Alicia’s son hated to eat. He wailed and became inconsolable whenever she introduced a meal. She was told his behavior was normal and to just keep exposing him to different baby foods. She tried and tried, but it didn’t improve. Going with her gut, she took him to a feeding therapist, who suspected sensory integration disorder.
Certainly, most cases of picky eating are considered a normal part of childhood development, especially between ages 2 and 6 years. But sometimes picky eating is a sign there is more going on. About 1 in 20 children up to 10 years old will demonstrate what experts call problem feeding—children who refuse to eat or eat a very limited number of selected foods.
Children who are at higher risk for being problem feeders are those who were born prematurely or with a low birth weight, have oral-motor problems, frequent respiratory infections and subsequent difficulty breathing, behavioral conditions such as ADHD or autism, food allergies, sensory processing disorder, and those who experience too much negative pressure at the meal table to eat.
Children with sensory-based feeding issues may have more sensitive taste buds, making them highly aware of food texture. They may also be more sensitive to food aromas, tastes, sounds, and visual appearances. Sensory-based feeding problems can begin as early as 6-12 months.
Signs of problem feeding include:
Baby: difficulty latching onto the breast; gagging or choking on lumpy foods; refusing new foods or textures; stuck on pureed food; lack of interest in eating; eating poorly.
Toddler: refusing new foods; sticking with similar textures or colors of food; eliminating one or more major food groups (e.g., protein, dairy, grains, fruit, vegetables); eating fewer than 20 different foods; dropping previously liked foods and never regaining them; crying or having a tantrum when new foods are presented; going days without eating; family stress at mealtime due to toddler’s eating patterns.
If you have a problem feeder, the main goal is to create a positive feeding environment where reinforcement of normal, healthy eating patterns occur. Remember, the key to food acceptance is food exposure, but you have to be careful to keep food, feeding, and mealtimes positive, especially with the problem feeder. Frustration, discipline, and too much pressure won’t make the problem feeder eat better or more—and it may make the child shut down and eat poorly.
There are things you can do at home to help the child who is a problem feeder, such as starting with very small bites of food, using a tasting plate for food trials rather than using mealtime as the time to try new foods, removing any pressure to eat at the meal table, and keeping things fun and engaging. Consider seeking professional help if your at-home efforts aren’t working, your child is losing weight, failing to grow well, or is getting ill frequently—a sign of poor nutrition.
- Castle, JL and Jacobsen MT
- Fearless Feeding: How to Raise Healthy Eaters from High Chair to High School, 2013.
- Sensory food aversions in infants and toddlers.
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