What causes feeding problems?  Is it a parent who won’t stand up to their child?  Is it a child so head strong no one can reason with him?  Is it a food allergy causing a disrupted GI tract?  Or is a disrupted GI tract causing an intolerance to food?  Is the child’s sensory system an issue?  Or does the child have an underlying disorder causing a disrupted sensory system?  Which came first, the chicken or the egg?  Why did the chicken cross the road?  Squirrel…

Working with an older child experiencing picky eating can be challenging to figure out.  The above description is not far off from a conversation a parent might have in his or her head multiple times a day.  The truth is, what started the picky eating may not be the factor that is keeping it going.  The longer the issue has persisted, the harder it can be to figure out what caused it.  And to make matters worse, the longer it has persisted, the more factors that may be keeping it going.  Not to mention the fact that the original cause may not even be a factor anymore.  So what do we do about the feeding problem?  Where do we start?

Building a Strong Foundation

First things first, develop a healthy foundation for meals and snacks.  Create a meal/snack schedule that prevents your child from grazing throughout the day.  A typical schedule may be similar to this:

• 7:00am Breakfast
• 9:30am Snack
• 12:00 Lunch
• 3:00 Snack
• 6:00 Dinner

Schedules can be adjusted to work around family and school activities.  The goal is to have 2-3 hours between meals and snacks and prevent grazing in-between.  This encourages appropriate hunger before scheduled meals allowing for a better opportunity to try new foods.

Next, keep food fun.  While our goal is to encourage new foods, we have to remember that exposure to new foods can be stressful because of past experiences.  We have to start by changing those experiences into a fun, relaxing environment.  Exposure does not equal eating.  There are many other ways to be exposed to foods without swallowing them.  Here are ways to expose your child to new foods:

• grocery shopping
• cooking or baking
• setting the table
• serving other people their food
• letting a non-preferred food sit on their plate without eating it
• tolerating their toys playing in the new food
• touching the new food
• kissing the new food
• licking the new food
• biting and spiting out the new food

Keeping exposure to new foods fun and low stress is the best way for your child to decide on their own they may want to eat it.  It will also help take the battle out of meal time.

Most importantly, remember who is responsible for what.  This is called the division of responsibility.  Ellyn Satter’s Division of Responsibility is a wonderful way to remember who does what at meal time.  The parents are only responsible for what is presented, when it is presented and where it is presented.  The child is responsible for how much they eat from the choices they are given.  As your child begins to tolerate new foods on his or her plate, provide your child with 2 foods they like and 1 food they do not like during each meal.  Following the division of responsibility using this format removes the battle from meal time, encourages exposure to new foods and helps to develop healthy eating habits.

Seeking Medical Help

While a good foundation is key to improving eating habits, we also have to make sure that any medical, underlying causes are addressed.  A few common medical diagnosis I see are the following:

• Reflux is a leading cause of picky eating.  If the patient is still having reflux, we must manage this medically before real progress will be made with picky eating.
• Food allergens is another common cause.  If the child is allergic to a particular food or food group (gluten, dairy, etc.), we must work to eliminate or reduce that portion of the child’s diet.  This is way easier said than done.  Humans tend to crave what they are allergic to (weird, I know).  Because of this, it is often challenging to eliminate an allergen from a picky eaters diet.  The allergen may be present in a considerable amount of the child’s preferred foods.  But, without removing the cause, real progress will be virtually impossible.
• Anxiety with food may be the original medical cause for picky eating or may be a bi-product of something else.  Either way, the anxiety may need medical management before progress can be made.

Chicken or the Egg?

So you can’t help a picky eater without removing the initial cause of their picky eating…but removing the initial cause may not be enough to restore healthy eating habits.  This is why a speech therapist must work in conjunction with other members of the medical team (PCP, Gastroenterologist, Dietician, Cardiologist, Psychologist, etc.) to fully restore healthy eating habits.  Developing healthy eating habits takes time.  Feeding therapy is lengthy and progress happens in small strides.  With consistent and steady change in meal-time structure, collaboration with the medical team as needed, and addressing any oral motor issues that have arose over time, progress will happen and healthy eating habits will develop.