Home Academia & Research Three Structures in a Child’s Mouth That Can Cause Picky Eating

Three Structures in a Child’s Mouth That Can Cause Picky Eating

by Melanie Potock MA
written by
Baby unwilling for feeding

Babies, toddlers, and older children can develop feeding difficulties—ranging from general picky eating to severe feeding disorders—for a variety of reasons. As a speech-language pathologist who specializes in feeding challenges in children, I peer into a lot of little mouths. In my professional experience, these three “mouth offenders” can shape a child’s willingness to try new foods.

Misaligned teeth: Crowded, missing or blocked teeth that haven’t erupted properly can impact a child’s ability to adequately chew food. The way the teeth contact each other might also indicate misalignment of the jaw. As a child’s face grows, the misalignment can worsen, affecting facial appearance and swallowing patterns. Kids who have trouble breaking down foods for comfortable swallowing might stick to softer foods, like macaroni and cheese, or meltables that blend easily with saliva, such as fish crackers. An anterior open bite—possibly caused by thumb, finger or pacifier sucking for prolonged periods—encourages the tongue to rest forward in the mouth. This forward posture might in turn create an immature swallowing pattern making certain foods difficult to propel back for swallowing. Once again, kids stick to certain foods because mechanically, they are just easier to eat. I suggest parents seek consultation with a pediatric dentist and a certified orofacial myologist.

Enlarged tonsils: The palatine tonsils are positioned neatly on the left and right side of the oral pharynx, in the back of the throat, nestled by the faucial pillars. Infection or the typical pattern of gradual tonsillar tissue growth from early childhood to the pre-teen years can cause enlargement. The issue is when they become too large in the relative small space of a child’s throat, affecting nasal and oral breathing, quality of sleep, and swallowing comfort. Kids with larger tonsils tend to gag easily because the tonsils contact the posterior edges of the tongue and pharyngeal surfaces, triggering the gag reflex. When children manipulate the tongue while eating the tonsillar tissue may also shift, once again eliciting a gag. Some children will gag first and then spit out the food. I often observe children with large tonsils attempt to spit out an offending food and gag in the process.  I suspect the forward movement of the tongue shifting the enlarged tonsillar tissue elicits the gag reflex. Gagging isn’t a pleasant experience and children quickly learn what foods to avoid and limit their food repertoire to what’s comfortable, predictable and safe. I suggest consultation with the child’s pediatrician or a pediatric otolaryngologist.

Tethered oral tissues: Tongue ties (ankyloglossia), lip ties and buccal ties can impede tongue, jaw and lip function.  When children can’t move these oral structures in a functional manner, problems can occur during various stages of feeding development. Ties can hinder a baby’s ability to breast and bottle feed, advance to solid foods or learn to eat a variety of foods in later childhood. On sharing my findings with a child’s caregivers and primary care physician, a pediatric dentist, oral surgeon or ENT will determine next steps.

More from The Leader:

Teaming Up to Correct Tongue Tie

The Tongue Was Involved, But What Was the Trouble?

Time to Move the Tongue Freely May Be Required to Develop Speech Perception


Melanie Potock, MA, CCC-SLP, treats children birth to teens who experience difficulty eating. She wrote the upcoming book, “Adventures in Veggieland: Help Your Kids Learn to Love Vegetables with 101 Easy Activities and Recipes.” Potock also co-authored “Raising a Healthy Happy Eater: A Stage-by-Stage Guide to Setting Your Child on the Path to Adventurous Eating (2015), “Baby Self-Feeding: Solid Food Solutions to Create Lifelong Healthy Eating Habits” and “Happy Mealtimes with Happy Kids, and produced the kids’ CD “Dancing in the Kitchen: Songs that Celebrate the Joy of Food!” Potock’s two-day course on pediatric feeding is offered for ASHA CEUs. She is an affiliate of ASHA Special Interest Group 13, Swallowing and Swallowing Disorders (Dysphagia). mymunchbug.com/contact-us/

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Cynthia Core August 22, 2017 - 8:03 pm

I’d like to see the evidence here. I also noticed that this needs copy editing. “Effecting” is not used correctly.

Shelley D. Hutchins August 23, 2017 - 2:23 pm

Thank you for pointing out our typo, Cynthia, and we corrected it! As for your question about evidence for this post, The Leader blog is a place to reflect the opinions, experiences, success stories and insights of our members. Melanie doesn’t make any evidence claims, only observations, in this post. We believe there is room in our professions to be able to talk about professional experiences, while still following EBP in treatment. We hope these posts and resulting discussions will help engender new evidence and research. We also welcome contributions from any ASHA member and encourage comments or counter-posts! https://blog.asha.org/blogger-application-form/

Robyn Merkel Walsh August 22, 2017 - 8:23 pm

Excellent Melanie !

Melanie Potock, MA, CCC-SLP August 23, 2017 - 11:42 am

Honored – such a fan of all you do Robyn, to help kids learn to love food!

Nicole Archambault Besson, EdS, MS, CCC-SLP August 28, 2017 - 11:20 pm

Thank you for an extremely worthwhile blog post and for sharing your expertise, Melanie! I appreciate your continued efforts to move our profession forward.

Melanie Potock, MA, CCC-SLP September 24, 2017 - 12:41 pm

Thank you Nichole! By the way, your article in the ASHA Leader this month was superb! Thank you for sharing your knowledge and compassion!

Busi September 7, 2017 - 12:31 pm

You’ve managed to add to some mysteries I have when dealing with children with feeding difficulties. Structural anomaly should never be undermined. Thank you.

Melanie Potock, MA, CCC-SLP September 24, 2017 - 12:41 pm

Thank you Busi!

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