Picky Eaters-Part 2: When it is More Than Picky Eating

Written by Nancy Horlick, M.D., Clinical Assistant Professor, Pediatrics
Midwestern University Multispecialty Clinic

For most children, picky eating is a developmental stage that goes away as the child gets older. However, in some cases, it may represent something more concerning.

When a child consistently refuses many foods, shows distress around eating, or isn’t growing as expected, it can signal a deeper feeding issue.

Recognizing when picky eating crosses into a clinical problem is important, as these children may require specialized evaluation and medical care.

Why It Matters

In the short term, picky eating is usually manageable. But if it lasts a long time, or the diet is very limited, it can cause illness and problems with development, including:

• Iron deficiency (especially in children who drink excessive amounts of milk)
• Vitamin and mineral deficiencies (zinc, B vitamins)
• Impaired bone growth if calcium intake is inadequate
• Constipation due to low fiber
• Behavioral and mood changes linked to nutrition
• Developmental delays
• Unhealthy weight (either underweight from taking in too little or overweight if diets rely heavily on processed, calorie-dense foods)
• Increased likelihood of becoming an adult who is unable to eat a wide mix of foods. These outcomes emphasize why pediatricians monitor not just growth curves, but also food variety and dietary patterns over time.

This article was originally published in the January 2026 issue of Arizona Parenting magazine.

_References

• _{Traig J. The making of the picky eater. Wall Street Journal. Published January 4, 2019.} 
• _{Nas Z, Herle M, Kininmonth AR, et al. Nature and nurture in fussy eating from toddlerhood to early adolescence: findings from the Gemini twin cohort. J Child Psychol Psychiatry. 2024;66(2):241-252. doi:10.1111/jcpp.14053}
• _{Children’s Hospital of Orange County. How much water should kids drink? CHOC Health Library.} 
• _{Institute of Medicine. Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate. Washington, DC: The National Academies Press; 2005. doi:10.17226/10925}
• _{Rethy J. Choose water for healthy hydration. HealthyChildren.org. American Academy of Pediatrics. Published July 26, 2024.} 
• _{Children’s Hospital of Philadelphia. How to keep kids hydrated. CHOP Newsroom. Published April 15, 2025.} 

_{This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider for questions about a medical or health condition.}