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When is Picky Eating a Cause for Concern?

Almost every parent will experience their child going through phases of “picky eating”. From the time they are  infants to elementary school age, most children eat around six times per day. That means, when eating is a challenge, it becomes a constant source of frustration to both the parent and the child. 


But what is the difference between a child who refuses to eat off anything not smothered in ketchup, or a child who will only eat chicken nuggets from Chick-Fil-A? Both can be “typical” phases of development, but how do you know when it’s a reason for concern?


Picky Eaters vs Problem Eaters - Red Flags

The phrase “picky eating” usually refers to a toddler or preschool aged child who has strong opinions about what they will and will not eat. They usually have at least 30 foods they will willingly eat. If they grow tired of a food, they will resume eating it after a couple weeks when they eat with their family but may have a different meal at times, and will eat a variety of textures from various nutritional groups. Remember, many of these behaviors are a harmless phase of development that will eventually pass. But, what about when it goes beyond that and a child is displaying significant or long term food refusal behaviors? 


A “problem feeder” is generally a child that has difficulty eating due to a skill deficit; it is not a behavioral issue. There are a variety of things that may impact your child’s ability to eat the same foods his or her peers do; medical issues such as GERD, constipation or respiratory issues; oral motor weakness or lack of coordination impacting the tongue, lips, facial muscles or jaw; or neurological or developmental disorders such as Autism Spectrum Disorder. Remember, not all children with these conditions will be identified as “problem feeders”. 


So what are the signs or red flags that your child may need extra support to advance their diet? 

  • Consistent avoidance of certain textures

  • Difficulties that present at every meal, every day and/or interferes with the family’s routine

  • Gagging on certain foods or textures

  • Displaying continual anxiety or stress over new food exposures

  • Difficulty chewing and/or swallowing; pocketing or spitting out foods they attempt to eat 

  • Slow weight gain or weight loss; stalled or slow growth

  • Twenty or less “safe” foods 

  • Any signs of physical discomfort during or after eating 


What Can I Do To Help My Child? 

Sometimes parents can do everything “right” and a child will still demonstrate selective eating, however, there are a few ways to try to support and encourage your child to widen their diet. 

  • Establish a mealtime routine

  • Set up age appropriate expectations and boundaries

  • Avoid continual snacking or grazing

  • Encourage your child to join you in the kitchen for meal preparation

  • Limit the number of new foods being introduced

  • Always offer one “safe” food at every meal

 

If you have been doing these things, reach out to your child’s pediatrician or seek out a feeding therapy evaluation. 


What Happens During a Feeding Evaluation? 

During a feeding evaluation, a Speech Language Pathologist will ask you questions about your child’s medical, developmental, and feeding history as well as your child’s current diet including preferred and non-preferred foods. Your child will be asked to eat, or interact with foods of different textures and food groups, as well as drink from an age appropriate cup and use utensils. 

The therapist will use this information to identify your child’s oral motor and feeding strengths and possible weaknesses. You will then work with your therapist to develop appropriate and attainable goals to help your child progress in their feeding journey. 


To schedule an evaluation for a feeding evaluation, contact our office at 919.238.9088 or visit our website and click “Contact” at the top of the page. 



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