Would you describe your child as a picky eater? Is every meal a struggle no matter what foods you put on their plate? Do the grapes have to be red, the crackers round, the crust cut off the bread, and the nuggets only from McDonald’s? This is a fairly common, very tricky issue with some children that takes a lot of repetition and a lot of patience. Good nutrition is critical for children’s brain and bone development. Here’s a guide to help you handle your child’s difficult eating habits.
First things first… rule out any underlying medical conditions interfering with a child’s ability to eat a variety of foods.
- Gastroesophageal Reflux Disease (GERD)
- Breathing difficulties
- GI issues
- Food allergies
- Oral motor disorders/delays
*If your child is frequently vomiting, coughing, choking or gagging while eating, bring up these issues with your child’s pediatrician for further evaluation.
Let’s differentiate “picky eaters” from “problem feeders”
A “problem feeder”
- has LESS THAN 20 foods in their diet
- May have a very strong reaction when new food is introduced (e.g. cry, tantrum, gag, vomit)
- May not stand touching new foods
- Foods lost from burn out due to “food jagging” aren’t eaten again after a break, resulting in decreased food in diet
- May reject entire food groups or textures (e.g. fruits, meats, soft cubes)
- Usually has an underlying medical condition, sensory processing disorder, or oral motor skill problems
A “picky eater”
- Eats more than 30 foods
- Wants to eat certain foods repeated over many days at a time
- If he burns out on a certain food from “food jagging,” he’ll usually accept it again after a break
Not every child will need to see a feeding specialist for picky eating habits, while some children will require a feeding specialist team (e.g. nutritionist, OT, SLP, etc.). Regardless of where your child falls on the spectrum of picky eating, these strategies can help.
*Make Mealtime FUN! *
- Try different textures, colors, smells
- Encourage your child to open lids or packages of food, talk about the smell, color, texture before handling/tasting it
- Play with food–paint with it, squish it, poke it, break it in half, make faces out of it
- Purchase a food coloring book
- Let your child help you at the grocery store by placing items in the cart
- Use cookie cutters to cut foods into different shapes
- Cook meals with your child, measuring and stirring the ingredients
- Make them part of mealtime routines (e.g. washing hands, setting table, serving food, cleaning up).
- As much as possible, be consistent with the mealtime setting and structure so the child learns what to expect.
- Snacks should last about 10-15 minutes and meals about 15-20 minutes when young, up to 30 minutes as they get older.
- Use an all-done bowl: teach children to put their foods in an “all-done” bowl. This helps teach them a sense of finality, but will also increase their interactions with foods that they may have refused to touch, taste, or eat during the snack or meal.
- No grazing. To build up hunger for scheduled meals and snacks, children should only be allowed to eat at the scheduled meals and snacks (usually 2 ½ to 3 hours apart, 5-6x/day).
*Oral Motor Techniques*
- Provide crunchy or chewy snacks to improve focus
- Raw carrots, celery, pretzel sticks, chewy fruit leather, dried fruit, twizzlers, etc.
- Blowing bubbles, pinwheels, whistles, cotton balls
- Drinking through a straw (smoothie, applesauce, pudding)
- Drinking from water bottles that require strong oral motor muscles
- Oral stimulation before eating (e.g. vibration)
- Do not allow children to watch tv, play with toys or have other distractions at the table during meal and snack time. Socializing, and soft music is ok.
- Use “first/then” strategies (e.g. first sit in your chair for ___minutes, then we can watch your favorite TV show).
- Positive verbal praise (e.g. “Thank you for sitting in your chair. You’re doing a great job waiting.”) Ignore behaviors you want to go away, and praise behaviors you want to see again.
- Use a timer to set the expectation of how long they need to stay at table.
- Offer a special toy if he eats a desired portion of food, tries a bite of a new food, or follows your mealtime rules.
- Ask your OT for foods that are appropriate for your child’s age and skill level
- Expose them to a wide variety of tastes and textures, as well as different brands of foods
- Offer at least 1 protein source, 1 carbohydrate source, and 1 fruit or vegetable for each meal. Make one of these a preferred food.
FOOD CHAINING: A list of foods that have the same features (e.g. flavor, texture, color) as he currently eats. Gradually varying the sensory properties of food they’ll eat can help introduce more food into their diet.
- Look at the foods your child consistently eats for patterns in taste, texture, temperature, consistency, color, etc.
- Introduce very similar items first and once he’s expanded the foods he’s eating, move to the next level of adding new foods still similar to the ones he likes, but have slightly different flavor/texture.
- Add sauces, dips, or condiments as needed
- Target only 2-3 foods in his core diet (foods he’ll consistently eat) at first
E.g. Chicken nugget with ketchup → chicken nugget with BBQ sauce → chicken nugget with ranch→ chicken nugget with honey mustard
E.g. Ritz crackers, Cheez-its → Ritz with cheese or peanut butter, goldfish crackers, Cheetos → thin-crust pizza with cheese, toast with cheese
A child’s ability to learn to eat new foods expands over a hierarchy that allows them to slowly accept new foods.
- Tolerates (e.g. being in same room, looking at food)
- Interacts with (e.g. uses utensil to touch it, assist in preparation of food)
- Smells (e.g. odor at table, leans down to smell)
- Touch (e.g. one finger tip, chin, lips, teeth, tongue)
- Taste (e.g. licks lip, bites off piece and spits)
- Eating (e.g. bites and chews, swallows)
Moving up this hierarchy while introducing new foods and eventually expanding our child’s diet is our goal!
If your child is a picky eater, problem feeder, or has other problems during mealtimes, ask your pediatrician for a referral for OT.
Contact me for personalized food chains or mealtime recommendations for your child at eatplayloveOT@gmail.com.
Info compiled from
Food Chaining: The Proven 6-Step Plan to Stop Picky Eating, Solve Feeding Problems, and Expand Your Child’s Diet. Buy it here.
Merry Mealtime Guide by Nina Ayd Johanson, MA, MS, CCC-SLP, CEIM, CHHP with Food Smart Kids
The SOS Approach to Feeding