Picky Eaters vs. Problem Feeders: How To Help Your Child Eat!
As a specialty practice area, occupational therapists are equipped to support feeding challenges relating to picky eating, problem feeding and hypersensitivities to food. Occupational therapists can also offer multi-disciplinary support with speech language pathologists, nutritionists and psychologists for comprehensive & collaborative approaches to problem feeding.
As parents, you are probably wondering just how picky your child is. Here is how we typically rule out the severity of picky eating versus problem feeding: Picky eaters often grow adequately, although it takes a great deal of effort on the family’s part to make sure that their child is eating regularly. Problem feeders often do not grow very well despite everyone’s best efforts, and their nutrition is frequently compromised even if they are growing sufficiently. Picky eating typically is noticed by parents around the age of 2 years, whereas problem feeders often struggle with eating from time of the introduction of foods. Problem feeders typically present with history of feeding challenges from birth or medical history that create negative reactions to food. Using Kay Toomey’s approach, Sequential-Oral-Sensory feeding, therapists are able to use the “Steps to Eating” to help children eat!
Picky Eaters:
Decreased Range or Variety of Foods- Typically has 30 or more foods in food range. Journal to figure out where your child falls
Foods lost but eaten again after a 2 week break
Can tolerate new foods on plate. Can touch or taste foods
Frequently eats different foods at a meal than the family. Typically eats at the same time as the family or with the family
Reported as picky at doctors appointments
Problem Feeders:
Restricted Range of foods - less than 20 foods
Foods lost and not eaten again resulting in a further decrease of foods
Cries, screams, tantrums, severe reactions to interaction with foods.
Always eats different foods, often at a different time than the family
What can parents and professionals do to help children avoid “picky eating”?
#1- Encourage parents to decrease the oral-motor challenge of the foods being rejected.
If your child is having difficulty with oral-motor skills relating to eating, change the consistency of foods. Chewing foods, moving foods within the mouth and correctly placing foods can be leading to mealtime challenges. For example, if a child is rejecting a grilled chicken breast, bread the chicken, make sure it is very soft and cut into smaller pieces. If your child is rejecting raw vegetables, try parboiling, adding salt or cinnamon. If they are rejecting apple wedges, try peeling slices, starting with apple sauce or cutting into cubes. If they are struggling with broccoli or cauliflower, turn into soup!
#2- Encourage parents to decrease and/or change the sensory challenge of the foods being rejected.
Changing the sensation of a food can work wonders when supporting your picky eater. A child may be more apt to try something freeze dried or frozen than soft and squishy. When thinking of foods, think of the many varieties that a food can be presented. During feeding therapy, therapists provide foods in all different ways. Here are some helpful ideas for food presentation and preparation. Change the size, shape (food cutters) texture, temperature & utensil during meals. Toothpicks, cocktail forks, small cookie cutters to create shapes & ramekins for dips go a long way!
#3- Educate parents about needing to offer their children foods over and over, even if they reject them at first.
It takes children an average of 10 times of trying a new food before they will eat it consistently. Offer these foods with preferred foods, change the shape, size & times of day!
#4- Encourage parents to continue to offer their children a wide variety of foods and to NOT let their children Food Jag.
A Food Jag is when the child wants to eat the same food prepared the same way over and over again. While many parents are told by professionals to let their child eat the same food over and over to avoid the power struggle, this is not helpful. Allowing a child to become very restricted in their food range between 2-3 years of age is how many picky eaters become problem feeders. Here is the rule followed in the SOS method to feeding: If a child has a food prepared a certain way, they are not able to have that same food the next day. The goal is that the parents would offer their child a different protein, starch, fruit and vegetable across every meal and snack, across 2 full days. Parents need to offer a variety of foods to their children from the very beginning of starting to feed them baby foods or table foods. Even if a child refuses a food, continue providing that food, even if is for interaction and play.
#5– Encourage parents to allow their child to play in their food.
Remember, a parent’s job is to teach their child how to eat a wide range of nutritious foods. That means that a parent needs to not get into a rut of serving their child the same foods over and over because their child is more likely to eat certain foods without a fuss or without more effort on the parent’s part. The parents need to find ways to make meals more fun and enjoyable and interesting to their child. The best way to make meals more appealing is by allowing their child to play and explore their foods, especially new foods. Let your child PLAY WITH FOOD & GET MESSY! The purpose is for the child to explore the food and to learn about how it moves out on the table so they will know how the food will move when it gets into their mouth. The parents can help structure the play by role modeling what they want their child to do. For example, building a tower, painting with yogurt, using toothpick or cocktail fork and popping it in one’s mouth to eat. Parents should also allow their child to use a kitchen utensil like a chopper or masher to break apart the foods into smaller more manageable pieces
#6– Make sure the child is posturally stable at all meals and snacks.
The child should be sitting up at the family table with the rest of the family. They would ideally be in an adjustable wooden chair (EX: Tripp Trapp/Stokke chair) with their hips, knees and ankles all at 90 degree angles. In addition, the chair needs to be adjusted so the table surface hits between the belly button and the breast nipples. If they are in a booster seat, this seat has to be brought to the front of the adult chair so the child’s knees hang over the edge at a 90 degree angle. In addition, the family will need to use a step stool as a foot rest so the ankles are at 90 degrees also. Postural stability creates a secure base for feeding. Remember, eating is a whole body activity.
#7- Make sure the family has a clear mealtime structure that is taught to the child beginning by 18 months of age (with the appropriate level of adult help).
Step 1 = 5 minute warning
Step 2 = Say – “it’s time to wash hands” and bring to the sink to wash hands (transition activity)
Step 3 = sit in the chair, and then pass out foods “Family Style” with the parent’s help
Step 4 = work on eating and drinking for at least 15 minutes
Step 5 = have the child Clean Up from the meal by placing at least one piece of every food served at the meal (whether they ate any of that food or not) into the trash or scraps bowl and then take their plate to the sink (or hand their plate to their parent)
Resource: Kay Toomey’s SOS Approach To Feeding, 2016 Administrator Handouts