Few things feel worse as a parent than when you can’t get your child to eat.

Why are they so picky?

Why will their cousins eat anything that’s set in front of them?

And, why aren’t they eating the foods they ate last week?

You are not alone!  You might feel like you’re only parent whose child only eats five foods, however, feeding issues in young kids are very common.

It’s estimated that 25-45% of typically developing children have feeding problems.  That jumps to about 80% for children with developmental delays, behavioral issues, and medical diagnoses.

Over the next few weeks I’m going to talk about several common feeding issues including:

• how to deal with challenging behaviors during meal times, 
• setting up meal time routines and expectations, and 
• how to teach your child to sit at the table.

My Picky Eating Disclaimer

Before we jump into feeding and related issues, I want to state that I am not a feeding expert.  I am not a dietician, GI specialist, nutritionist, speech-language pathologist, etc.  I am not trained to assess and treat children with complex swallowing, feeding, and oral-motor issues.  My posts and resources will contain information that I am qualified to speak about (feeding development/skills, behavioral strategies, routines/schedules, etc.).  You will need to seek out the advice and recommendations of your child’s pediatrician, speech and occupational therapists, nutritionists, and other professionals that are familiar with your child’s specific needs.

The First Step in Tackling Picky Eating

Maybe your child is just starting to show signs of feeding issues.

Maybe your child has always seemed to struggle with eating — even nursing/bottle feeding was difficult.

However, before we can get into any strategies or think about introducing new foods, we have to rule out any medical reasons your child is struggling with eating.

This applies if you’re just starting to see some concerns or whether your child has been struggling with eating for a while.

(Ruling out medical concerns is also important for possible hearing and attention issues.)

We cannot jump into strategies without making sure your child is able to eat and swallow safely.

Symptoms of Possible Feeding Problems

Symptoms related to feeding issues can vary greatly depending on why your child isn’t eating well.  If you are noticing any of the following symptoms, contact your child’s pediatrician or other medical professionals familiar with your child.

• Vomiting
• Choking / Gagging
• Coughing
• Difficulty swallowing
• Diarrhea / constipation
• Eczema
• Reflux
• Low appetite
• Low weight gain
• Rash / hives
• Noisy breathing
• Wheezing

Picky Eating Takes a Village

When your child is experiencing feeding difficulties, it often takes a team to figure out the reasons and manage those reasons.

It’s very tempting to want to put off more appointments for your child. 

You just want your child to sit at the table. 

You want them to eat with utensils. 

You really want them to eat the same meals you make for the rest of your family.

But again, it’s critical that your child is safe to swallow and eat certain foods and liquids before thinking about strategies.

It’s also very important to assess which skills your child already has and which skills we need to teach to make eating more successful.

Pediatrician

Usually the pediatrician is your first stop.  You see them for everything, right?

Generally speaking, pediatricians are not feeding experts.  They will usually need to refer you on to a specialist.

You can help your pediatrician know who to refer your child to by being as specific as you can about your concerns:

• Write down foods your child eats / refuses
• Make a list of behaviors you are seeing around meal times (refusing to come to the table, screaming, choking, gagging, coughing, etc.)
• Other symptoms you’ve noticed (constipation, diarrhea, rashes, vomiting, reflux, food staying in mouth after meals, etc.)
• Video a sample of meal time or snack
• Speech concerns (these can often be closely tied in with eating skills)

The feedback I hear from families most often is that they tell the pediatrician their child will only eat five foods and they are told, “Your child will eat when they get hungry enough.”

This is absolutely not the case for a lot of our kids!

Being specific about the behaviors you are seeing can help your child’s doctor have a better picture of what you’re seeing daily.

If you aren’t receiving the help you need, you may need to seek out a specialist on your own or see a new pediatrician.

Pediatric Gastroenterologist

A pediatric GI doctor can assess and treat problems related to digestion, reflux, constipation/diarrhea, vomiting, as well as allergies or intolerances.  They are specially trained to assess and treat nutritional problems in children.

Pediatric ENT

A pediatric otolaryngologist might be a part of your child’s team if there are concerns about breathing and swallowing.  They can assess and determine if there are issues with your child’s upper airway and if tonsils, adenoids, or vocal cords are also part of the issue.  

They’re also an important part of your child’s team if you have concerns about your child’s sleep (snoring) or if your child is having chronic ear infections.

Pediatric Allergist

If it’s suspected that your child has certain symptoms or feeding difficulties due to potential allergies, you may be sent to an allergist.  They can help treat and manage your child’s allergies.  They can also teach families how to minimize exposure to certain allergens.  

Pediatric Speech-Language Pathologist

A pediatric SLP will be incredibly helpful in assessing your child’s swallowing, sucking, biting, chewing, breathing, and coordination skills.  They’ll discuss your child’s medical history, foods and liquids your child is safely able to manage now, self-feeding skills, and your child’s oral-motor skills.  Once they have all of this information and have observed your child eating and drinking, they will develop a treatment plan and help you implement it.

Pediatric Occupational Therapist

A pediatric OT is another very valuable part of a feeding team.  They can assess any feeding issues related to sensory sensitivities.  They can assess which textures, smells, tastes, sounds, etc. may be impacting your child’s ability to eat comfortably and learn new skills.  They can help with positioning a child so they can safely eat.  They can also help you choose cups and other utensils to assist with feeding.  OTs are also able to assess and make changes in the eating environment to make it a more pleasant experience for the child and family.  Lastly, OTs can also assess your child’s motor skills to make sure they are able to feed themselves and drink from a bottle or cup safely.  They’ll teach you how to help your child learn new feeding skills.

Picky Eating is Complicated

As you can see from the list of possible symptoms and specialists, picky eating can be a complicated issue to tackle.  

It’s not simply waiting until your child is hungry enough.

It’s not something that will go away on its own.

And lastly, picky eating is not due to your child being naughty or due to bad parenting.

It is a real problem.

However, it can get better!

Solving Picky Eating is a Marathon

We all want the magic wand that we can wave and our kids would eat foods from all food groups safely and happily.

Maybe they would even thank us for the wonderful meals we prepared!!  

However, when your child has feeding difficulties, there isn’t a magic wand.

It takes a team.  

It takes time.

The first thing we HAVE to do when there are feeding concerns is rule out any medical issues that might be affecting our child’s ability to eat.

To get started on improving your child’s ability to eat:

• Learn about feeding skills and portion sizes for young children
• Contact your child’s pediatrician
• Get referrals to specialists as needed
• Call your local early intervention program if your child is under 3 for an assessment
• Call your child’s school district if your child is over 3 for an assessment

We’re Just Getting Started

Check back next week when I discuss how to manage common challenging behaviors during meal times!