Picky Eating – When should I be concerned?

By Madison Gwizdalski MS-CCC, SLP

Picky eaters…. It seems like all of us know someone who can fit inside this category. Even as adults we can think of others who are very selective in their food choices. For children, it may seem as if your kiddos food preferences change weekly, even daily! But how do we distinguish between children who are eating normally, children who are “picky eaters”, and children who are “problem feeders”?

There are a couple differences between picky eaters and problem feeders, but generally the difference is related to severity and when the problems are noticed.  Picky eaters are typically identified later and, although mealtimes are a struggle and the child may not be eating “regularly”, they continue to grow adequately. Problem feeders usually struggle with eating as soon as baby foods, finger foods, or table foods are introduced (6-11 months of age), and do not grow well due to compromised nutrition. Why do children become picky eaters or problem feeders? The answer is complex. To truly understand why a child might have developed picky eating, we must look at several factors including health (pain, discomfort, illness), oral-motor skills, sensory processing, cognition, behavior, nutrition, temperament, and environmental factors.

Wondering if you should be concerned about your child’s picky eating? Any of the following may indicate that your child could benefit from a feeding evaluation (Dr. Kay A Toomey, 2010):

• Ongoing poor weight gain (rate re: percentiles falling) or weight loss
• Ongoing choking, gagging or coughing during meals
• Ongoing problems with vomiting
• More than once incident of nasal reflux
• History of a traumatic choking incident
• History of eating and breathing coordination problems, with ongoing respiratory issues
• Parents reporting child as being “picky” at 2 or more well child checks
• Inability to transition to baby food purees by 10 months of age
• Inability to accept any table food solids by 12 months of age
• Inability to transition from breast/bottle to a cup by 16 months of age
• Has not weaned off baby foods by 16 months of age
• Aversion or avoidance of all foods in specific texture or nutrition group
• Food range of less than 20 foods, especially if foods are being dropped over time with no new foods replacing those lost
• An infant who cries and/or arches at most meals
• Family is fighting about food and feeding (i.e.. Meals are battles)
• Parent repeatedly reports that the child is difficult for everyone to feed
• Parental history of an eating disorder, with a child not meeting weight goals (parents not causing the problem, but may be more stressed and in need of extra supports)

How can I support my child in the meantime?

1. Decrease oral-motor challenges with rejected foods – you can make foods easier to manage by cutting them into smaller pieces, blending vegetables into purees, or making food softer by boiling it.
2. Decrease sensory challenges
   1. Sometimes toddlers and children struggle with wet foods due to sensory preferences. You can offer dry, crunchy foods as an alternative. For example, if your toddler is rejecting strawberries, you can offer freeze dried strawberries instead.
   2. Try serving mixed texture as separate textures first. For example, instead of a sandwich, serve bread, turkey, cheese, and mustard separately.
   3. Allow your child to experiment with their food. For example, serve ketchup and ­­hot dogs separately and allow your child to dip into the sauce on their own.
3. Offer your child foods repeatedly, even if rejected! – on average, it takes children 10 times of trying a new food consistently before they try it.
4. Offer your child a variety of foods – If your child eats a preferred food one day, ideally, they will not have that food until 2 days later. Why?! We want to avoid children becoming overly restricted in the range of foods that they eat. We should strive to offer a different protein, starch, and fruit/vegetable at every meal and snack, across 2 full days… start offering a variety of food as early as you begin feeding the baby table foods.
5. Make sure your child has a chair that supports their posture during mealtimes- check out this link for recommendations)! Feet, knees, and hips should be held at 90-90-90-degree angles for optimal support.
6. As early as 18 months, introduce a clear structure to mealtimes. They should have a beginning (wash hands, sit, pass out food), middle (eat), and end (clean up time).
7. Remember… it is developmentally appropriate and FUN to play with your food! You can make mealtimes fun by playing with a purpose, introducing tools, and encouraging your child with lots of praise.

If you would like to have your child evaluated for feeding therapy, contact Uplift Therapy Center for more information!