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Picky Eaters: When to Worry about Your Child’s Nutrition

Updated on May 26, 2016

Picky Eating or Health Problem?

A child who refuses all foods should be seen by a doctor, to rule out medical conditions that cause feeding problems.
A child who refuses all foods should be seen by a doctor, to rule out medical conditions that cause feeding problems. | Source

Normal Picky Eating vs. Feeding Disorder

Nearly every child goes through a phase of rejecting food, usually during the toddler years. Broccoli may be left untouched on the dinner plate, peas thrown at the wall, or a nose wrinkled in disgust at the sight of a healthy meal.

This phase is common and usually overcome with consistency and time, but sometimes “picky eating” is a sign of a medical or nutritional problem in a child. How can one tell if a child is merely going through a normal developmental stage or experiencing a health problem?

When Not to Worry about Feeding Problems

A two year old toddler will eat in fits and spurts – one day he may eat only a few handfuls of cereal, and the next day he may eat everything in sight! In general, don’t look at what a child eats in a single day, but over the course of time. If a toddler has an “off” day but eats well over the course of the week and is gaining weight well, this is usually typical pickiness common to all toddlers and preschoolers. If, however, that toddler only eats a handful of cereal all week, refuses all other food, and doesn’t gain (or even loses) weight, see a doctor immediately.

When a Child Doesn't Eat Enough

The author's son, at the age of two, would take a full day to eat a single cookie. He has reflux and delayed emptying that create feeding problems.
The author's son, at the age of two, would take a full day to eat a single cookie. He has reflux and delayed emptying that create feeding problems. | Source

Feeding Problems: A Poll

What type of feeding problem does your child have?

See results

Ten Signs of Feeding Problems in Children

The following signs indicate a feeding or health problem, and the child should be seen by a pediatrician or other physician for review:

1. Refuses all food: while picky eating involves a child who will eat their favorite, limited food items, it is not normal for a child to refuse to eat all types of solid food.

2. Gags or chokes on food: swallowing difficulties including gagging or choking should be immediately investigated by a physician or a feeding clinic.

3. Refuses all foods of a specific texture: some children have sensory processing difficulties and will only tolerate crunchy foods or soft foods, for example. A child who will only tolerate one food texture should be evaluated.

4. Vomits frequently: any child who regurgitates food should be reviewed by a physician.

5. Failure to thrive: if a child is not growing and gaining weight appropriately (maintaining their own percentile on growth charts), immediate review is necessary. Children who fall below the 5th percentile should also be reviewed and monitored.

6. Develops stomach bloating: if a child’s belly becomes distended and bloated after eating, a physician should be seen.

7. Will not allow a spoon to pass through the lips: some children have oral defensiveness, and will gag or vomit if an object passes (or even touches) their lips.

8. Cries or has behavior problems at mealtimes: while typical children will have tantrums at the table, a child who has a tantrum at every single meal or snack opportunity should be seen by a doctor.

9. Has constipation or frequent diarrhea: bowel problems can contribute to a lack of appetite and should be reviewed by the appropriate specialist.

10. The parent has a worry that is not being addressed: sometimes a parent’s intuition is the most powerful tool in existence. If you are concerned about your child’s growth or nutritional status, take them to the doctor.

Diagnostic Tests for Feeding Problems in Children

The author's son wears a pH monitoring device, to measure the amount of acid reflux in a 24 hour period. Acid reflux can contribute to eating problems in children.
The author's son wears a pH monitoring device, to measure the amount of acid reflux in a 24 hour period. Acid reflux can contribute to eating problems in children. | Source

Eosinophilic Esophagitis: One Cause of Feeding Problems in Children

Conditions that Cause a Poor Appetite in Children

There are many conditions that can cause children to eat poorly – and the cause for each child must be investigated by his or her doctor. The following is a list of some of the conditions that can cause a child’s appetite to wane:

· Acid Reflux: children who have reflux often refuse to eat food because they associate food with pain. Some children have frank reflux (vomiting) which contributes to weight loss, and others have “silent” reflux which has no outward symptoms, but causes pain with eating. Medication is generally helpful to children with this condition.

· Delayed Gastric Emptying: some children have stomachs that empty slowly, so they feel full too soon and don’t feel hunger. Medication and diet changes are sometimes helpful in managing this condition.

· Constipation: children who are chronically constipated may feel nauseated or have stomach pain, limiting the amount they eat.

· Food allergies: a child may have a food allergy, contributing to stomach pain and lack of appetite. Some children, for example, have a milk allergy that causes bloating and diarrhea. Eosinophilic Esophagitis is a condition where eosinophils (a type of white blood cell) attack the lining of the esophagus – this condition requires specialized care.

· Dysphagia: occasionally, a child may have difficulty swallowing. This condition is called dysphagia and must be evaluated by a physician promptly.

· Sensory Processing Disorder: some children are extremely averse to certain textures, smells, or tastes, causing them to severely limit the type of foods they are willing to eat.

Food Chaining Success Story

Feeding Clinic Success Story

Treatment for Feeding Problems in Children

Once a child has been identified with a true feeding problem, the next step is to find the underlying cause of the food refusal. A child will often be referred to a Gastrointestinal specialist (GI) and/or to a feeding clinic for evaluation and feeding therapy. Depending on the cause of the eating difficulties, a child may need medication, surgery, or supplemental nutrition while they are going through a feeding clinic program.

What does a feeding clinic do? They monitor the weight and growth of the child while helping children to explore and learn to eat different types of food. A child who has difficulty coordinating chewing and swallowing, for example, may be given a dissolvable food like cheese puffs under the close supervision of a speech-language pathologist and nursing staff. For children with texture issues, a technique called “food chaining” can help a child learn to accept a greater variety of foods.

The basic premise behind food chaining lies in identifying a food the child already accepts, and then expanding the child’s food repertoire based on that one food item. For example, say a child will only eat pretzels. With food chaining, a food with similar characteristics is found: hard breadsticks may serve as the first food following pretzels. If the child accepts eating the crunchy breadsticks, soft bread may be tried. This technique allows for a gradual widening of the child’s accepted food items.

A feeding clinic will help a family set up a routine and diet that works for a specific child. They may encourage a family to allow the child to “play” with his or her food – painting with pudding and applesauce may be a recommended activity. Smearing a favorite taste on a child’s cheek is one technique to encourage a child to learn to use his or her tongue (the child will try to lick the flavor off his chin and cheeks).

Sometimes, a feeding clinic cannot help a child eat enough to gain weight. This is often the case with complicated, significant medical issues. In these cases, supplemental nutrition is generally required.

Supplemental Nutrition

Supplemental feeding through a g-tube may be used to help children with medical conditions maintain weight and grow.
Supplemental feeding through a g-tube may be used to help children with medical conditions maintain weight and grow. | Source

Supplemental Nutrition for Children with Feeding Problems

For children with complex medical needs, metabolic disorders, or severe gastric motility problems, supplemental nutrition is often needed. Sometimes the supplemental nourishment can be provided orally, but some children will require enteral nutrition through the use of a gastrostomy tube (g-tube). A g-tube is generally only placed for children who cannot take in enough food to grow and develop appropriately. Children who receive g-tubes will be monitored closely by a physician, have frequent weight checks, and may attend a feeding clinic on a regular basis.

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    • leahlefler profile image
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      Leah Lefler 2 years ago from Western New York

      Our child has a medical problem that makes eating difficult - it is important to separate "normal" picky toddler eating from medical issues in children. Our pediatrician was unable to make the distinction and our child was very ill by the time we obtained the appropriate help (he was 29 pounds at the age of 5 years).

    • peachpurple profile image

      peachy 2 years ago from Home Sweet Home

      so sorry to hear your boy has eating problem. Must be very frustrating for you

    • leahlefler profile image
      Author

      Leah Lefler 4 years ago from Western New York

      Thank you, Stellar Phoenix Review. My son has gastroparesis and severe reflux (treated with a surgery called a Nissen Fundoplication) and receives formula through a g-tube to maintain a normal growth rate. I hope other parents recognize the signs of true feeding disorders vs. "picky eating."

    • profile image

      Stellar Phoenix Review 4 years ago

      This content is spectacular! You most certainly know how to keep a reader sustained. Between your wit and your awesome content, I was almost moved to start my own blog (well, almost..lol.) Wonderful job. I really enjoyed what you had to say, and more than that, how you presented it. Too cool! Stellar Phoenix Review

    • leahlefler profile image
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      Leah Lefler 5 years ago from Western New York

      Espero que tus ninos son bien, Cambita.

      Es tan difícil cuando los niños no pueden comer o no puede crecer.

    • leahlefler profile image
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      Leah Lefler 5 years ago from Western New York

      CassyLu1981, picky eating can definitely be a difficult situation even when children are "typical" in their fussiness. It is important to recognize the signs of a real feeding problem so that help can be obtained for kids who are truly struggling!

    • leahlefler profile image
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      Leah Lefler 5 years ago from Western New York

      iefox5, it is vital to catch true feeding disorders when a child is very young, as the longer growth is affected the worse the long term consequences. I hope this article will help parents recognize the warning signs to a true feeding disorder (as opposed to typical picky eating)!

    • leahlefler profile image
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      Leah Lefler 5 years ago from Western New York

      Kdubarryo3, I am glad I helped in some way - as most children are simply picky eaters and have no underlying disorder. The biggest red flag is when a child doesn't follow their own growth curve over time - most children are able to thrive despite a slightly picky diet.

    • leahlefler profile image
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      Leah Lefler 5 years ago from Western New York

      Mary615, teenage-hood presents its own set of difficulties, with the presence of junk food and vending machines on school campuses! I hope your kids learn to prefer wholesome food as they venture into adulthood!

    • leahlefler profile image
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      Leah Lefler 5 years ago from Western New York

      Thanks for the compliments on the photos, rebeccamealey - my son has struggled with eating for quite some time. ABA is extremely helpful for children with sensory processing disorders or autism, and the food texture aversions can be very serious in some children. Fortunately our son is not aversive to textures, but simply cannot take in enough volume to sustain growth. He will eat, but cannot eat enough quantity - food chaining is not helpful in our situation, but does help others. Finding a high quality feeding clinic is vital for children, to assess the cause of the growth failure and to address the underlying issues.

    • leahlefler profile image
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      Leah Lefler 5 years ago from Western New York

      DzyMsLizzy, feeding tubes are definitely difficult for parents and children - the photo above is of my son's tummy (he had one placed after fundoplication surgery and we are starting supplemental feeds this coming month). The failure to thrive diagnosis can be very frightening, as many only associate the term with neglect and abuse - there are many "organic" failure to thrive cases where the child simply cannot eat due to an underlying medical condition. It is a terrible place to be. We follow the same "blue plate special" rules at home, particularly for my healthy six year old. Nolan presents his own special set of circumstances, as his digestive system does not work as it should.

    • leahlefler profile image
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      Leah Lefler 5 years ago from Western New York

      StephanieBCrosby, it can be a very lonely feeling to work with your child on something as simple as eating. It is an activity most parents take for granted - there are many support groups out there (I recommend the special needs parenting board parent2parent for those with complex medical issues or related facebook pages for parents seeking support - they have been immensely helpful to us).

    • leahlefler profile image
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      Leah Lefler 5 years ago from Western New York

      I am glad it was helpful for you, dbuddhika. I hope this article reaches those who really need help with their children's feeding issues.

    • leahlefler profile image
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      Leah Lefler 5 years ago from Western New York

      I hope you never experience a true feeding problem with your children, Momster - they are horrible and a very challenging situation for families. We are starting supplemental feeds for our almost-five year old this month, and there is a feeling of failure associated with a parent who cannot feed their child enough in the typical way. Our six year old is a piece of cake compared to our little one - and we never take that ease of eating for granted!

    • leahlefler profile image
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      Leah Lefler 5 years ago from Western New York

      That is interesting, Cardelean. Nolan would only do liquids as a young toddler due to the reflux - the liquid was soothing and he refused to swallow solid food. After a while, he became dysphagic and could not swallow properly - fortunately medication helped Nolan at first, but many times pediatricians pass off real warning signs as "normal," when they are an indicator of something more serious at play.

    • leahlefler profile image
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      Leah Lefler 5 years ago from Western New York

      Some kids are certainly pickier than others, healthylife - I feel sorry for my own parents as I was a terrible eater as a young child. Thankfully kids who are typical picky eaters often outgrow the issue!

    • leahlefler profile image
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      Leah Lefler 5 years ago from Western New York

      ComfortB, I hope your children learn to love their veggies soon - my six year old has no medical issues and still turns his nose up at everything from green beans to peas - gotta love those picky eaters!

    • leahlefler profile image
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      Leah Lefler 5 years ago from Western New York

      Your Cousins - I am glad they finally realized that your great nephew had a reason behind his 'pickiness.' It is so important for parents and doctors to recognize the signs of a real feeding disorder in children, as opposed to typical "picky eating."

    • leahlefler profile image
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      Leah Lefler 5 years ago from Western New York

      Kelley Ward, I hope your daughter learns to eat more textures with time. Picky eating is a normal developmental phase for toddlers and preschoolers, and most children will expand their palates over time.

    • leahlefler profile image
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      Leah Lefler 5 years ago from Western New York

      ChaplinSpeaks, sensory integration disorder can seriously impact what children will eat - sometimes it results in failure to thrive and other times it results in overfeeding. Feeding clinics are spectacular at addressing these issues in some kids (other kids have a far harder time, depending on the severity of the sensory issues). I hope your son learns to accept new textures over time!

    • leahlefler profile image
      Author

      Leah Lefler 5 years ago from Western New York

      Laura Schneider, my heart breaks for you (and your parents). We went through a similar situation with our Nolan - we were told that we were simply too lenient with milk and that was why our son wouldn't eat. Of course, he has a medical cause behind his troubles and our pediatrician caused him harm by ignoring it. I am so glad your parents followed up with an allergist and found the true reason behind your inability to eat and grow!

    • leahlefler profile image
      Author

      Leah Lefler 5 years ago from Western New York

      Very true, Made- picky eating is fairly typical in young children and if they are maintaining their growth curves there is no worry - kids who lose weight or become stunted in height are a concern, but most kids go through periods where they eat less and periods where they eat more. As long as they are growing, there is nothing to worry about!

    • leahlefler profile image
      Author

      Leah Lefler 5 years ago from Western New York

      Thanks, chamilj, I hope it helps others!

    • leahlefler profile image
      Author

      Leah Lefler 5 years ago from Western New York

      pstraubie48, I am glad your nephew is being evaluated for the cause behind his weight struggles. Our son Nolan was failure to thrive for over a year before we could find a doctor to help us, as our pediatrician kept passing it off - he was only 19 pounds at the age of 2 years due to a combination of acid reflux and delayed emptying. I hope they can find the cause and help your little nephew grow and thrive!

    • profile image

      Cambita 5 years ago

      muy buena informacion me gusta la web la voy a recomendar en facebook

    • CassyLu1981 profile image

      CassyLu1981 5 years ago from Spring Lake, NC

      Hub of the day! Congrats, it's a great topic for sure! My kids are super picky eaters. Lots of great information in this hub :) Voted up and shared!

    • iefox5 profile image

      iefox5 5 years ago

      Consider your child's nutrition as early as possible to ensure a healthy baby.

    • profile image

      KDuBarry03 5 years ago

      Congrats on HOTD! This hub is definitely very informative and insightful. When I was reading this, I definitely realized that my nephew is a picky eater, no disorders. I wish all the luck and best for any parent with a child with an eating disorder!

    • mary615 profile image

      Mary Hyatt 5 years ago from Florida

      Congrats on HOTD! This is a very informative and interesting Hub. My children were never picky eaters when they were small, but when they became teenagers they were a problem by not eatng the right foods. They preferred junk food!

      I voted this Hub UP, etc.etc.

    • rebeccamealey profile image

      Rebecca Mealey 5 years ago from Northeastern Georgia, USA

      Very interesting and informative article here, that I know is certain to help many parents as it floats around in cyberspace for years! Such good content, and your pics are too cute!

      I love the chaining idea with the pretzels and bread sticks. I was a special ed teacher for 9 years, and the chaining technique is a part of applied behavior analysis. Great , super, fantastic job!

    • DzyMsLizzy profile image

      Liz Elias 5 years ago from Oakley, CA

      Congrats on HOTD!

      This is scary stuff. I winced at the photo of the stomach tube. What a horrible thing for a child to have to endure!

      Luckily, my kids had no such problems, and I was able to deal with 'normal pickiness,' by simply advising them, "Well, that's what there is to eat until the next meal. Eat it or go without." We were not made of money, and I wasn't about to set the (hard to undo) precedent of playing short-order cook. (No one ever died from missing a meal.)

      However, the really scary side of this issue happened to some friends of ours. Their youngest was the tiniest little thing, and skinny as a rail with no "baby fat" even at a year old. UNfortunately, because they were highly visible (out of work/forced to be on welfare and county medical), the pediatrician was an idiot, and when he diagnosed "failure to thrive," CPS pounced and took away ALL 3 of their kids! They were devastated.

      It was the foster mom who suspected there was a medical issue, and took the child at her own expense to her doctor, where they indeed found the root of the problem, and got it treated. It took an entire year and a half for the system to grind through the process and give the kids back to their parents.

      Great, informative article and well researched. Voted up, interesting and useful.

    • StephanieBCrosby profile image

      Stephanie Bradberry 5 years ago from New Jersey

      First and foremost, congratulations on your Hub of the Day.

      I think this is a fabulous article for parents. It should be read by new parents, parents to be, and parents that are experiencing any of the issues mentioned here. Even if one has found a way to handle picky eater situations or something more serious, it is still to read a bit about related topics so the parent does not feel alone or like he or she is doing something incorrectly.

      Thanks for the great writing!

    • dbuddhika profile image

      dbuddhika 5 years ago

      Very helpful information and Thanks for sharing this great information.

      Congrats on Hub of the Day.

    • momster profile image

      momster 5 years ago

      Very helpful information. Great job on your writing and visuals. I did not realize there were so many eating disorders. I have never had issues with any of my children and their eating habits. Thanks for sharing this great information. Congrats on Hub of the Day.

    • cardelean profile image

      cardelean 5 years ago from Michigan

      Congrats on your HOTD! You have some really important information for parents in this hub. Although I didn't have any real problems with my kids eating, we had some friends years ago whose son would only 'drink' to eat. They were constantly feeding him pediasure type of drinks. When I asked them what the dr. said about it, they told me that they can't find anything wrong, he was three at the time. I always thought that he had some sort of sensory issue. We have lost touch with them over the years but I still wonder what ever became of his eating. Great job Leah!

    • healthylife2 profile image

      Healthy Life 5 years ago from Connecticut, USA

      Great information letting people know when it's important to worry. My younger son was always a picky eater. Congratulations on Hub of the Day!

    • ComfortB profile image

      Comfort Babatola 5 years ago from Bonaire, GA, USA

      Wow, don't even know what to say. You've packed so much useful information into this hub. Though all I have is a child who whines all the time about eating his veggies, I sure learned some new things here. Thanks, and congrats on the HOTD award!

    • Your Cousins profile image

      Your Cousins 5 years ago from Atlanta, GA

      My great nephew would only eat white-colored foods and his favorite was French Fries. Everyone kept trying to get him to eat other foods but he wasn't interested. He was later diagnosed with Autism. I learned a lot from your HOTD. Thanks.

    • profile image

      kelleyward 5 years ago

      Great article. Congrats on the HOTD! My youngest was an extremely picky eater but lately he is trying new foods. Thanks for writing this. Take care, Kelley

    • ChaplinSpeaks profile image

      Sarah Johnson 5 years ago from Charleston, South Carolina

      Wonderful hub for an important issue! My son has sensory integration disorder and only eats dry crunchy food, though we have managed to get in a few other things. The problem we have, though, is him being heavy. So a battle in a different way. I had not heard of the feeding clinic. I plan to try the food chaining which you mentioned. Thanks, and awesome job for Hub of the Day!

    • Laura Schneider profile image

      Laura Schneider 5 years ago from Minneapolis-St. Paul, Minnesota, USA

      If only my parents had had this article when I was young! I wasn't diagnosed until I was 6, by an allergist, but it turns out that I am allergic to an enzyme in all plants. Cooking (at a high enough temperature and for a long-enough time--i.e. not stir-fry) breaks down this enzyme. So while I would eat foods that had been cooked, I disliked any quantities of raw apple, carrot sticks, celery, etc. I would throw a tantrum from even a small touch of the food, which covered the signs of a potentially dangerous allergic reaction: bright red face, very red and enlarged lips and tongue, red eyes, strange breathing...

      In short, your article might have educated my parents and the pediatrician to prevent some of the trauma I went through or even saved my life if they had followed the pediatrician's advice to "make" me eat frest fruits and vegetables because they were "necessary", which I think most people believe.

      Thank you for writing this important article; you'll probably save more than one life with it.

      Also, congratulations on Hub of the Day! It is well-deserved, and if you don't mind I will become a follower of yours. Voted up, shared.

    • Made profile image

      Madeleine Salin 5 years ago from Finland

      Congrats on the HOTD! This is a very well written and important hub. I have two children myself (4 and 6). There are periods when they eat less, but I don't need to worry about it. They always eat much when they are really hungry and need to "catch up".

    • chamilj profile image

      chamilj 5 years ago from Sri Lanka

      Truly important information. Thanks!

    • pstraubie48 profile image

      Patricia Scott 5 years ago from sunny Florida

      Very important information has been shared here. What to watch for and be aware of as our children make decisions about food is vital. My nephew is currently being evaluated by doctors because he often will eat little food and has lost weight. He has been monitored for a few months. The weight loss has fluctuated during these few months due to lack of intake and increasing digestive discomfort. Thankfully the doctors are on top of it.

      At first my niece thought he was just a picky eater but quickly realized that was not the case.

      Thank you for sharing this information and congratulations on hub of the day.

    • leahlefler profile image
      Author

      Leah Lefler 5 years ago from Western New York

      It is true, Simone - the vast majorities of "picky eaters" are simply normal toddlers who wax and wane with their appetites. It is good for parents to know the warning signs of true feeding problems which can signal a medical problem, but most kids who are choosy are just displaying regular toddler development. It is always anxiety invoking to any mother, though!

    • Simone Smith profile image

      Simone Haruko Smith 5 years ago from San Francisco

      I was a terribly picky eater when I was little- and would definitely go through those periods of eating almost nothing to eating a lot. My pediatrician described those periods of eating as "tanking up". Thanks for sharing the sound explanations and advice. My mother would have really appreciated this Hub back when she was dealing with my younger self!

    • leahlefler profile image
      Author

      Leah Lefler 5 years ago from Western New York

      We (unfortunately) have a lot of insight into feeding issues. Our son is considered organic failure to thrive, which means there is a medical problem causing eating and growth difficulties. It takes a great deal of work to get him to grow - we had him up to the 20th percentile at one point, but now he has fallen off the growth charts again. It is really important to get a prompt investigation for children who refuse food, because there is often a medical condition underlying total food refusal.

    • Om Paramapoonya profile image

      Om Paramapoonya 5 years ago

      Wow, you obviously have great insight on this issue. I agree parents should observe their kids' eating habits closely, and learn whether the kids are just being picky or having a more serious problem. A feeding disorder is such a crucial issue because it can affect children's health in so many ways. Thanks for this wonderful hub.