for supporting them.
The next step is to skill your child up - to equip them to manage their anxiety and do everything you can to create an environment that is as un-anxiety-provoking as possible. With love and patience, you can make an enormous difference.