Feeding Therapy: Determining WHY a Child is a “Picky Eater”

This is a guest post by Melanie Potock, MA, CCC-SLP.

picky eater
Tried all the “expert tips” on how to get your kid to eat vegetables or become a more adventurous eater?  Shopped together, gardened together, cooked together?  Created elaborate bento boxes that rival fine art?  Why is it that your picky eater is still stuck on chicken nuggets and refuses to take just one bite of a new food, when you’ve followed the advice of so many authorities on raising a healthy eater?
I’m one of those “experts” and here’s my own piece of advice: No two kids are alike.  For many kids,  it’s a joyful process discovering new foods!  But for others, it’s more complicated.  As a pediatric feeding therapist, my first role is to be a “feeding detective.”  When I meet a child for the first time, my job is to assess much more than just what foods he will or will not eat.  Assessing WHY a child won’t eat requires investigating three areas directly related to eating:  physiology, motor skills and behavior.
Physiology:  Simply put, I ask myself  “How does this little guy’s body function?”  I consider the whole child in a multitude of ways and one example is the gastrointestinal system.  If the child is coming to me for any sort of difficulty eating, I always ask that the parents to consult with a pediatric GI physician.  Even if the doctor doesn’t suspect GI issues, I want his/her experienced hands on that belly.  I want a baseline of information to begin to put all the pieces of the puzzle together including ruling out a GI component.  Another important piece of physiology is the child’s sensory system.  Is he a sensory seeker or a sensory avoider?  What sorts of tastes, temperatures, textures, auditory input  (yes, every food has its own sound), olfactory  and visual stimuli does he tolerate, enjoy, resist or avoid with all his might?  How about his vestibular system and his proprioceptive system: how comfortable is he with movement, balance and input through this joints and muscles?   So, if you toddler was colicky as an infant or has persistent rashes, a food intolerance may be (or was) the culprit.  Or, if your preschooler has had even mild sensory challenges those same issues may be influencing his attitude at the dinner table.

Motor Skills: This includes both gross and fine motor skills.  The development of age appropriate fine motor skills (such as the ability to pick up a single piece of dry cereal between one tiny finger and thumb) requires strong & stable gross motor skills.   When I treat a 9-month old child with low muscle tone who has trouble sitting up on his own, I know he is going to have trouble with the fine motor skill of moving his jaw, lips and tongue to clean applesauce off a spoon, even if I am feeding it to him.  I’m going to have to come up with strategies to provide additional stability for his mouth to work in an optimal manner.  Fine motor skills are always dependent on gross motor skill development, whether it’s the first bites of puree from a spoon presented by a parent or learning to self-feed pieces of cereal.  So, if your 4 year old had even mild delays in fine or gross motor development as a toddler, it still may be affecting her willingness to try new foods today.  In fact, it may have stalled her feeding development and that is why she is still eating toddler foods, rather than the “big kid” foods that her playmates have begun to enjoy.

Behavior:  What sorts of behavior am I seeing that is helpful when learning to try new foods or perhaps hinders eating? What has the child learned to do to avoid trying new foods? What has he learned to do to request or even demand favorite foods?  Does he scream till gets his chicken nuggets? Does he toss the broccoli on the floor, or just dump the entire plate?  Keep in mind that the term “behavior” includes desired behaviors and I’m watching closely for those too.  Does he run to the high chair and eagerly climb up when it’s lunch time?  I’m trying to see the big picture and learn how the child’s physiology and motor skills influenced certain behaviors to develop. Kids may come to me after the gastroenterologist has solved  their tummy issues, after the best occupational therapist has helped to balance the child’s sensory system, or even after a dentist has resolved chronic tooth pain, but now, the learned behaviors remain.  If eating was uncomfortable for a period of time and then, comfort was restored, it’s likely that the child will still be a hesitant eater, because he learned to avoid associate eating with discomfort or pain.

Behavior also includes the family’s behavior and family dynamics that may or may not influence how a child learns to eat.  Parents genuinely want to find a solution to their child’s difficulties with food.  Typically, parents are open to feedback and guidance regarding what I observe is going well and what they might want to tweak in terms of their own behavior around mealtimes.  It’s not always easy to change, but the first step is being open to hearing what the possibilities may be.

Likewise, I try to keep an open ear and an open heart.  While I can certainly empathize (one of my own kids was a picky eater thanks to some mild sensory issues), each family’s situation is different and each child’s symptoms unique.  That’s why I love being a therapist – it requires a little detective work to figure out all the pieces of the puzzle.
By the way, those strategies mentioned in the very first sentence of this article -  shopping, gardening, cooking, etc.?  Truly great advice!  Keep doing those.

If progress seems slow, have your child evaluated by an experienced speech language pathologist or occupational therapist that specializes in feeding.  There may be more pieces of the puzzle to uncover.

Melanie PotockMelanie Potock, MA, CCC-SLP,  is a national speaker on the topic of Picky Eating, the author of Happy Mealtimes with Happy Kids, the executive producer of the award-winning children’s CD Dancing in the Kitchen and the founder of My Munch Bug.com.  Find her on facebook, twitter and pinterest.

  • momx2

    I would love to know what strategies the author used for her child. I also have a child with mild sensory issues (doesn’t like certain textures or strong flavours and will chew on some foods for a very long time before swallowing them – often to spit out a mouthful of pulp that “won’t go down”). Occupational therapists that specialize in feeding are hard to come by in my area.

    • Melanie Potock

      HI! I hope you’ll join me on twitter, pinterest and/or facebook. I post tips there too. It’s hard to give specific advice since each child is different, but I hope some of my ideas in my book (Happy Mealtimes with Happy Kids) and on my website http://www.mymunchbug.com will be helpful. Thank you!

  • Syrah McGivern

    Thanks for this eye opening article. Much better than the “you have to expose a child to a new food many times” advice that frustrates many parents. Another important reason a child can be picky eater is if he/she is deficient in minerals such as zinc which can affect taste buds (make foods taste “funny”/unappealing). Syrah McGivern, MS, RD

    • Melanie Potock

      Yes, such a good point Syrah! Zinc defficiency can also affect our sense of smell and hunger as well. It’s all part of considering the whole child – thank you for mentioning it!

  • PTtally

    Thanks for writing this article and sharing your expertise. You have validated my concerns for my picky eater who is a sensory smart kid. Its such a challenge to work against the norm to know these are not just normal behavioral problems…that something is really going on their little bodies and the answer isn’t always easy to identify. I will definitely look around to find a pediatric feeding specialist in my area. I didn’t know your specialty existed until now.

  • Kim Humphrey

    What a great article, you’ve done a great job explaining the building blocks of a feeding evaluation! I have started a blog on food play and would love to link to this article in an upcoming post ’5 reasons to play with your food’! Thank you for making this aspect of our profession so visible and accessible!

  • Kate prettyjohns

    I would love to get to the bottom of my sons feeding issues. He’s 17 months and has had problems since day 1 of weaning. He had cmpa which he’s now outgrown but is still left with the terrible feeding habits. I also believe he could have a posterior tt but the ent guy looked ( briefly) into lo’s mouth with a lollypop stick and laughed at me at the suggestion of a posterior tt( as if he doesn’t believe in such a thing). So a negative diagnosis from him. My lo is also very stubborn and if he says he isn’t going to eat something, he won’t. I’d just like him to eat healthy food, it’s such a struggle.

  • Allison Moss-Fritch

    I never feed packaged food for starters…no TV dinners, NO boxed french fries, NO mcNuggets… Make your own if you want them. That is much more self limiting, tastes better and is usually more healthy. Plus making your own is a good family activiity.