Often a parent who experiences the daily challenges of having a child who struggles with eating will tell you, “I never thought I would have a child who wouldn’t eat.” It’s new territory for many families and one that can feel overwhelming and futile. Perhaps your child is anxious about trying new foods, but the few foods that he/she does eat feels “good enough”. Or, your child eats well at home, but can’t eat in the school cafeteria or other environments. The complexities of a picky eater can create stress not only for the child, but also for the entire family.
If your child experiences some of the following examples, he/she may have a feeding disorder and could use assistance and education from a feeding therapist.
Does your child…
…eat less than 20 foods?
…scream/cry when ‘new’ foods are presented?
…avoid certain food groups?
…have aversions to textures, tastes and smells?
…have overall difficulties with eating and drinking?
…have mealtime ‘behaviors’?
…seem to have a fear of food?
…have foods they once loved to eat, but refuses them now?
…have to have the TV on in order to eat?
…refuse to eat with other people or in other environments?
Feeding Development: Texture Perspective
“Texture” refers to how smooth, lumpy, thick or thin the food is. This chart describes textures, examples of food, and the age the child generally is expected to handle a given texture:
|0 – 13 months||breast / bottle|
|6 months||thin purees||stage 1 Baby Food|
|7 months||thick purees||stage 2 Baby Food|
|9 months||meltable hard solids||Graham crackers, Fruit Loops (foods which dissolve with spit only)|
|10 months||soft cubes||Gerber Graduates fruits, boiled potatoes, bananas|
|11 months||single textured soft mechanical||muffins, soft pasta, thin meats in small rectangles|
|12 months||mixed texture soft mechanical||macaroni and cheese, fries, spaghetti|
|16 months||hard mechanical||pretzel sticks, ritz crackers, chips|
When working with your child with chewing and/or swallowing difficulties, there are a few general principles to keep in mind:
- Often times, a child with swallowing problems is able to handle thicker foods and liquids best (e.g. apple sauce in apple juice, yogurt, etc).
- Chewable foods that maintain a solid mass are often easier to handle (e.g. banana, pancakes, etc).
Foods with more than one consistency are more difficult to handle (e.g. soup with veggies/meat).
Feeding Development: Sensory Perspective
Children developmentally learn to accept new foods through their senses such as smell, touch, and taste. Providing children experiences to learn each new food from its’ sight, smell, and texture often increases their tolerance and acceptance. Here are some guidelines and ideas to promote your child’s sensory development in feeding:
- Activities for learning about new foods can be implemented either at the end of the meal or a separate scheduled time dedicated to “learning about new foods”
- Graded sensory input (such as background visual and auditory stimuli) to fit the child’s level of sensitivity
- Keep it fun without any coercion to explore a new food and maintain a positive and supportive attitude
- Activities to “touch” new foods
- Painting with food
- Stamping with food
- Stringing the food items onto yarn to make food jewelry
- Activities to “smell” new foods
- Placing a food item in the container and have your child smell it through the hole on the top then guess the item
- Activities to “taste” new foods
- Tasting a new food item begins with licking the item, then holding a small bite on the tongue, and finally chewing a small portion
- Allow your child to spit out a new food items during the beginning of the exploration or have ice or water on hand for your child to use
- Have your child to make a “teeth mark” on a food item
- Invite your child to join the cooking process
Environmental Control Perspective for Picky Eaters
Environmental factors play a key role in developing and maintaining food aversions and problem eating. Environmental controls include scheduling meals, selecting and appropriate setting, creating a supportive climate, designing meals and portion sized, and addressing food jags.
Guidelines for creating the meal/snack schedule to help with consistency and predictable routines:
- Write a schedule that is understandable and clear to the child
- Use a timer to indicate when the next meal/snack will begin
- Use a kitchen timer during the meal to set the pace and length of the meal
- Make sure the mealtime schedule includes snacks
- Offer the child at least one preferred food item at every meal and/or snack
- Provide only water to the child between the scheduled meal/snack time to limit grazing
Mealtime setting should be a comfortable and supportive setting to help your child relax and focus on learning new skills to eat:
- Eating and drinking should be done at the table for proper stability and posture
- Child should sit in a chair with feet resting on the floor
- The amount of distractions at mealtimes should be kept to a minimum
- Parents, siblings, and peers play an important role during the meal for socialization
Guidelines for creating a supportive mealtime environment for a child to feel supported, safe, nurtured, and trusted to explore new foods/skills:
- Respect the child and do not invade his/her mouth without permission
- Role–play and demonstrate eating techniques
- Never discuss the child’s eating habits or how much he/she eats during the meal
- Discuss the taste, texture, and smell of new foods
Portion size and food selection should be presented in a manner that allows a child to be successful.
- Provide your child with an age-appropriate sized plate and utensils
- It is better to start the meal with smaller portion sizes as it allows the child to see the results when taking a few small bites
- A good rule of thumb for controlling portion size is to consider one tablespoon of each type of food for each year of the child’s age
Food selection should take into consideration the child’s age and eating habits. Keep in mind that new and exotic foods can be scary for your child.
- Select only one menu for entire family and include a variety of foods familiar to the picky eater as well as some new foods
- Select foods that are child friendly
- Consider texture, color, and smell when introducing a new food
- Include a piece of bread or roll with meals
- Be flexible since the goal is for long-term changes it is ok to miss one balanced meal or not to always have the family eat the exact same meal
Food Jags refers to the insistence on the same food, serving utensils, or even the same setting over long periods of time. Guidelines for addressing food jags:
- Create opportunities for structured flexibility and choice making allowing the child to have some choices (foods, dining ware etc) while maintaining structure of the schedule and healthy choices
- Do not cater to the child’s rigidity in wanting only the same foods. Make slight changes in the presentation such as changing the noodle shape for insistent mac-n-cheese eaters
- Include the child in food preparation and presentation
Guidelines for implementing appropriate mealtime behaviors:
- Resistant eaters often exhibit challenging behaviors during mealtimes due to their persistent food aversions. Be patient and take time to extinguish challenging behaviors and replace with appropriate behaviors
- Set up a routine for transitioning to the table
- If the child exhibits noncompliance or tantrums during the meal, calmly remove them to a safe area away from the group
- If the child throws food or destroys food, he must clean it up
- Analyze your judgment about the child’s behavior in terms of cultural beliefs, messiness, and expectations