My toddler is a very picky eater. What should I know about picky eaters?
Picky eating is a common problem among many children, and we know it can be very difficult for parents who want to ensure their child is receiving the appropriate nutrition. Picky eating, however, can also be a symptom of a more serious issue, such as a pediatric feeding disorder. Feeding difficulties can be related to a number of factors, including but not limited to, decreased sensory processing skills, decreased oral motor skills, a variety of medical conditions, anxiety or a combination.
Your child may benefit from an assessment for feeding therapy and assistance if they are demonstrating any of the following criteria:
- Have been described as a picky eater at more than two well-child check-ups
- Drastic change in feeding abilities and loss of “safe” foods
- Refusal to eat foods that are hard to chew, like meat or raw fruits and raw veggies
- Little to no (or inconsistent) weight gain
- Consistent gagging, choking, coughing or gurgling when/after eating
- Excessive vomiting
- Breast or bottle-feeding concerns that haven’t been resolved by a lactation consultant
- Require specific food preferences or like to eat the same foods prepared in the same way
- Extreme pickiness — eats less than 15-20 foods
- Mealtime battles including behavioral challenges or meltdowns at meals
- G-tube or NG-tube dependence
- Over-reliance on “baby or toddler foods” (soft meltables, purees, bottles)
- Tethered oral tissue concerns such as tongue ties, lip ties, cheek ties
- Avoids certain foods based on textures or colors
- Refuses entire food groups
- Have difficulty exploring foods with eyes, hands, nose and tongue
If your child demonstrates any of the above criteria, he/she may be more than a picky eater and further assessment is recommended. During a feeding evaluation and therapy session you can expect the therapist to assess your child’s oral motor skills and sensory processing/reaction to a variety of foods. Based on the evaluation results, the therapist will create a treatment plan to support your child’s and family’s specific needs using sensory-rich, play-based techniques focused on positive engagement with foods.
Feeding therapy often includes sensory motor warm-up activities to regulate the body prior to being presented with food. These activities can include obstacle courses, swinging, climbing and jumping. The therapist will likely include messy play (both food and non-food play), and non-preferred food exposures. Overall, feeding therapy will focus on building a strong rapport and trusting relationship between the child, their family and the therapist. Feeding therapy is usually once or twice a week and will include home programs written specifically for each child and their family.
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If your child has a hard time tolerating mealtime and being presented with foods (new or otherwise), try focusing on sensory and food play. Encourage your child to engage with their food in ways that do not include eating. Make letters with peas, paint with ketchup using broccoli, or stack cubes of tofu. You can even encourage food play at non-meal times. Other ideas may include building blocks with Jell-O cubes, making chia seed slime or using whipped cream with food coloring to paint. Encourage your child to focus on creating something fun and new rather than focusing on what they do not want to eat.
When encouraging your child to eat, especially in the home, sit down for meal time all together. Children can learn so much from simply observing parental actions. If your child is old enough, let them serve themselves. Providing your child with that control can decrease pressure and mealtime battles. Note that the goal of family meals is for your child to eat a volume of their preferred foods, while a secondary goal is for your child to be learning about other, non-preferred, or new foods as well. Try to offer your child at least one protein, one starch and one fruit/vegetable in every meal or snack, making sure that at least one of these foods is a preferred/safe food.
Finally, start small and celebrate any interaction with non-preferred foods. Allow any engagement with a new or non-preferred food to be a win. Did they look at it without gagging? Hooray! Did they touch it, even just to move it off their plate? Hooray! Did they try a bite but spit it out? Still hooray!
Above all, don’t panic. There are supports and assistance out there, ready to help whenever you may need it.
Bess Sorensen, MOT, OTR/L, is a pediatric occupational and feeding therapist with Tumble ‘N Dots Pediatric Therapy in Irvine. She received her bachelor’s degree in Human Development and Family Studies from Colorado State University and her master’s degree in Occupational Therapy from Samuel Merritt University. In her free time, she loves to spend time with her family, go to Disneyland and decorate cookies. Please visit www.tumblendots.com or follow us @Tumblendots on Instagram for more information.