A concern I hear most from parents is that their child is a picky eater. At some point, most parents will experience some type of picky eating with their child. Typically it’s either during the toddler stage when a child is discovering their control, or it’s an older child on a food jag. Most children will go through stages of accepting foods and then later rejecting them, it’s very normal. When picky eating continues to get worse, and food continues to be rejected and food groups or textures eliminated, the picky eater can become a problem feeder.
Dr. Kay Toomey, a pediatric psychologist, has spent nearly 30 years working with children who don’t eat. Based on her experience, she has defined picky eating behavior into two groups; the problem feeder and the picky eater. She provides distinct approaches for treatment that I incorporate into my treatment strategy with each family.
What is a Picky Eater vs. Problem Feeder?
Most of the time when a child is a picky eater, a behavioral approach at home based on principles and philosophies from feeding expert Ellyn Satter, dietitian and counselor, can help turn the problem around. A picky eater can turn into a problem feeder if the behavior in the home environment becomes stressful and/or the parent allows a child to dictate their food preferences.
Helpful tips for parents with picky eaters:
1) Have a consistent schedule with meals and snacks.
3) Don’t bribe, reward or punish at meals.
4) Make one meal for the family, take into consideration your children’s preferences.
5) Make it fun and talk positive about food.
6) Remember it can take 10-15 exposures prior to your child accepting a new food
When a child is a problem feeder, I refer to Kay Toomey’s Sequencial approach for treatment, which is based on a 6 step approach to accepting new foods. The first step is as simple as tolerating the food on the table or plate and working up to smelling, touching and finally tasting. Helping a child who is a problem feeder is a marathon not a sprint and it’s important to recognize all of these small achievements along the way and be supportive and encouraging
Often this process involves 30-50 food exposures which is required for these type of problem feeders. With older children (older then 7) I work with families on food challenges, where food tastes and exposure are daily homework with goals to work towards 30-50 bites over several weeks, which often result in a child accepting, rejecting or being willing to keep trying the food. This approach works best with small awards and a motivated child. Younger children benefit from an approach around food chaining and introducing new foods that are very similar to foods they accept already. If I suspect an oral motor delay or a sensory-related food aversion, I recommend a referral to an OT and/or SLP for an evaluation and treatment plan. Oral motor delays or sensory food aversions can be the root cause of the problem feeder.
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