[Ed. Note: a more recent blog on this subject can be found here).

There is a little talked-about pediatric eating disorder that I have not covered extensively in my blogs, nor is it covered well in most discussions elsewhere, including the various iterations of the DSM.  As a general pediatrician, like all other pediatricians, I ran into it, but it wasn’t until I read Dr. Rachel Bryant-Waugh and Dr. Bryan Lask’s  Eating Disorders: A Parents' Guide  years ago, that I was introduced to a more systematic discussion of this fairly common derangement of “normal” eating, referred to as “selective eating”. Since then I have seen many such patients.

I am not aware of any good epidemiology, but my experience has been that selective eating runs in families and is often seen in males.  And while it is not fatal nor necessarily accompanied by other psychological difficulties, it does cause a lot of parental anguish and by extension, childhood misery.

Ok.  So what is selective eating?  SE is a condition present since earliest childhood where a child eats only a very narrow range of foods and refuses all others and yet where linear growth is normal.  Such children are not amenable to persuasion; neither bribes, punishments, “gold stars” nor being left at the table “until they finish their food” helps in the slightest.  Parents of selective eaters report regularly having tried all these things and more—often to appease grandparents—to no avail. These children would literally prefer to starve than eat food outside their range.

And what a range it is!  Typically their favored foods are things diabolically designed to make parents feel bad about offering them:  Cheetos, chocolate syrup in a particular kind of milk, smooth (hydrogenated) peanut butter, chicken nuggets from McDonald's only, white bread of a particularly anti-nutritious type...  mostly starches and sugars and fats.  Rarely will such a child eat just any old white bread or any old peanut butter—no, it has to be from a certain place and cannot be altered or improved in any way.  Can you imagine how frustrating this is for the parents?  They see their pediatrician, they are told the child is normal and will grow out of it.  

Well…. normal, yes.  Grow out of it, unlikely.  Selective eaters may “burn out” on certain foods they formerly favored and find new (equally appalling) substitutes, but they usually enter adulthood able to eat only a very narrow range, becoming that husband (or less commonly, wife) who only eats “white things, plain and unembellished”—no green vegetables, only corn, no fruit, etc.  And they function perfectly well.  And I do mean well.  Warren Buffet is a famous selective eater and he is more than successful, thank you very much.

The overwhelming majority of selective eaters are never referred to a pediatric eating disorder doctor like me, but a few are.  The critical information on any such child is contained in their growth chart.  If that is fine, there simply is not a problem.  God knows why these children are able to grow so well and become so smart on Cheetos, chocolate milk and chicken nuggets, but they are.  Off the top of my head, I do not recall an obese or even overweight selective eater, and provided they are not hounded into a feeling of inferiority and “bad behavior” because of their eating habits, they are otherwise fine children, perhaps a little neo-phobic (fear of change and new things) in general, but definitely not mentally ill.

But the parents’ distress is real.  We are hard-wired to feel bad if we cannot nourish our children well.  Mothers in particular come under fire from well-meaning advice givers: “take away his iPad until he eats something good for him” or

“just make her sit there, she’ll eat when she gets hungry enough”.  Oh no she/he won’t. Absolutely not.  And this is not a failure of parenting nor a failure of caring.  So, one of the first things I do when I see such a child and review the (almost invariably) normal growth chart, is complement the parents on what a good job they have done taking care of their child.  And they have.

At the risk of having to be quite graphic, I need to leave those of you who believe such children can “branch out” if they “have to”, with this thought: what would it take to convince you to eat dog excrement?  See what I mean?  Likely if you were forced to, you would gag and vomit—exactly what many of these children do when presented with food outside their range. How likely would you be to “change your mind” about this delicacy, no matter who else ate it and found it health-giving.  Take pity on the child whose brain is wired to reject what we find “normal” eating.  If growth is normal, we are home free.  Release these parents from their sense of failure, complement them on their good job raising a child who is growing well, and let their children get on with the real tasks of childhood:  having fun, learning new things, making friends and finding themselves in the world.

Famously—and perhaps ironically, coming from an eating disorder doctor—man does not live by bread alone.