As feeding therapists, we get this question a lot. And it’s hard to know what to do when there is competing information everywhere!
If you are not sure if your child is a picky eater (a child that tends to outgrow their picky tendencies), or a problem feeder (a child who struggles with learning about new foods for extended periods), take a look at this chart and see which column best fits your child:
| Picky Eaters | Problem Feeders |
|---|---|
| 30 or more foods in their entire food repertoire | 20 or fewer foods in their entire food repertoire |
| Foods lost due to “burn out” or “food jagging” are usually eaten again after a 2- week break | Foods lost due to “burn out” or “food jagging” are not eaten again. The list of foods that are eaten tend to dwindle down |
| Eats at least 1 food from most nutritional or textural groups | Refuses entire categories of food textures (e.g., hard munchable textures, purees) or nutritional groups (vegetables, proteins) |
| Can tolerate new foods being on their plate | “Falls apart” (e.g., screaming, crying, throwing items) when new foods are presented |
Toomey, 2000
If your child has 1 or more characteristics from the “problem feeder” category, then they are likely a problem feeder. This means they are not likely to “just grow out” their eating habits.
Where did this come from?
Questions we hear caregivers ask us is, “where did this problem start?” or “we don’t have this issue with our other children- why is this happening?
Problem feeding can stem from many different areas, or a combination thereof.
Common areas that impact feeding include:
- History or current Gastrointestinal Reflux Disease (GERD)
- Food allergies
- Delays in oral motor skills (not able to fully close lips on cup rim, straw or spoon, loss of food out of mouth while chewing or unable to chew harder textures such as meats, raw vegetables).
- Cardiorespiratory conditions (heart defects, asthma, apnea)
- Anatomical or physiological disorders including cerebral palsy, Down Syndrome,
and William’s Syndrome
Trauma (from choking, difficulty weaning, pain from dental problems, strong-tasting medicine, or food insecurity - Gastritis, chronic constipation or other GI issues
- Sensory differences such as high or low sensory sensitivity (SPD, ASD, ADHD)
- Decreased or delayed exposure to new foods
- Psychological diagnoses such as anxiety or depression
So, what do I do now?
If you are concerned that your child is a problem feeder, we recommend taking the following steps to start your journey towards feeding success:
- Visit your pediatrician. Discuss your concerns and check your child’s growth relative to the growth curve. Pediatricians are vital resources to make sure that your child’s health and wellbeing come first!
- Get an allergy test done. While some allergies are very clear, other intolerances such as tongue prickliness or stomach pain after eating are more subtle. Since these may be harder for a child to discern, getting a test done can make this process more straightforward. Additionally, even non-food allergies such as seasonal or pollen allergies may also impact our body’s reaction to foods and drinks.
- Contact a feeding therapist. Feeding therapy is individualized to each child and family’s needs. We recommend a feeding therapist who uses child-led treatment approaches to ensure client autonomy and caregiver education/training to give you the knowledge and tools needed to make small, manageable changes at home.
- Remember that you are not alone. Based on data from 2020, anywhere from 26%-33% of children in the United States are problem feeders or have a diagnosis of Pediatric Feeding Disorder.
Resources:
- Kids Eat in Color– a website run by pediatricians, dietitians, psychologists, child development specialists, and occupational therapists about how to talk about food with children.
- My Munch Bug– a website run by an SLP and feeding therapist full of resources and videos
- Feeding Plus– a website run by an SLP and feeding therapist with how-to blogs and ideas for introducing new foods
Written by Nicole Okada
