If you have ever had a picky eater you know how frustrating it can be!  For most of us, mealtimes are a time to share, relax, socialize, and enjoy each other.  When you have a child that is a picky eater, mealtime is a nightmare!  You literally will dance on your head, bribe, cajole, barter, whatever it takes to get your child to eat. 

My daughter was a good eater until around the age of 2 or 3. She started to eat the standard "toddler diet".  You know, like macaroni and cheese, chicken nuggets, grilled cheese, hot dogs, and french fries.  Whenever my husband and I would try to get her to eat real food like vegetables, fruits, or meats, drama would ensue.  She would cry, gag, regurgitate her food, and outright refuse to eat.  Not only was I super frustrated, but I felt like a failure too.  

A few things you should know.  I have worked with children for 20 years.  I have taken every continuing education course known to man, and these have included courses on feeding, oral-motor, feeding aversions, and sensory aversions that affect feeding.  Nothing I was doing was working.  Not only was I failing as a parent, I was failing as a therapist!  It's amazing how having children can humble you.  

Did you know:

• 25-35% of typically developing children have a feeding disorder
• 40-70% of children with chronic medical conditions or those born prematurely have a feeding disorder

What are the risk factors for developing a feeding aversion or feeding disorder?

• History of reflux
• History of constipation
• Failure to thrive, poor weight gain, poor weight loss
• Recurrent pneumonia
• Food sensitivities/food allergies

What you can do at home….

Relax - the most important thing you can do is to relax during mealtimes.  Our children feel our emotions, and this can have a huge impact on their willingness to try new foods or even sit at the diner table with us.  If we stress, they will too.  They are not going to starve to death if they don't eat what you give them.

Offer - continue to offer the foods you want your child to eat.  Did you know that it can take upwards of 30 tries before a child may start to eat a new food?  Exposure is everything.  

Presentation - change it up.  For instance, if you would like your child to eat apples, cut them up into slices or cubes.  Keep the peels or take them off.  Try all the different colors of apples and share your thoughts with your child.  for example, "This green apple is tart" or "This red apple is sweet and juicy".  

Play - let them play with the food.  Before we can eat something, we must be able to touch it first.  Don't be afraid of messes, kids are supposed to make messes.  This is how they learn.

Feed you -allow your child opportunities to feed you  They can feed you finger foods or with a spoon or fork.  

Let them help - what better way to get kids interested in eating than to let them help in the kitchen?  Not only does this provide exposure to various foods, but it also provides an excellent learning opportunity.  So many skills are used while we work in the kitchen.

Limit liquids.  This sounds a little crazy, but I have heard parents say their 2 year-old drinks 30 ounces of milk during the day.  Well, if I drank that much milk I wouldn't be hungry either.  Monitor how much your child is drinking.  You would be surprised, that by limiting their dairy intake, how much more food they will try.

Positioning - look at how your child is positioned during mealtimes.  Make sure your child has a place to rest their feet.  This will provide the stability your child needs to support the upright posture needed for efficient feeding, chewing, and swallowing.  Ideally, with support at the feet, your child should have their knees and hips at 90 degrees, while their elbows/arms can rest easily on the table surface.  At times, back support can also be beneficial.  

Don't force it!  This is a big one!  Forcing kids to eat foods that they are not ready for or they don't like won't help.  Force-feeding can turn a food aversion into a feeding disorder.  

Signs that intervention is needed:

• Arching or stiffening of the body during feeding
• Difficulty coordinating breathing while eating and drinking
• Gagging, coughing, choking when eating or drinking
• Difficulty or inability to transition to baby foods
• Difficulty or inability to transition to table foods by 1 year
• Anxiety associated with eating/mealtimes
• Eyes watering or sniffling while eating
• Holding food in the mouth or swallowing it whole
• Extreme food selectivity
• Difficulty with foods that have certain colors, textures, and/or temperatures
• Diet that consists of 20 foods or less

How can therapy help?

Depending upon the needs of your child, intervention can vary.  Speech and occupational therapists typically address the oral-motor, oral sensory, tactile, swallowing, feeding, and chewing aspects involved with eating and drinking.  At times a motor therapy is also required to address any muscular and skeletal deficits that may contribute to your child's posture, strength, and coordination associated with feeding and eating.  

You probably are wondering how it worked out with my daughter.  Well, I am embarrassed to say I broke the 2 most important rules.  I didn't relax, and I might have force fed her from time-to-time.  Not proud of this, but it's the truth!  She was evaluated multiple times for feeding issues, and eventually she received feeding therapy.  When we discovered she had food sensitivities, we removed those foods, and she started eating everything!  I'm not exaggerating.  She was eating multi-textures, spaghetti, vegetables, meats, and even fish!  It's likely that it was a combination of the two interventions, removing the sensitivities, while reducing he anxiety and fear associated with eating.  

If you're looking for suggestions on how to expand your child's food choices, call a local therapy clinic that works with children.  They may be able to provide you with a free screening or offer suggestions.  It's never too early to start!