Finding a way to get nutrition is an instinct and skill that we are born with. This is why it is so common for babies to be given to the mother for breastfeeding almost immediately after birth. For many babies and mothers this is a process that goes smoothly and easily. As baby grows, he/she is introduced to many new experiences with feeding. While there may be a few “bumps in the road,” most children will overcome them and it does not become a problem. However, this may not be the case for all children.

There are children who experience feeding difficulties, which can take place as early as infancy with breast or bottle feeding, or they can take place at any of the stages of feeding – transitioning to purees, weaning off a bottle/breast, transitioning to solid foods and beyond. Signs you may see include: gagging, coughing, vomiting, spitting out food, pocketing food in their cheeks, taking a long time to eat or fussiness/crying. If a child experiences difficulty with feeding at any age, it can lead to more complicated issues later on.

Some feeding difficulties may be more subtle at first, but as children get older and venture into an ever-expanding variety of tastes and textures, difficulties can become more apparent. Refusal to eat foods is typically not a behavior issue, but rather is often a sign that a child is having difficulty. There are many possible reasons for the difficulties – they could be a medical issue, a physical issue, a sensory issue, a motor-planning issue or a combination of these. These difficulties are often the underlying cause of picky eating.

What is picky eating?

Picky eating refers to children who will only eat the same set of foods over and over again, refuse to eat certain foods or refuse to try new foods. They seem to be limiting their diet, for reasons which may be unclear to you. There are times when some picky eating is common in children — especially in toddlers who are trying to be more independent and want to exert control. In these situations you should eventually see it resolve on its own. If it persists, then there may actually be a problem.

Today, there are so many prepared foods that are targeted specifically to kids, which are quick and easy – such as fruit and veggie pouches, “to go” yogurts, frozen mini-pizzas or fun-shaped chicken nuggets, just to name a few. We are all (or at least most of us are) guilty of indulging in some of these quick and easy foods from time to time and that is okay But, for some kids, this is not a “once in a while” type of food, but rather becomes the only food they will eat. This is when it raises some red flags.

When we’re talking about picky eaters, we must look at the child’s diet as a whole. Here are some sample questions we need to ask in order to determine when a child’s picky eating is problematic:

• Is there a variety of foods in their diet, which includes foods from all the different food categories (fruits, vegetables, proteins, dairy, etc.)? Or, is their diet more limited? For example:

o Does his/her diet consist of mostly carbohydrates (ex: pasta, rice, bread, french fries, etc.) and not much protein?

o Are food pouches the only way that he/she will eat vegetables or fruits?

o Does he/she drink (milk, juice, water) all day long, and eat very little solid food?

• Are there strong preferences for eating only specific consistencies (for example only crunchy foods vs. only soft foods); or only specific tastes (such as only salty foods or only sweet foods, etc.); and so on.

• Are there specific “rules” of what they will and won’t accept? And, how limited is that group of “acceptable foods”? At times, children will become extremely specific.

There are other issues that could indicate a problem as well. We also need to look at the child’s emotions and reactions around foods and/or mealtimes; as well as the impact the picky eating is having in your family’s daily life.

• What is his/her reaction to foods?

o Does he/she get upset, tantrum, or refuse to eat certain foods or to try new foods?

o Do you struggle to get that first “bite” in, but then he/she will eat it?

o Does he/she gag if a food they don’t like is seen or near them?

o Will he/she get upset or refuse if a food they like is cut/served differently than usual?

• What is your response to mealtime?

o Do you worry that he/she is not getting enough nutrition?

o Do you worry that you can’t go out to eat (at a friend’s house on Shabbat, or at a restaurant, because “there’s nothing they will eat”; or you fear that they’ll tantrum?)

o Has mealtime become stressful for you/your family?

Additionally, feeding difficulties and/or picky eating can also often lead to growth and development issues. Your pediatrician may mention concerns about your child’s weight (such as poor weight gain), or growth-chart patterns (such as low percentiles for height/weight). Feeding issues can affect their milestones (crawling, walking, talking), their sleep habits and focus in school (in older children).

If you have concerns about your child’s feeding skills or eating habits, at any age, reach out to your child’s pediatrician, and to a feeding specialist (a speech- language pathologist who is specifically trained in feeding issues). The feeding specialist can evaluate your child and determine if a feeding difficulty or picky eating is present, and make recommendations about if, and what type of therapy or treatment is needed.

By Susan (Shoshana) Rothschild, M.S., CCC-SLP

Susan Rothschild, M.S., CCC-SLP is a licensed speech- language pathologist, and owner of Horizon Speech Therapy Services®, located in Hackensack, New Jersey, which specializes in speech and feeding evaluations and therapy. Her sensory-motor approach to feeding has helped many children improve their skills, increase their confidence in eating and improve their nutrition which is essential for their growth and development. For more information, call 201-880-6009, text 201-775-9409 or send an email to: [email protected].