My child is a picky eater, What do I do?
- dorothy599
- 5 days ago
- 7 min read
Updated: 2 hours ago
As parents, navigating the challenges of feeding children can be a complex journey, especially when faced with picky eating habits or more significant feeding difficulties.
From an occupational therapist's perspective, distinguishing between picky eaters and problem feeders and understanding the Sequential Oral Sensory (SOS) feeding program are essential for promoting positive mealtime experiences and healthy eating habits in children.
In this guide, we will explore the fundamentals of the SOS feeding program, shed light on the differences between picky eaters and problem feeders, and offer practical strategies for supporting your child's feeding journey.
Table of Contents
Developmental Feeding Milestones
Before diving into assessment of feeding, it is important to understand the developmental milestones that surround feeding, as there are several motor and visual skills that should be acquired before independently consuming food.
12-14 months |
Motor and postural stability
Oral motor
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18-24 months |
Motor and postural stability
Oral motor
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How can I tell a Picky Eater from a Problem Feeder?
It is crucial to assess whether a child is a picky eater or a problem feeder to effectively address their feeding challenges.
Picky eaters typically exhibit selective eating preferences, often avoiding certain textures, flavours, or food groups. While their eating habits may be restrictive, picky eaters generally maintain adequate growth and nutritional status.
On the other hand, problem feeders experience significant challenges with eating that extend beyond typical picky eating behaviours. These children may have aversions to a wide range of foods, struggle with oral motor skills, exhibit sensory sensitivities, or experience anxiety surrounding mealtimes.
Problem feeders are at risk of:
nutritional deficiencies
growth faltering
negative mealtime interactions
See key differences between Picky Eaters and Problem Feeders below:
Picky Eater | Problem Feeder |
Decreased range of variety of foods, will eat 30 or more foods | Restricted range or variety of foods, usually less than 20 foods |
Food jagging | Food lost due to food jags and are NOT re-acquired |
Able to tolerate new foods on play, can usually touch or taste new foods (even if reluctantly) | Refuses entire categories of food textures e.g. mushy goods including bananas, soft vegetables |
Eats at least one food from most or all texture groups | Almost always eats different foods than the family |
Frequently eats a different set of foods than the rest of the family, but usually eats with the family | Cries and ‘falls apart’ when presented with new foods |
Will add new foods to repertoire in 15-25 steps on the steps to eating feeding hierarchy | Adds new foods in more than 25 steps on the steps to eating hierarchy |
Questions to determine whether your child is a picky or problem eater
1. If you were to make a list of all of the foods that your child eats, how many foods would be on that list?
Picky Eaters generally eat at least 30 different foods.
Problem Feeders have a restricted range or variety of foods, and usually eat less than 20 foods.
2. What happens when they food jag (eat the same food over and over, then suddenly stop eating that food)?
Picky Eaters will normally accept and eat that food after taking a 2 week break without eating it.
Problem Feeders will rarely ever accept that food again, even after taking a break, and this often results in a decreasing number of foods in a child’s food range.
3. What happens if you put a new food on their plate?
Picky Eaters are generally able to tolerate new foods on their plate, and can usually touch or taste a new food, even if they do so very reluctantly.
Problem Feeders cry, protest, and “fall apart” when presented with new foods. They completely refuse to do anything with the food.
4. Do they eat at least one food from most nutrition (proteins, vegetables, etc.) and texture (purees, soft foods, chewy foods, etc.) categories?
Picky Eaters eat at least one food from most food texture and nutrition groups.
Problem Feeders refuse entire categories of food textures or nutrition groups.
5. What does their plate look like at meals compared to the rest of the family’s?
Picky Eaters frequently eat different foods at a meal than the rest of the family, but usually eat with the family.
Problem Feeders almost always eat different foods at a meal than the rest of the family, and often don’t eat with the family (either eat at separate times or eat alone in a separate space).
6. How hard is it for them to learn about new foods?
Picky Eaters will add new foods to their repertoire in 20-25 steps on the Steps to Eating Hierarchy.
Problem Feeders add new foods in more than 25 steps on the Steps to Eating Hierarchy.
7. How often has the child been reported as a “picky eater” at well-child check-ups?
Picky Eaters are sometimes reported by a parent as a “picky eater” at well-child check-ups.
Problem Feeders are persistently reported by a parent as a “picky eater” across multiple well-child check-ups.
The SOS steps to eating feeding hierarchy
The SOS feeding program, developed by Dr. Kay Toomey, is a comprehensive approach to addressing feeding difficulties in children.
In the SOS feeding approach, feeding problems can be conceptualised as the tip of the iceberg. The child’s feeding difficulties and weight gain are what everyone sees, but it is the underlying factors which cause and contribute to difficulty with feeding.
These factors include:
Organs (e.g. workings of the digestive system)
Every muscle (inside and out)
Sensory processing (including all 8 senses)
Learning history/style/capacity
Development
Nutritional status/history
Environment
The SOS feeding program aims to expand a child's food repertoire and create positive mealtime interactions through systematically exposing children to various foods.
The process to be comfortable with a food can be complex, and non-linear.
First, we must tolerate the physical presence or the look of the food. This might even include just being in the same room as the food. Then, perhaps, we can interact with the food without directly touching the food to your skin, maybe by using a kitchen utensil like a mini food chopper or a fork.
Next, our body needs to process and manage the smell or odor of a food. The play then expands to include touching the food with your fingers, hands, body, and mouth. Think about that baby first learning to eat!
Tasting comes next, which might look like quickly poking the food with the tip of your tongue, or maybe putting the food in your mouth, and spitting it out. Finally, we are ready to practice chewing and swallowing.
Practical Strategies to Support Your Child
Help support the child’s body: The best way for you to teach your child to listen to their body about when they are hungry and when they are full, is to have a structured and regular mealtime schedule. Offer 3 meals and 2-3 snacks every day at 2.5 – 3 hour intervals (measuring from start of one meal to start of next meal. Keep mealtimes to 15-30 minutes).
Create a Positive Mealtime Environment: Establishing a calm and positive atmosphere during meals can help reduce stress and anxiety for your child. Minimise distractions, such as screens or toys, and focus on fostering enjoyable family interactions around the table.
Offer a Variety of Foods: Introduce a diverse range of foods to your child's diet, including different textures, colours, and flavours. Encourage exploration and experimentation by involving your child in meal planning and grocery shopping.
Implement Gradual Exposure: Use the SOS feeding program's hierarchical approach to gradually expose your child to new foods and textures. Start with familiar foods and gradually introduce more challenging options over time, respecting your child's pace and preferences.
Incorporate Sensory Play: Engage your child in sensory play activities, such as touching, smelling, and tasting different foods outside of mealtime. This can help desensitize them to new sensations and increase their comfort level with unfamiliar foods.
Seek Professional Support: If your child's feeding difficulties persist or significantly impact their health and well-being, consider seeking guidance from a qualified occupational therapist or feeding specialist. They can conduct a comprehensive assessment and develop personalized intervention strategies to address your child's unique needs.
Final Thoughts
By understanding the principles of the SOS feeding program and recognising the differences between picky eaters and problem feeders, parents can be a proactive role in supporting their child's feeding journey. Through patience, consistency, and a nurturing approach, parents can empower their children to develop healthy eating habits and enjoy positive mealtime experiences.
References
American Occupational Therapy Association. (2018). Occupational therapy practice framework: Domain and process (3rd ed.). American Journal of Occupational Therapy, 68(Suppl. 1), S1-S48.
Arvedson, J. C. (2008). Pediatric swallowing and feeding: Assessment and management (2nd ed.). Singular Publishing Group.
Fraker, C., Fishbein, M., Cox, S., Walbert, L., & Toomey, K. (2014). Food Chaining: The Proven 6-Step Plan to Stop Picky Eating, Solve Feeding Problems, and Expand Your Child's Diet. Da Capo Lifelong Books.
Toomey, K., & Associates. (2010). SOS Approach to Feeding. Pro-Ed.
Our team of occupational therapists and speech pathologists can provide expert, tailored support for your child. Get in touch with us today to book an appointment.  | ||
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