It can be difficult to know whether your child is just a picky eater or has a disorder that makes it difficult for them to consume certain foods. Some children may throw a tantrum, gag, spit out their food, or outright refuse to eat.
Mealtime can be a real problem for some families, especially for children who respond negatively to certain textures. This may be due to a sensory processing disorder like autism or neurological or motor deficits from a disorder such as cerebral palsy.
Families who experience feeding time difficulties can benefit from consulting with a feeding therapist or speech therapist to develop an actionable plan such as feeding therapy or pediatric feeding therapy.
Feeding Disorders in Children
If your child has a feeding disorder, you may notice them refusing to eat or having difficulty eating or swallowing. They may lose weight or become malnourished as a result. Other signs that your child may have a feeding disorder include lethargy and impaired social-emotional or intellectual development.
Medical, physiological, behavioral, developmental, and psychosocial factors may contribute to a child’s feeding disorder.
Up to 25% of children have difficulty during feeding times, primarily during infancy and early childhood. This percentage increases if the feeding disorder is accompanied by a developmental disability.
Picky Eating vs. Disordered Eating. Your child may just be a picky eater. This can often be resolved without medical intervention. Some children get bored with eating the same meals all the time, while others are afraid to try something new. Some options to help your child through picky eating include:
- Discussing the food and their aversion to it, instead of just demanding they eat it
- Praising them for interacting with the food, whether through look, touch, smell, or taste
- Waking up the mouth with a toothbrush
- Allowing your child to feed themselves
- Letting them play with food (and clean it up, of course)
- Allowing your child to help with food preparation
Signs of a Food Disorder
Your child may benefit from food therapy if they exhibit any of the following signs:
- Aversion to food
- Refusing food and specific food textures
- Poor oral motor function
- Failure to thrive
- Tantrums during feeding times
- Problems with self-feeding
- Swallowing issues, such as coughing, gagging, choking, and vomiting during feedings
- Frequent respiratory diseases, such as pneumonia
Other symptoms to look for include difficulties with breathing while attempting to eat or drink, holding food in their mouths without swallowing, and difficulty chewing.
Food Disorders Risk Factors
Some feeding and swallowing disorders may contribute to a food disorder, including:
- Premature birth or low birth weight
- Stomach issues, such as reflux
- Breathing difficulties, including asthma
- Cleft lip or palate
- Face and neck muscle weakness
- Certain medications that contribute to drowsiness or loss of appetite
Other risk factors include sensory issues, such as autism spectrum disorder, and neurological and nervous system disorders, like cystic fibrosis, Down’s syndrome, and meningitis.
Heart disease, behavioral problems, and head and neck issues can also contribute to an increased risk of food disorders.
When Is the Right Time for Feeding Therapy?
If your child is struggling to eat or drink, it may be time to consult a pediatrician. The doctor may suggest trying out food therapy for kids.
Seeing a pediatrician. Your child's pediatrician may recommend seeing a speech-language pathologist or an occupational therapist. These professionals specialize in feeding and swallowing disorders in children. They will evaluate your child and may suggest working alongside a gastroenterologist or psychologist as well.
Don’t be afraid to get a second opinion, especially if your pediatrician insists that your child is just a picky eater. You will know your child better than anyone else, and if you believe it’s more than picky eating, consult another doctor.
If you’re unsure of where to find help, you can look into early intervention services. These services are especially helpful for children who are younger than three. Evaluations are normally free and include observing speech and gross and fine motor skills. Call your local early intervention providers and ask about therapists for feeding disorders. You can also contact your state’s children's hospital or private therapists.
Getting evaluated. During your child’s evaluation, the doctor will review their feeding history. The feeding history should include a report conducted by you on your child’s eating habits and a journal detailing your child’s meals over the course of three days. Your child’s doctor may also order a swallow study. This study observes what your child's throat and esophagus do as your child swallows. It will help your child's doctor understand why your child may struggle with feeding times.
How Does Feeding Therapy Work?
Pediatric feeding therapy techniques will depend on the person providing the treatment and your child’s condition. Feeding therapy may take place in a hospital, therapy center, doctor’s office, or nutritionist’s office.
A few approaches to feeding therapy may be administered, including sensory, behavioral, and motor therapies. Your child’s doctor will work with you to determine which therapy model best fits your child. Some popular approaches include:
Get Permission. The Get Permission approach is based on developing a healthy and trusting feeding relationship between the caregiver and the child. This requires the caregiver to set goals and follow the child’s pace by reading cues that signal the child is “giving permission” for the caregiver to move forward.
At the start, your child will be introduced to food and made to look at it. Subsequent steps include smelling, touching, and tasting the food, before finally eating it.
Beckman Oral Motor. Children with oral motor difficulties may benefit from the Beckman Oral Motor Approach, which guides children in responding to pressure and movement, including range, variety, strength, and control of the lips, jaw, tongue, and cheeks. A focus on these areas allows children to be supported in their feedings.
Behavioral. Behavioral approaches tend to use a reward-based system to reward children for interacting with food. For example, a child who eats new food may be rewarded with a piece of candy, sticker, or toy. With behavioral therapy, children are more likely to try new foods in the future if they learn to associate this experience with positive reinforcement.
Incorporating Feeding Therapy at Home
You can take a few steps at home to make feeding more positive for your child and help them develop good eating habits. First, be sure to have a positive and supportive attitude so that your child does not withdraw from feeding times. If you get frustrated, your child will likely become frustrated too.
Be fun and creative during mealtime. Design fun patterns or use plenty of colors in your child's food. You can even play with your child and their food by making the food into an airplane or train, complete with sound effects. You'll also want to give your child plenty of food to choose from, and let them make the choice on what food they want to eat. Avoid forcing your child to eat something they don't like. Forcing them to eat will make them associate food with troubled feelings.
Another way to incorporate feeding therapy at home is to lead by example. Demonstrate good eating behaviors, such as eating vegetables, by doing it yourself, in front of your child. Also, be consistent in your mealtime routines. Set specific times when meals will be given and stick with them.
Finally, if your child has food allergies, discuss these allergies with their pediatrician.
