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There are several different terminologies used to describe children with feeding difficulties. Some of the most commonly used terms are; selective eater, problem feeder, neophobic (afraid of new foods), food aversive, failure to thrive and of course “picky eaters.” The first thing to understand as a parent is to know it is NOT your fault and NO you did not do anything wrong. It’s also important for you to know that you are not alone! 1 in 3 parents identifies her child as a picky eater and up to 80% of children with developmental delays struggle with eating and research has noted that 3-25% of American children have feeding challenges.

First, it’s important to understand that feeding problems are common in childhood and almost all children experience some form of picky eating. Their pickiness may or may not coincide with developmental growth periods as your child starts to exert control and may show independence through eating habits. However, this is not the case for all children and picky eating habits evolve into a pattern of feeding selectivity and may progress to an eating problem or feeding disorder that can result in poor growth, failure to thrive and malnutrition.

Like everything in life, being a picky eater may stem from a diverse clusters of traits. Thus, it is imperative to understand the difference between a “picky eater”, an individual with strong preferences and/or eating behaviors and a child who has a true feeding disorder, a weak oral motor musculature and control, behavioral difficulties and deficits, or more pervasive neurologically based dysfunctions which compromise the child’s existence. This may include sensory integration disorder (SID), Asperger’s syndrome, Non-Verbal Learning Disability (NVLD), and/or Pervasive Developmental Disorder (PDD) and can include such symptoms as choking, gagging, vomiting, difficulty swallowing, etc. Additionally, physiological conditions that can create or exacerbate feeding problems include cystic fibrosis, cerebral palsy, autism, low muscle tone and allergies, as well as sensory, oral-motor, gastro, cardiac, metabolic and genetic disorders.

To varying degrees, children that present to be a picky eater may experience similar physical effects as children with feeding disorders, but the symptoms with picky eaters are often less severe and pervasive than in children with feeding disorders. Picky eaters are generally perceived by others as being stubborn, inflexible, obstinate and unadventurous. However, it’s important to note that rigidity and the inability to adjust to new foods generalize to anxiety and fear in the face of newness and change in all other aspects in life. At times, picky eaters may use food as a device to attract attention and/or exert undue control in family situations, and others, it may be because of an underlying sensory integration dysfunction (SPD) where the brain has trouble processing information through the senses. SPD affects about 16% of children in the United States.

SPD is common in children who have autism and attention deficit hyperactivity disorder, but it also affects a surprising number of other young children who do not present with autism or ADD/ADHD. Not any two children with SPD are the same; some may show sensitivities to things such as a tag on a shirt or the sound of a vacuum cleaner, while others may be uncoordinated, hard to engage in play or in constant motion. With SPD, foods with mixed textures can feel highly irritating and uncomfortable, while slippery or smooth foods that provide little input can be disorienting. Some children may squeeze you too hard for comfort, grind their teeth, or hold their hands over their ears trying to regulate or sooth themselves while others may break into an uncontrollable tantrum.

Children classified as having a feeding disorder do not consume enough calories and nutrients to promote healthy growth and development, whereas a picky eater may consume a restricted but still nourishing diet, for example, only three to four types of foods, eliminating entire food groups and compromising healthy growth. Some children can have aversions to food groups or certain textures and colors, while others lack the skills to self-feed or refuse to eat any food at all.

Another contributing factor could be if your child presents with motor challenges. This translates into not having proper jaw function that’s the foundation for oral motor skills, including coordinated tongue movements that are essential to feeding and swallowing such as transferring of the food from one side of the mouth to the other, proper mastication, lip closure to keep food in, and tightening of the cheek muscles to keep food out of the cheeks (pocketing/holding the food a long period of time). Often times you may see your child bringing the food towards the front of their mouth rather than chewing with their molars which requires greater chewing force and precision. They may exhaust quickly after only a couple of bites and may take an extended time to complete a meal and at times may not complete it entirely. Moving the tongue only in and out and up and down leaves children able to eat only soft, mashable foods whereas being able to laterlize (move sideways) is necessary for chewing harder foods and collecting food out of the cheeks and teeth to be swallowed. Insufficient mastication (chewing) will result in a poorly formed bolus (food in mouth) which may lead to spitting the food out or swallowing the food half chewed endangering your child of “gagging” or “choking” when eating and/or drinking. Your child may also present with an open mouth posture, often times with their tongue rested on their bottom lip or drooling when he/she is not teething.

A picky eater is defined as: not eating enough quantity or variety to support a healthy emotional, physical, or social development or eating patterns that are a significant source of conflict or worry.

Ok, so how DO you distinguish if your child is a picky eater: 

  1. Does your child eat fewer than 10-20 foods and really struggle to try new foods
  2. Eats different foods than the rest of the family and/or peers
  3. Becomes upset around new foods
  4. Limited range of accepted foods and refusal of unfamiliar foods
  5. Does your child fails to eat adequately and gain weight or presents with significant weight loss over at least 1 month
  6. Are the disturbance due to gastrointestinal or other general medical condition (e.g., esophageal reflux)
  7. Does your child consistently refuse to eat foods with specific tastes, textures, or smells.
  8. Did the onset of the food refusal occurs during the introduction of a novel type of food (e.g., the child may drink one type of milk but refuse another, may eat carrots but refuse green beans, may drink milk but refuse baby food)
  9. Does your child eat without difficulty when offered preferred foods, and the food refusal causes specific nutritional deficiencies or a delay of oral-motor development
  10. Does your child become upset or cry often around food
  11. Does your child have documented nutritional deficiencies
  12. Is your child falling off their own growth curve
  13. Does your child have poor energy and/or frequent meltdowns when hungry
  14. Does your child have difficulties going to sleep in social gatherings
  15. Is your child indifferent to “pocketing” food (where it gets stuck in the cheeks)PICKYEATERS

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