As a pediatric occupational therapist I encounter a large amount of children that have feeding disorders of all varieties. Of all the problems that I see and address, feeding is by far the most distressing problem to both the parent and the child. Because of the wide range of symptoms and problems, there is obviously no cookie cutter approach to addressing feeding. However, it is important as a therapist to determine an underlying cause. Is the behavior just typical picky eating? Is there an underlying physical problem? Is it sensory based? The purpose of this post is to help parents determine whether their picky eater may need additional evaluation or intervention.
Children can make limited food choices for a myriad of different reasons ranging from food allergies, sensory issues, or an honest dislike of a food. While sensory issues can cause picky eating, not all picky eating is sensory based, but how do parents differentiate between the two? Nearly half of all children could be considered picky eaters, and it is an extremely common part of childhood. However, if you are a parent who is wondering if your child’s feeding behaviors go beyond picky eating and into the realm of selective eating or sensory related feeding disorders then consider the following information:
- Children with sensory based food selectivity typically eat less than 10 food items. While your child may seem extremely picky, consider all the different foods that he/she eats. You may be surprised! You may even consider logging the food for 3 days to see the variety.
- Children who are “picky” typically will eat a limited number of foods, but will eat something to represent each food group. While limited, they will often still have a well-rounded diet.
- Picky eaters will have an expanding food repertoire even if it expands extremely slowly. It is common for picky children to ask for one food all the time, reject it, and then go back to it again. Overall, however, there will be an increase. Selective eaters typically will decrease their food repertoire and will never go back to a rejected food.
- Children that are picky typically can tolerate watching other people eat food they don’t like, whereas selective eaters may gag or vomit watching another eat a food they don’t accept. (Warning: Not all gagging should be considered a warning sign for sensory based feeding disorder. Gagging is often a natural response to a strong dislike of a food and becomes a learned behavior to avoid something when reinforced by a caregiver).
- Selective eaters may display more extreme patterns of behavior such as crying or extreme distress, head turning, spitting out food, throwing food and utensils, packing food in his mouth, coughing/gagging, and leaving the dinner table. Most kids will go through a phase of having tantrums at some point, and some tantrums could be related to picky eating. However, the extreme behaviors listed above are fairly consistent and will typically occur even when the child is through the “tantrum” phase and doesn’t tantrum for other reasons.
- Children with food sensitivities may not properly digest their food, if a meal is followed by messy diapers or multiple trips to the toilet this could be a sign of a problem that is beyond picky eating.
- Children with sensory based feeding disorders typically show patterns to aversions to food groups or certain textures or colors. These aversions can seem unusual or even extreme (i.e. avoiding ALL brown foods, ALL cold foods, ALL fruits, ALL crunchy foods, etc.). This kind of restriction is particularly dangerous as elimination of whole food groups is possible. This could compromise healthy growth and development.
- Sensory based selective eaters may have intensified sensory perceptions of food. For example something served warm may seem unbearably hot, something mild may be described as “bitter”, something sweet may be perceived as extremely sweet or even sour.
If any of these warning signs sound too familiar to you, first go visit your family doctor or pediatrician. Come prepared with a food log of the past 3 days of eating, as well as a list of all behaviors that occur. Your physician may recommend further testing for food allergies and sensitivities or may suggest a consult/evaluation with a dietician or occupational therapist.
Written by Rebecca Smith, Occupational Therapist