Picky Eater versus Problem Eater


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My child is a picky eater, when does this become a bigger issue?
During development there will be phase where all children become “picky eaters,” but what happens when this phase does not go away? Problem feeding is not a normal part of child development. This is a growing concern as the incidence of feeding disorders in typically developing children are being reported in 6-40% of children. If a child is a problem eater and this is left untreated it can lead to malnutrition, poor weight gain and growth, vitamin and mineral deficiencies, dehydration, impaired intellectual, emotional and academic development.
Problem feeders will often need extensive therapy from a multi-disciplinary feeding team, including a speech therapist, occupational therapist, nutritionist and primary physician. The most important part of the feeding team will be the parents. Studies have shown that treatment success and gains at home were largely due to parental compliance in implementing the clinician’s suggestions and protocols for treatment.

Typical Feeding Development

0-3 months Babies are solely breast and/or bottle fed. Suckling and swallowing reflex should be present
4-6 months Babies begin sucking and are no longer only suckling. Soft solid foods such as cereal and pureed foods are introduced
6-9 months Babies can tolerate eating from a spoon and clear the spoon with their upper lip. Dissolvable soft foods and ground or lumpy solids are introduced. By 9 months the child can drink from a straw
10-12 months Mashed or chopped table foods with noticeable lumps are introduced and most liquids are taken from a cup
13-15 months Can use a controlled bite and bite through a hard cookie, chopped table food continues
16-18 months More challenging foods that require chewing, such as meat.
19-24 months Drinking solely from a cup and are able to eat every type of food.

Picky Eater or Problem Feeder

Picky Eater Problem Feeder
Decreased range of variety of foods that child will eat = 30 foods or less Restricted range of variety of foods that child will eat = 20 foods or less
Child will continue to eat foods that they enjoy and may request certain foods. Child will resist food that they once ate and/or enjoyed
Able to tolerate new foods on plate and will taste a new food (even if they will not eat it) Cries and may throw a fit when introduced to new food
Eats at least one food from all texture groups Refuses entire categories of food textures
Frequently eats a different set of food than the rest of the family Almost always eats different foods than the family
Reported by parents as “picky eater” at well child check up Persistently reported by parents as “picky eaters” across multiple well child check ups

If your child has any of the signs and symptoms below you should contact your physician or call for a feeding evaluation

• Poor weight gain or weight loss
• Choking, gagging or coughing during meals
• Consistent vomiting
• Parents reporting child as being “picky” at 2 or more well child checks
• Inability to transition to baby food purees by 10 months of age
• Inability to accept any table food solids by 12 months of age
• Inability to transition from breast/bottle to a cup by 16 months of age
• Has not weaned off baby foods by 16 months of age
• Aversion or avoidance of all foods in specific texture or nutrition groups
• Food range of less than 20 foods, especially if foods are being dropped over time with no new foods replacing those lost
• An infant who cries and/or arches at most meals

Treatment methods and how feeding therapy will help
The goal of feeding therapy is to increase the child’s comfort level by exploring and learning about the taste, texture, smell and consistency of food. Treatment may require an interdisciplinary approach relying on a team of speech therapists, occupational therapists and physical therapists along with dietitians.
The treatment plan will integrate sensory, motor, oral, behavior/learning, medical and nutritional factors. It will follow the typical steps toward feeding to help desensitize your child to the triggers of aversion. For example, children must become comfortable with having food around, once the child is able to sit with food present they are taught to “play” with the food, to touch it, smell it, explore it, lick and eventually taste it. The treatment approach should allow the child to interact and learn about foods in playful, non-stressful ways. This will help increase the child’s comfort level by exploring different properties of the foods, including color, shape, texture, smell and taste. Parent education and involvement are an essential part of any feeding program.

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To initiate Feeding Therapy please Register Here and someone will be in contact with you within 24-48 hours.

You can also contact us via Email by clicking here if you have any  questions or to set up a phone consultation.