Home Speech-Language Pathology Typical Picky Eating or Something Else?

Typical Picky Eating or Something Else?

by Melanie Potock MA
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Child spitting out food

Child spitting out food

Many children go through a phase of picky eating as toddlers or preschoolers, but what appears to be just a phase might indicate something more serious. At least 20 percent of apparently typical children get diagnosed with feeding disorders. I most commonly treat infants, toddlers and young school-age children; however, increased awareness in the media about avoidant restrictive food intake disorder (ARFID) caused more parents to inquire about feeding treatment. They often say they expected their child to grow out of the picky stage but, sadly, it’s only getting worse.

Learning to eat a variety of foods is a developmental process just like learning to crawl, walk and run. When kids stall in any developmental process, early intervention helps them get back on track. When it comes to eating, not only is the child’s nutritional status at stake, but apprehension around the social aspects of dining out, enjoying family mealtimes and interacting with peers at school or community events take a toll on kids who are hesitant eaters. It’s often not as simple as, “Just try it, you’ll like it!” when a child has been a “picky eater” for most of his life.

Parents of children with special needs might already know a possibility of a feeding disorder exists. But for children who otherwise appear typically developing, these signs might indicate the need for a feeding evaluation:

Infants experience:

  • Difficult and stressful feeding sessions, rather than enjoyable ones. A feeding specialist acts as a feeding detective and helps parents figure out why.
  • No weight gain. An SLP with feeding expertise collaborates with a pediatrician and other professionals to examine all possibilities as to why.
  • Trouble transitioning to purees or solid foods.
  • Gagging and/or vomiting daily.
  • Inability to drink from an open cup with assistance, or can’t drink from a straw by 1 year, despite trying to learn.

Toddlers, preschoolers and school-age children experience:

  • Frustrating feeding sessions. Challenging behaviors that parents can’t solve on their own include a toddler not sitting still in his highchair; throwing bowls, utensils or food; and preferring to graze and play.
  • Lack of a steady growth curve, with a diagnosis of “underweight” or “failure to thrive.”
  • Successful eating in one environment, but not in another, such as home/daycare/school environments, or when two parents live in different homes.
  • Families who refer to the child as “the picky eater in the family” and make accommodations on a regular basis for him/her.
  • Food allergies that limit social interactions or willingness to try new foods. For example, when a child suddenly becomes allergic to dairy products yet selects a diet of 50 percent dairy-based foods, the child’s ability to get adequate nutrition becomes at risk. Learning to try new, non-preferred foods isn’t always easy for kids with an already limited repertoire.
  • Inability to eat in stimulating environments, such as the school cafeteria or a bustling restaurant.
  • Desire to try new foods, but anxiety around doing so.

Most important, if parents find their child’s reluctance to try new foods creates stress for the child or any member of the family, it’s best to consult with the child’s pediatrician immediately. Early intervention can often prevent a hesitant eater from becoming more selective over time.


Melanie Potock, MA, CCC-SLP, treats children, birth to teens, who have difficulty eating. She is the co-author of “Raising a Healthy, Happy Eater: A Parent’s Handbook—A Stage by Stage Guide to Setting Your Child on the Path to Adventurous Eating,” the author of “Happy Mealtimes with Happy Kids,” and the producer of the award-winning kids’ CD: “Dancing in the Kitchen: Songs That Celebrate the Joy of Food!mymunchbug.com/contact-us 

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Lauren Tarzia March 10, 2016 - 2:42 pm

I’m interested to hear your thoughts on school-based feeding evaluations and need for therapy. If you have a child who’s healthy and growing, eating independently in school and eating less preferred food in school but not at home what would you suggest the school should responsible for? Is this much more of a behavior type of therapy?

Melanie Potock March 10, 2016 - 11:14 pm

Hi Lauren, If the child is having difficulty eating at home, but not at school (if I understood your comments correctly) and thus is getting adequate nutrition/calories to learn well at school, it doesn’t feel like a something that the school would be responsible for. But I’d love to hear from other therapists on this one. Regarding the type of therapy for home, the first step would be an evaluation to determine why the child chooses those foods over the others provided at school. For example, perhaps it’s that the food at school is easier to chew and the foods at home are more challenging. Or, the environment may play a factor. Perhaps the child’s seating at home is contributing to silent reflux and pain. It might be a parenting style that is coming into play. Regardless, an evaluation should assess physiological and sensory components, motor components and learned behaviors, as well as family dynamics. It’s a complicated and often, not just one factor that is hindering feeding progress. Hope that’s helpful info and thank you for commenting.

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