Helping Your Child with Extreme Picky Eating

1. Understand typical eating development to gauge your child's progress

Young children don't eat the way we're told they should.

Typical eating is unpredictable. Children's eating patterns vary greatly from meal to meal and day to day. They may eat large amounts some days and little on others, refuse favorite foods on a whim, and prefer carbohydrates. This variability is normal and doesn't necessarily indicate a problem.

Growth patterns differ. The largest determinant of a child's adult height and weight is genetics. Growth charts should be used as a tool to track progress over time, not as a report card. Labels like "failure to thrive" can be misleading and inconsistently applied.

Developmental milestones vary. The process of learning to eat solids typically takes two to three years, beginning around six months of age. Skills like chewing and self-feeding develop at different rates for different children. Gagging is a normal part of learning to eat and usually resolves as children gain more experience with different textures.

2. Recognize and address underlying causes of extreme picky eating

Children do well when they can.

Medical issues: Pain, reflux, allergies, or other medical conditions can contribute to food refusal. These should be ruled out or addressed by a healthcare professional.

Oral motor challenges: Difficulties with chewing, swallowing, or coordinating mouth movements can make eating certain textures challenging.

Sensory processing: Some children may be hypersensitive or hyposensitive to textures, tastes, smells, or other sensory aspects of food.

Temperament and anxiety: A cautious temperament, strong desire for control, or anxiety can all contribute to picky eating behaviors.

Negative experiences: Past choking episodes, forced feeding, or other traumatic experiences with food can create lasting aversions.

3. Implement a worry-free approach to feeding your child

Anxiety, fear, and conflict turn off appetite and make children eat and grow less well.

Address parental anxiety. Recognize that your own worries about nutrition, growth, or your child's eating habits can contribute to mealtime stress. Focus on creating a positive atmosphere rather than enforcing specific intake goals.

Avoid pressure tactics. Bribes, threats, praise for eating, or insisting on "just one bite" can backfire and increase anxiety around food. Instead, trust your child to eat according to their own internal cues of hunger and fullness.

Reframe "encouragement" as "facilitation." Rather than trying to get your child to eat, focus on creating an environment where they feel safe to explore food at their own pace. This might include:

• Offering a variety of foods without comment
• Allowing messy eating and food play
• Modeling enjoyment of different foods yourself

4. Establish a structured routine for meals and snacks

Routine helps behavior, anxiety, and appetite.

Set regular mealtimes. Aim for 4-5 eating opportunities per day, spaced 2-4 hours apart depending on the child's age. This helps optimize appetite and provides a sense of predictability.

Avoid grazing. Constant snacking or sipping on caloric drinks between meals can dull appetite and interfere with hunger cues. Stick to water between eating opportunities.

Be flexible within structure. While consistency is important, allow for some flexibility to accommodate special occasions or changing schedules. The goal is a general framework, not rigid rules.

Manage transitions. Use visual schedules, timers, or verbal cues to help children prepare for mealtimes. This can be especially helpful for children who struggle with changes in routine.

5. Create positive family meal experiences

You are the most important thing at the table, not the vegetables.

Focus on connection, not consumption. Make mealtimes about enjoying each other's company rather than monitoring what or how much your child eats. Engage in pleasant conversation unrelated to food.

Model positive eating behaviors. Children learn by watching their parents and siblings. Demonstrate enjoyment of a variety of foods without pressuring your child to try them.

Set a welcoming atmosphere. Consider:

• Using comfortable seating with good support
• Minimizing distractions like TV or phones
• Using pleasant lighting and tableware
• Involving children in age-appropriate meal preparation or table-setting tasks

Be patient with manners. For now, prioritize a relaxed atmosphere over perfect table manners. As anxiety decreases, there will be opportunities to work on skills like using utensils or sitting through a full meal.

6. Serve a variety of foods family-style to reduce pressure

Serving family style sounds intimidating, but it simply means putting the food in the middle of the table so everyone can serve themselves.

Offer, don't insist. Present a variety of foods, including at least one "safe" food your child reliably eats, but allow them to choose what and how much to put on their plate.

Serve dessert with the meal. This removes the power struggle over "earning" dessert and allows children to learn to balance different foods.

Provide paper napkins for discreet spitting. This reduces anxiety about trying new foods, as children know they have an "escape route" if they don't like something.

Consider presentation:

• Cut foods into manageable sizes
• Offer dips or sauces separately
• Use divided plates if your child prefers foods not to touch
• Experiment with different temperatures (some children prefer room temperature foods)

7. Build skills and familiarity with food through play and exploration

If you wouldn't touch something with your hands, would you eat it?

Encourage sensory play. Activities like playing with rice in a bin, finger painting, or making mud pies can help children become more comfortable with different textures.

Cook together. Involve children in age-appropriate food preparation tasks. This builds familiarity with ingredients without pressure to eat.

Garden or visit farms. Growing food or seeing where it comes from can increase interest and willingness to try new things.

Use food in non-eating activities. Try:

• Making stamps out of cut vegetables
• Using foods for counting or sorting games
• Creating art projects with dry pasta or beans

Offer opportunities to explore without eating. Allow children to touch, smell, or lick foods without expectation that they will eat them. This builds comfort and familiarity over time.

8. Evaluate and choose appropriate therapy options if needed

A good feeding therapist is a diagnostician who can put together the pieces of the puzzle (your child's history and current issues, and how feeding is going) and synthesize the information to come up with a plan.

Consider an evaluation if:

• Your child is losing weight or not gaining appropriately
• There are signs of swallowing difficulties
• Frequent gagging or vomiting occurs
• Your child can't progress beyond purees by 15 months (given appropriate opportunities)
• You feel overwhelmed and need professional guidance

Understand therapy options. Approaches range from play-based interventions that support internal motivation to more structured behavioral programs. Choose an approach that aligns with your family's values and your child's needs.

Look for a good fit. A therapist should:

• Be developmentally appropriate in their approach
• Support both you and your child
• Teach you skills to use at home
• Help you recognize progress

Remember that you are the expert on your child. Trust your instincts and don't be afraid to seek a second opinion or change therapists if something doesn't feel right.

Last updated: November 21, 2024