Picky Eating and ADHD: Tips from a Dietitian Mom

Picky eating and ADHD: if you’re a parent or caregiver of a child with ADHD, you likely know the struggle of dealing with this. As a pediatric dietitian and mom, I’m here to walk you through how to support your child through this feeding challenge.

What is ADHD? Reframing the Disorder

Attention Deficit/Hyperactivity Disorder (ADHD) is commonly understood as a neurodevelopmental condition, often identified in boys more frequently than girls. Approximately 6% of youth and nearly 3% of adults worldwide are affected by ADHD (that we know of). Research indicates that a combination of genetic and environmental factors can contribute to the development of ADHD in children.

However, as an inclusive and neurodiversity-affirming dietitian, I believe it’s essential to address the stigma and misunderstandings surrounding ADHD before we can address feeding concerns, so let’s shake things up! Traditionally viewed through a medical lens as a “disorder” requiring treatment, ADHD is often perceived as an “abnormal” condition. This perspective can be limiting and stigmatizing.

Instead, imagine this: embracing a social model of ADHD allows us to see it not as a problem within the individual but as a variation in human neurodiversity. This shift in perspective emphasizes that the challenges faced by children (and really, anyone!) with ADHD are often exacerbated by societal structures and expectations.

For instance, children with ADHD may struggle with traditional expectations, such as sitting still at the dinner table or participating in family meals in conventional ways. Rather than viewing these behaviors as problems to be fixed, we can adopt a more flexible approach that accommodates their unique needs. This might involve creating an inclusive environment where children with ADHD are supported in their natural eating patterns and behaviors. That’s exactly what this post will cover.

Focus on the “How” of Feeding

If you suspect your child may have ADHD, speak with their doctor first. While understanding the symptoms and obtaining a diagnosis is important (as a dietitian, I cannot diagnose ADHD), it’s equally crucial to support children with ADHD in a way that respects their neurodivergence.

In the context of nutrition and feeding, this means recognizing that children with ADHD may have different needs and behaviors around food. For example, they might benefit from more flexible meal times, varied textures and flavors, or alternative seating arrangements that allow movement. By focusing on the “how” of feeding, we can better support the nutritional and emotional well-being of kiddos with ADHD, helping them to thrive in an environment that acknowledges who they are and meets them where they’re at!

And speaking of nutritional needs, while there is no explicit “ADHD diet for children”, there are nutrition and feeding strategies that can help to manage picky eating and ADHD symptoms and support your child to develop a positive relationship with food. Let’s walk through some common feeding concerns and solutions together!

Rule out Possible Food Sensitivities or Allergies

Before we dive into picky eating, we need to consider the possibility of food sensitivities and allergies. Kids with ADHD may have a higher chance of food allergies and/or sensitivities.

Food allergies can trigger severe symptoms such as skin rashes, nausea, vomiting, inflammation, and trouble breathing. They are diagnosed by a pediatrician and/or food allergist, and must be completely eliminated from your child’s diet to reduce risk of anaphylaxis (a life-threatening allergic reaction).

Food sensitivities typically trigger less severe symptoms when compared to allergic reactions that often show up in the gut with bloating, diarrhea, and tummy pain. Food intolerance can also lead to feelings of fatigue, head fog, body aches and pains, and tend to worsen symptoms of ADHD. And so it becomes a vicious cycle!

Please don’t try to identify food allergies or possible food sensitivity triggers by yourself. First and foremost, you’re going to need support from a pediatric dietitian who can help you plan around possible food eliminations while ensuring your child’s diet stays nutritionally balanced. Learn more about common food culprits that may exacerbate symptoms of ADHD in some kids, including food dyes and behaviour in kids.

Picky Eating is a Symptom of ADHD

But why does picky eating happen? Three primary signs and symptoms of ADHD in children significantly increase the probability of picky eating. These symptoms include:

1. Inattention e.g. short attention span, easily distracted, etc.
2. Hyperactivity e.g. fidgeting and squirming, difficulty remaining seated, restlessness, etc.
3. Impulsivity e.g. impulsively eating food, blurting out answers before questions are completed, interrupting others frequently, etc.

Picky eating manifests when the classic ADHD symptoms of inattention (including hyperfixation), hyperactivity, and impulsivity start to disrupt mealtimes and a child’s sensory processing around food.

Here’s what this might look like:

Inattention

Your child may struggle to focus on their food or eating, becoming easily distracted by their environment. On top of this, your child may have difficulty sitting still at mealtimes, seeking movement or stimulation to help them focus. This all may boil down to poor overall intake of meals. Now on the flipside, we can see kids with the exact opposite issue: hyperfixation.

Hyperfixation

You may notice that your child has a unique ability to focus intensely on an activity or interest of theirs (such as playing a particular video game, playing with a specific toy, drawing, reading a book etc.) for what feels like a very long time. This hyperfocus is actually a bit of a superpower sometimes!

Children with ADHD can show varying levels of interest in food, all the way from total indifference to being overly focused on it (hyperfixation), making self-regulation challenging. Hyperfixation tendencies may lead to missing meals or erratic eating habits as your child may forget to eat, or opt for easy-to-eat snacks instead of full meals (so they can avoid removing focus from their preferred activity). Not eating enough or going too long without nourishment ultimately causes fluctuating energy levels and mood swings.

Hyperactivity

Kids may have difficulty sitting still long enough to complete a meal, leading to inconsistent eating habits. Not sitting at the table, constantly fidgeting with food or utensils, or getting up without eating can be labeled as picky eating behaviour.

Impulsivity

Some children might impulsively eat without considering the type or amount of food, while others might impulsively reject foods based on sensory input. Children with ADHD are more likely to experience sensory processing differences, making them sensitive to certain textures, flavors, or smells, which can further contribute to picky eating behaviors.

In either case, impulsive behavior may lead to difficulty interpreting and responding to internal feelings of hunger or fullness, which makes intuitive eating challenging.

Another Reason for Picky Eating: ADHD Medication Side Effects

But what about medication and their effect on diet or nutrition? Starting your child on ADHD medication can be overwhelming, with concerns about side effects, stigma, and long-term impacts. These worries are completely valid. However, research shows that ADHD medications can greatly improve a child’s attention, focus, and behavior, enhancing not only their social well-being but also their nutritional well-being.

In general, whether it be a stimulant or non-stimulate medication, both types of medication may cause side effects that impact your child’s nutrition, such as loss of appetite, sleep problems, stomach aches, drowsiness, fatigue, nausea, and dry mouth. Luckily, some strategies can help manage these side effects.

Nausea and Stomach Aches

First, establish a consistent routine where medication is taken at the same time each day with food (ideally a source of both protein and carbohydrate) to help minimize side effects such as nausea, headaches and stomach aches.

Loss of Appetite, Drowsiness and Fatigue

For appetite loss with stimulants, plan to offer more calorically dense and satisfying meal options to your child when the medication has a lower effect. Since stimulants are taken in the morning, their effects are less at both breakfast and dinner time. Offer smaller nourishing meals and snacks throughout the day that aren’t overwhelming in portion size.

For fatigue and drowsiness with non-stimulants, it is best to take the medication at bedtime to mitigate these symptoms.

Dry Mouth and Headaches

In either case, aim to keep your child well-hydrated throughout the day to lower the risk of other side effects like mood swings, headaches and dry mouth. Refill their water bottle regularly and offer fruits, vegetables, and smoothies, as hydrating snack options.

5+ Tips to Manage Picky Eating with ADHD

Phew! It’s a lot to consider as a busy parent. Not to mention, all of these challenges can lead to power struggles at the table. This can range from negotiation and bargaining around what’s on the menu, to emotional outbursts or an outright refusal to eat. But fear not! There are ways to support your child in getting enough nourishment so let’s dive in.

1) Introduce Foods in a Pressure-Free Way

Introduce new foods in a pressure-free way, offered in small less intimidating portions, to help ease into new foods and improve their acceptance over time. Rather than putting pressure on them to “just try it” or “take a few bites”, aim to understand their processing differences, and seek advice from health care professionals specialized in this area (i.e. pediatric registered dietitian, speech language pathologist and occupational therapist).

2) Try Food Chaining

Something you might also want to try is the “food chaining” method. This is a strategy where a new food is introduced in a way that is similar to one of your child’s accepted foods to improve its approachability. For example, if your child will only eat a certain brand of frozen chicken nuggets, you could try offering frozen chicken strips of the same brand. Eventually transition to the brand’s chicken burgers, and with time try offering homemade chicken nuggets that look somewhat similar to the original frozen ones.

3) Maintain a Consistent Mealtime Routine With Flexibility

A consistent routine can help reduce your child’s anxiety around eating and mealtimes, improving their focus and lowering the risk of impulsive behaviors. My recommendation is to establish a structured and predictable eating routine where meals and snacks are offered every 2-3 hours. Visual schedules of their eating routine and/or physical timers can be a helpful way to remind your child that it is time to transition from their activity to enjoy an eating/ hydration break!

However, it’s important to recognize that children with ADHD may need a different structure than the “norm” based on various factors. For instance, a child taking medication like Vyvanse might not have much appetite during the day but may be very hungry when the medication wears off. So being flexible is important. Yes, regular meals and snacks can encourage better attention, behavior, satiety, and growth, but tailoring this approach to fit your child’s specific situation is key.

Offer Snacks Throughout the Day

However, if structured meals are too overwhelming, take the focus off of them and offer nutritious snacks throughout the day instead! Your child may still have six eating occasions but with more of a “snack-like” vibe to food you offer.  You can do this by changing up the types of food you offer, how you offer it, and even switch up the location of where you serve their food to give it more of a snack time feel!

For example, you could serve nourishing snacks in less formal eating places such as the coffee table, on their playroom craft table, or picnic style on the floor either inside or outside (ideally with a water-resistant blanket to sit on)! Alternatively, you could try ditching the plate and try offering food in a portable bento box style lunch kit or in a muffin tin so that there are many small portions of different foods to interact with!

Examples of Nourishing Snack Recipes to Try

• Healthy No-Bake Peanut Butter Cups with Oats & Banana – Sarah Remmer, RD
• Coconut Banana Chia Pudding – Sarah Remmer, RD
• No Bake Coconut Almond Energy Bites – Sarah Remmer, RD
• Kid-Friendly, Easy Vegan Lentil Nuggets | Sarah Remmer, Dietitian
• Green Monster Blender Muffins – Sarah Remmer, RD
• Sweet and Salty Chocolate Lentil Granola Bars (sarahremmer.com)
• Flourless Peanut Butter, Banana Chocolate Chip Muffin Recipe (sarahremmer.com)
• Baked Cauliflower Tots in a Muffin Tin (sarahremmer.com)
• Mixed Berry Greek Frozen Yogurt – Sarah Remmer, RD
• Dietitian-Approved Bento Box Lunch Ideas – Sarah Remmer, RD

You may find more success with your child’s engagement in eating as they may feel less overwhelmed with the snacking approach compared to a structured sit-down meal.

4) Keep Distractions at Bay and Mealtimes Short

Minimize distractions at the table to help your child focus on the task at hand (eating!). Remove screens, loud noises, and toys so that your child is less likely to become distracted during a meal. On the other hand, some ADHD kiddos may do well with having a small fidget toy to help keep their hands busy, improving their focus on the meal in front of them.

Keep meal times short, no longer than 15-20 minutes of expected sitting time, which will help your child to stay engaged. Shorter, more frequent eating occasions may help improve their overall food intake in the day.

5) Experiment with Relaxation Techniques

Try adding relaxation techniques before meal times such as deep breathing exercises, calming music, or a few minutes of quiet time to help prime their senses for a peaceful meal.

You can try taking your child through a guided meditation of sorts, asking them to close their eyes while tuning into certain sensations and feelings throughout their body. Start at the head, move down to their tummy, eventually ending at their legs and feet. Ask them to think about if they feel hungry and how it might impact the sensations in different parts of their body. This technique will help them to connect with their internal body signals improving their interoceptive awareness over time!

6) Try Moving Before Meals

Set up their environment for success! For more wiggly kiddos, try planning to engage them in some form of physical activity before sitting down to eat such as jumping jacks, a kitchen dance party, hula hooping, or yoga poses. This strategy allows your child to get their wiggles out before mealtime.

7) Respond Calmly and Compassionately

Try your best to respond to emotional outbursts or disruptive behavior is a calm and consistent manner. The goal is to uphold your family’s mealtime boundaries in both a firm, and loving way. For example, “you don’t have to eat, but we do need to sit together as a family until the timer goes off.” Proceed to ask your child about their day, or a topic they are interested in versus putting pressure on them to eat. This will help to avoid escalation of conflict at the table, allowing for a more positive mealtime experience (even if they don’t end up eating anything that particular meal!).

8) Include Your Child in Menu Planning

Another way to reduce power struggles at the table is to include your child in the decision around what will make it on the menu. This gives them back some level of autonomy around what ends up on their plate. Offer them a structured choice so that they feel they have more control, helping to reduce their feelings of frustration. For example, ask “would you like cheese bread or rice with our meal today?”

Dietitian Case Study #1: Managing ADHD and Hunger Cues

Want to learn how our team of dietitians can support you and your child with ADHD? Here’s a case study example, with names and identifying details removed for confidentiality. IMPORTANT: These are examples only and should not be applied to your child.

Background

Child’s Profile: 11-year-old boy diagnosed with inattentive ADHD.

Eating Habits and Challenges:

• Medication impacts hunger cues.
• Very picky eater due to sensory issues and anxiety about eating too much or the wrong foods.
• Often feels full after eating very little.
• Significant weight drop from the 30th percentile to the 3rd percentile, raising health concerns and affecting self-esteem.
• Eats small meals and few snacks, with a preference for bland, plain foods.
• Dislikes fruit and vegetables.
• Family has structured mealtimes but allows grazing between meals.

Family Mealtime Dynamics:

• Family eats dinner together nightly, and mealtimes are generally pleasant.
• Eats slowly and is reluctant to try new foods.
• Enjoys basics like tacos, chicken fingers, hot dogs, and pizza.
• Eats better on more active days.

Dietitian’s Assessment and Recommendations

Initial Assessment:

• Reassured parents that the foods the boy consumes are contributing to his growth, despite his selective eating habits.
• Identified iron as a nutrient of concern and provided guidance on how much is needed and what foods to offer to support this nutrient.

Structured Eating Plan:

1. Snack Box Strategy:

• Introduced a snack box for home and school.
• Child packs the snack box with preferred foods.
• Accessible at set times (approximately every 2 hours) to provide variety and ease of access.

2. Reclassify Eating Opportunities:

• New Meal Schedule:
  • Meal 1: Breakfast
  • Meal 2: Dinner
  • Meal 3: Evening Meal (e.g., egg sandwich, protein pancakes)
  • Snacks as a bonus.
• Timing: Maximize eating when medications have worn off. Treat school eating times as optional with accessible snacks.

3. Preferred Meals Schedule:

• Rotation Plan: Alternate preferred meals on M/W/F/Sun and family meals on T/Th/Sat.
• Family Style Serving:
  • Serve all meal options on the table.
  • Encourage self-serving to meet individual appetite needs.
• Safe Foods: Ensure 1-2 safe foods are available at each meal.

4. Boost Caloric Intake:

• Add Extra Fat:
  • Incorporate liquid whipping cream into cereal, milkshakes, and mashed potatoes.
• Milkshakes:
  • Blend milk and ice cream.
  • Rotate flavors to maintain interest.
• Increase Breakfast Size:
  • Serve two bowls of cereal with different flavors.
  • Offer calorie-rich drinks.
• School Strategy: Use headphones and music to reduce distractions during meals.

Outcome:

This structured approach aims to address this boy’s unique needs, ensuring he has access to nutritious and preferred foods, enhancing his appetite, and supporting his growth. Regular evaluation and adjustment of the plan will help in managing his ADHD and improving his overall well-being.

Dietitian Case Study #2: Supporting ADHD and Selective Eating

• Jack, a 9-year-old boy, recently diagnosed with ADHD.

Eating Habits Prior to Diagnosis:

• Very selective eater.
• Diet primarily consisted of carbohydrates, sweets, lots of fruit, minimal veggies, and limited meat.
• Rushed mornings led to eating breakfast on the way to school.
• Lunch often returned home uneaten, with the main components untouched.

Challenges Post-Diagnosis:

• Since starting ADHD medication, Jack’s lunch still goes uneaten.
• Extremely hungry when medication wears off around 7:00 pm.
• Parents frustrated with food wastage, limited consumption, and Jack’s refusal to eat.
• Goals: Help Jack meet his nutritional needs for growth and make mealtimes less of a battle.

Dietitian’s Assessment and Recommendations

• Jack was meeting his nutrient needs despite parental concerns.
• Reassured parents that Jack’s diet, though limited in veggies and meat, was balanced by his high fruit and carbohydrate intake.
• Adequate protein intake from meat, dairy, and carbohydrates.
• Iron identified as the primary nutrient of concern.

Nutrient Guidance:

• Provided guidance on iron requirements and foods rich in iron.

Feeding Structure:

• Introduced Ellyn Satter’s Division of Responsibility (sDOR) to clarify feeding roles of parent versus child.
• Emphasized the importance of structured eating times.

Breakfast Recommendations:

• Suggested parents offer breakfast before Jack takes his ADHD medication and goes to school to help manage hunger throughout the day.

School Lunch and Snack Ideas:

• Recommended nutrient-dense and familiar lunch kits with smaller portion snacks.
• Developed snack ideas for after school, ensuring they were both nutrient and calorically dense.

Supper and Bedtime Snack:

• Encouraged a relaxed approach to suppertime by adopting sDOR, shifting the focus from pressure to fun.
• Advised offering a bedtime snack regardless of how much supper Jack ate, as he was often more willing to explore foods when feeling hungry after his medication wore off.
• Predetermined bedtime snacks with input from Jack, his parents, and the dietitian.

Outcome:

Jack is thriving, and his parents are more confident in their feeding role. Jack has started to explore new foods and is gradually expanding his diet.

Other Lifestyle Factors to Consider

Other key lifestyle factors can influence the severity of your child’s ADHD symptoms and therefore have an impact on their nutrition. Knowing what you can do to adjust these factors will empower you and your child to better manage the environment to support their ADHD. 

Physical Activity

Regular exercise helps to improve cognitive function, reducing symptoms of inattention, hyperactivity and impulsivity. Moving our bodies also helps to increase our appetite.

Aerobic exercise for at least 20-30 minutes 3-5 times a week is found to be beneficial! This type of exercise includes activities like running, swimming, cycling, and sports teams (soccer, basketball, hockey, etc.).

Media Use

Reducing screen time on phones, tablets, and television, is found to help reduce hyperactivity and inattention symptoms.

Research suggests that limiting screen time to 1-2 hours per day is beneficial. Aim to encourage screen-free activities, especially before bedtime. If your child is significantly exceeding this level of daily screen time, aim to cut down on screen time in small realistic amounts over time to allow for a smoother transition.

Sleep

Regular and adequate sleep has been shown to reduce symptoms of inattention and hyperactivity. Studies show that getting enough sleep is critical in managing ADHD symptoms.

Make sure to establish a consistent bedtime routine, that includes a screen-free wind-down period for at least an hour before bed.

• Toddlers (1-2 years) total sleep time: at least 11-14 hours
• Preschoolers (3-5 years) total sleep time: at least 10-13 hours
• School-aged (6-13 years) total sleep time: 9-11 hours
• Teenager (13+ years) total sleep time: at least 8-10 hours

When to Seek Support for Picky Eating

Typically, picky eating is part of normal development for most young kids, and usually is not a cause for concern. However, with neurodivergent kiddos (such as those with ADHD), picky eating behaviors may be more severe, impacting their growth, weight gain, mood and overall quality of life. This is referred to as “extreme picky eating”, and requires professional help from pediatricians, speech therapists, dietitians, and occupational therapists who specialize in pediatric nutrition support.

Extreme Picky Eating

There are a variety of categories for extreme picky eating to help parents identify the eating challenges their child faces, and how to better support them. A child may present with an extreme fear of new foods (aka. Neophobia) or sensory integration challenges that lead to severe food restriction (aka ARFID). On the other hand, extreme picky eating may be caused by physical deficiencies in a child’s ability to properly suck, chew or swallow a variety of food textures.  

In most cases extreme picky eating results in lack of weight gain, weight loss, mood changes, fatigue, missing developmental milestones, and stress both at home and in social situations that involve food.

Common Experiences in Extreme Picky Eating

Trust your parental instincts! If you feel your child with ADHD could be experiencing extreme picky eating, here are some common experiences to be aware of:

• Physical discomfort due to underlying medical issues (such as painful reflux after eating)
• Oral-motor control problems (i.e. problems with sucking, chewing and swallowing)
• Sensory integration challenges (extreme aversions to certain textures, smells, tastes, or visual appearance of food)
• Behavioural traits such as anxiety, fear or extreme avoidance of certain foods
• Past trauma related to eating (vomiting or choking episodes)

Bottom Line

Remember, you are not alone in navigating picky eating with a child who has ADHD. With support from a registered dietitian and the right strategies in place, over time it can become much easier. By understanding your child’s unique sensory and behavioral needs, you can create a more relaxed and enjoyable mealtime environment for the whole family.

References

1. Attention-Deficit / Hyperactivity Disorder (ADHD) | Attention-Deficit / Hyperactivity Disorder (ADHD) | CDC
2. The World Federation of ADHD International Consensus Statement: 208 Evidence-based Conclusions about the Disorder – PMC (nih.gov)
3. Attention-deficit/hyperactivity disorder (ADHD) in children – Diagnosis and treatment – Mayo Clinic
4. Nutrition in the Management of ADHD: A Review of Recent Research – PMC (nih.gov)
5. Attention-Deficit Hyperactivity Disorder at a Glance | NCCIH (nih.gov)
6. Lifestyle and attention deficit/hyperactivity disorder | Movement and Nutrition in Health and Disease (movement-nutrition.de)
7. Elimination diets’ efficacy and mechanisms in attention deficit hyperactivity disorder and autism spectrum disorder | European Child & Adolescent Psychiatry (springer.com)
8. Restriction and Elimination Diets in ADHD Treatment – PMC (nih.gov)