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What to do when ‘picky eating’ becomes extreme

September 13, 2022

Editor's note:  For more coverage of the 2022 AAP National Conference & Exhibition, visit

Pediatricians have seen an influx of patients seeking evaluation for eating disorders since the pandemic began. While many youths are restricting their food intake intentionally, others have extreme food aversions and meet the criteria for avoidant restrictive food intake disorder (ARFID).

“This is a new diagnosis in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), though patients have been presenting with these aversive and extremely picky eating behaviors for quite some time,” said Jennifer L. Carlson, M.D., FAAP, clinical professor of adolescent medicine at Stanford University School of Medicine in Palo Alto, Calif. “Over the last several years, we have been seeing more patients in our eating disorder program (both inpatient and outpatient) who have malnutrition that is not related to body image but rather to ARFID.”

As more patients seek care at eating disorder programs, access to many of the recommended treatments have been in short supply, she added. “So having primary care providers prepared with as many tools as possible is critical for meeting the clinical needs of our patients.”

Dr. Carlson will describe these tools during a session titled “Making Sense of Sensitive Tastebuds: Practical Approaches To the Picky Eater” from 2-3:30 p.m. PDT Monday, Oct. 10 (I4440) and 8:30-10 a.m. PDT Tuesday, Oct. 11 (I5140) in room 205 of the convention center. She will be joined by Larry W. Desch, M.D., FAAP, associate professor of clinical pediatrics at Chicago Medical School and a member of the AAP Section on Developmental and Behavioral Pediatrics and Council on Children with Disabilities.

“I am fortunate to be partnered with Dr. Larry Desch for this session, as he will bring his expertise in working with younger children to complement my work with adolescents and young adults,” said Dr. Carlson, a member of the AAP Section on Adolescent Health.

The pair will cover normal vs. abnormal eating, medical issues or symptoms that might be cause for concern and practical tips for working with patients and families who are struggling with food aversions. They plan to use case-based discussions with attendees to illustrate approaches and tools that can be used in the clinical setting.

Some picky eating can be developmentally appropriate in younger children, Dr. Carlson said. But it becomes concerning when the behavior is sustained or eating becomes extremely restrictive.

“Pediatricians should know that picky eating can evolve into an issue that may have serious medical and psychosocial complications,” Dr. Carlson said, “and there are strategies that can minimize more serious complications.”

For more information on the National Conference, visit View the conference schedule at

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