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I Think I Have a Picky Eater, Now What?

Updated: May 8, 2023

Sometimes the most challenging part of seeking support is determining if there is even a “problem”. It can be difficult to know what is “normal” and what warrants concern, especially when it comes to little ones or children with different abilities. What may be a behaviour of concern for one child may not be a concern for another child. Many caregivers report that when they seek advice or assistance from certain professionals the response is often...”my child did that too, he’ll probably grow out of it”, “she is still in a healthy range on the growth chart, keep giving the meal enhancer and she should be fine” or “try cutting back on the foods they REALLY like, they’ll get hungry and start to try new foods”. Many caregivers come to us expressing frustration over receiving these types of responses. A study conducted by McDermott, Mmun, Najman, Williams, O’Callaghan & Bar in 2009 indicated that 40% of children who were “irregular eaters” at 5 years of age were found to be “irregular eaters” at 14 years of age. Unfortunately, there is no one answer, and the most important consideration is the child’s overall health and nutritional intake.

That said, it is also important to review stress levels of caregivers and children and the social impacts that rigidity or restrictions on food and mealtimes have on everyone involved.

The first step is ALWAYS seeking out medical advice if you or any caregiver have concerns about a child’s nutrition or health. So, if you have concerns and you have not spoken with your family physician or pediatrician this is the first step. Have a look at this chart, if you answer “yes” to any of the questions below make an appointment with your family physician.


Question

Answer

Action

Is there any concern about the child’s nutritional intake?

Yes

Call family doctor

Is there any concern that the child is not getting enough food daily?

Yes

Call family doctor

How long has there been a concern?

*3 months or more

Call family doctor *you don't have to wait 3 months! Call as soon as you are concerned

Are there any other health concerns that coincide with the feeding issues?

Yes Examples: constipation, lack of specific vitamins, proteins or minerals in their diet, fatigue

Call family doctor

Are there any mental health or emotional implications for the child?

Yes

Call family doctor

Are there any mental health or emotional implications for the caregivers?

Yes Examples: increased stress around meal preparation, increased worry regarding child’s wellbeing

Call family doctor

Are there any social impacts on the caregiver, child or others?

Yes Examples: unable to join birthday parties, restricted to eating only at home or bringing specific foods to events, interferes with joining social events with family and friends

Call family doctor

Share all your concerns with your physician. Ask questions about the child’s:

  • ears, nose and throat

  • tummy and gastrointestinal functions

  • possibility of allergies or food sensitivities

  • respiratory functions

  • report any frequent illness or reoccurring illnesses

  • Anything else that you have observed and are concerned about - there are no wrong questions!

Once the doctor has medically cleared the child and determines that they are a safe oral feeder and there are no medical concerns that are the cause of the eating/feeding issues you may want to seek out assistance from a speech language pathologist, occupational therapist or board certified behaviour analyst. Now, I’m guessing the next question is who helps with what?? Below is a general overview of what each professional can assist with. Please keep in mind this is not an exhaustive list and not every speech language pathologist, occupational therapist or board certified behaviour analyst has the experience or skills required to provide you with assistance in eating/feeding so be sure to ask them about their experience and the approaches they like to use when working with children to develop skills needed for mealtime and eating.


Speech Language Pathologist (SLP)

Occupational Therapist (OT)

Board Certified Behaviour Analyst (BCBA)

Assessment of chewing and swallowing

Assessment of fine motor skills

Mealtime routines & environmental set up

Assessment of oral motor skills

Assessment of gross motor skills

Structuring & scheduling of meals & snacks throughout the day

Strategies on how to develop oral motor skills needed for eating

Assessment of environmental set up (e.g., chair, body positioning etc.)

Increasing cooperation with trying new foods

Recommendations on bite sizes based on oral motor skills

Strategies for increasing fine & gross motor skills associated with eating (e.g., using a fork or spoon, helpful instruments to use at mealtime etc.)

Increasing cooperation & flexibility with mealtimes (e.g., sitting at the table, introduction of eating in new environments, new utensils, new brands etc.)

Recommendations on textures

Strategies for children who have been diagnosed with sensory processing issues

Decreasing behaviours that interfere with consumption (e.g., expelling food, spitting, etc.) & challenging behaviour during meals (e.g., running away, aggression, self-injury, property destruction)

Other strategies associated with oral motor development, chewing & swallowing

Other strategies associated with fine and gross motor development, materials and environmental set up

Other strategies associated with increasing cooperation with mealtimes and trying new foods

If you are looking for recommendations for nutritional intake or caloric intake it is best to ask your physician if they have any resources to share or if they can refer you to a dietician.


In an ideal world a team would be built to incorporate all these professionals, unfortunately there are not many teams currently available to provide that service. The good news is most SLPs, OTs and BCBAs are VERY happy to collaborate and provide an interdisciplinary service that is organized by a parent or case worker.


If you have concerns hopefully this information has helped you determine the next step. If you are still unsure and want to speak to someone, please contact us.



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