As a feeding therapist, I often get asked "How do I know if my child is just a picky eater, or if there is a more serious problem?" In today's post I will review what 'typical' picky eating looks like , what defines a 'problem eaters' and when you might need to have a discussion with your child's pediatrician or consult a feeding specialist for guidance.
No doubt that feeding difficulties are on the rise. Approximately 10-25% of children are classified as 'picky or problem' eaters. The percentage is even higher in children with chronic medical conditions. But what does 'picky eating' or 'problem eaters' mean exactly?
While there is not currently an agreed-upon classification system that captures the complexity of pediatric feeding problems, there are a few terms that are used frequently in the pediatric world. In this blog post I'll discuss two common terms: Picky Eaters and Problem Eaters.
According to the book 'Food Chaining' (by: Cheri Fraker, Mark Fishbein, Sibyl Cox, and Laura Walbert) Picky Eaters generally don't have any significant medical issues, but might have had a history of reflux as an infant or might have some mild sensory difficulties that make it difficult to eat certain textures of foods. Often, they become picky because they have been exposed to a limited number of foods. Other common characteristics include but are not limited to:
- Very selective about what foods he will eat.
- Accepts 30 or more foods
- Will want to eat certain foods for many days at a time
- If he tires of a certain food and stops eating it, he will usually accept the food again after a break from eating it.
Problem Eaters often will have an accompanied medical condition or oral motor problem that prevents them from eating certain foods. In addition, problem eaters might have a sensory processing disorder or food aversion which prevents them from trying (or even touching) certain foods. Other characteristics include but are not limited to:
- Accepts only a few foods, usually fewer than 20
- May have a strong phobic reaction to new foods. He may cry, throw a tantrum, gag or vomit when a new food is offered.
- Might not even be able to touch a new food
- If a food is rejected by a Problem Eater after eating it for an extended time, they might have a hard time accepting the food again.
-A problem eater may reject entire groups of food (i.e. , he wont eat any vegetables or any fruits at all)
Regardless of where your child falls in the categories above, there are plenty of things you can do in the home to help your child explore a variety of foods! Here are my top 5 tips I use with the clients I work with:
1. In the book, Helping Your Child with Extreme Picky Eating (Dr. Katja Rowell and Jenny McGlothlin, SLP), the authors suggest giving children mealtime jobs. Some good examples of this could be: washing fruits/veggies, stirring foods, shaking salt /pepper, or helping to gather ingredients. You can also let them help you pick produce at the store, or look for a recipe in a cookbook.
2. Stay away from power struggles! As anyone who has been around a two-year old knows, the power struggles at this age are difficult! Young children often use food as a way to control their environment and assert independence. One way to avoid power struggles is to adopt the concept of 'Division of Responsibility' in your feeding routines. The Division of Responsibility concept was pioneered by Ellyn Satter , a feeding expert, author, dietitian and family therapist , in 1986. Here are the principles of her concept:
YOUR JOB : is to decide when, where and what foods are offered (as long as you include something your child can eat.)
YOUR CHILD'S JOB: is to decide whether and how much to eat
It sounds simple, but can be difficult to implement at first. When you are in the midst of a power struggle over food, ask yourself, "What is my job?" and, "Am I allowing my child to do his job?"
3. Rotate what foods are offered frequently. Melanie Potuck, author of 'Raising a healthy, happy eater' suggests writing down what your toddler is offered to eat and then rotate those foods frequently so that new flavors reappear, regardless if your child liked (or didn't like) them on the first few encounters. This is about building familiarity with a variety of foods.
4. Offer small portions. Present small samples. They can always ask for more food if they want it! This can help hesitant eaters not be overwhelmed at mealtimes.
5. Get help early on! If mealtimes are a struggle at your house, or if your child has characteristics of a problem eater, then ask for help. This might include visiting with your child's pediatrician, getting some help for your child from a feeding specialist, or implementing some of the above strategies. For more ideas or for a complimentary consultation to discuss your child's eating difficulties, email or call me at Staci@SpeechNest.com
Staci Henderson, M.S. CCC-SLP is the owner of Speech Nest, a pediatric speech therapy practice in Frisco, Texas. Staci has worked with children in a variety of settings and enjoys sharing her expertise with the families she works with.
Food Chaining by Cheri Fraker, Mark Fishbein, Sibyl Cox, and Laura Walbert , 2007
Helping Your Child with Extreme Picky Eating by Katja Rowell and Jenny McGlothlin , 2015
Raising a Healthy, Happy Eater by Nimali Fernando and Melanie Potock , 2015