While eating is second nature to most of us and our biggest concern regarding food is when/what we will eat next, it is not that straightforward for many kiddos. The act of eating involves many different components that go unnoticed by most of us – things like the surrounding environment, what the plate looks like, what the food itself looks like, what happens to the food once you take a bite, how the tongue needs to be moved to keep a bite from going down too soon, and many others. When considering why your child might be a picky eater, though, we can break down most issues into one of four main causes:
#1: Medical
Does your child have (or in the past had) reflux? Does he have allergies? Is she taking any medications that might have side effects that impact appetite? Is he constipated? Are there any other medical concerns going on right now that could impact eating? These issues could easily impact your child’s desire to eat.
If your child has reflux or is constipated, eating hurts. If every time you put on a specific pair of shoes and you get a blister, you are most likely NOT going to want to wear those shoes every day. Having an allergic reaction can quickly cause kids to avoid any foods that remind them of the way that felt. It is important to rule out and/or manage any medical factors before assuming your child is simply being stubborn at mealtime.
#2: Oral Motor
Oral motor skills require the use of all of the different facial muscles – both their strength and movement together to chew/manipulate food and drink and coordinate a safe swallow (and speak…but that’s a whole different post!) are necessary. A lot of skills are required to eat foods safely, such as: tongue elevation, tongue lateralization, jaw strength, coordination, lip seal, timing…we could go on, but you get it…it’s complicated! These skills are typically stunted if a child exhibits muscle weakness (low tone), coordination difficulties, limited tongue mobility, jaw misalignment (overbite/underbite), enlarged tonsils and adenoids, and certain other conditions.
Things children do when eating that are red flags for oral motor difficulties include, but are not limited to: putting fingers in the mouth while eating, taking small bites, chewing one bite for a ridiculously long time, overstuffing the mouth, coughing, gagging, vomiting, spitting out, pocking (saving that piece of chicken in their cheek for three hours!), taking FOREVERRRRR to eat and/or needing breaks during meal time.
In addition to these oral motor weakness red flags, aspiration (food/drink going into the lungs instead of the stomach) is another possible hazard resulting from oral motor weakness. Signs/symptoms of aspiration include coughing during/after meals and sips, watery eyes, gurgly voice (again, after meals and sips), and frequent upper respiratory infections.
If your child is showing any of these red flags, an evaluation from a Speech-Language Pathologist with feeding training is important.
#3: Sensory
We all know the five traditionally recognized senses…sight, smell, touch, taste, and hearing. Occupational therapists also include balance (known as vestibular sense) and proprioception (awareness of body in space) into their list of senses. How do your senses impact feeding?
Taste: We all know flavor plays a big role in food. Some like pepperoni pizza and others prefer plain cheese. You know what tastes good to you. Peanut butter and jelly to your child could be like brussels sprouts to you!
Smell: Have you ever been at a restaurant and someone at the table ordered a tuna sandwich and it made your burger less appetizing? The surrounding smells, as well as the food we are eating, dramatically impact our experience with food.
Sight: What food looks like, as well as the environment we are in (busy, distracting, or calm) can impact a child’s visual system and cause shutdown (or overstimulation). Kiddos that are visually overwhelmed might turn away from the food and/or push the food away.
Hearing: If either the environment is too loud, or the food is super crunchy and loud in your head (think of when you bite celery…WOWZA!), a child may resist eating.
Touch: Everyone responds differently to different textures. Some people have no problem throwing their hands into a bowl of raw meat to make burgers, while others will run in the opposite direction if asked to do so. If kids have a hard time touching the food, they will most likely refuse to put it in their mouth. Slimy, sticky, crunchy, soft, wet, dry, hot, cold….again, you get it.
Balance: If your child has balance (vestibular) difficulties, he may frequently become nauseous and food will only make that worse, hence, avoidance. A less obvious issue is a small child in an adult-sized chair – she might be fearful and unwilling to eat because her feet are off of the ground.
Proprioception: Kiddos that have difficulty with knowing where their body is in space will tend to also have difficulties with knowing where food is located in their mouth…this can lead to over stuffing their mouth (a larger amount helps them keep track of where it is), and/or choking (food going back to swallow before they are ready).
If your child seems to have sensory difficulties such as these, consider an evaluation by an occupational therapist.
#4: Behavioral
Children tend to want two things: attention and control (or power) over situations. Behaviors are always purposeful, whether they are used to escape an undesirable situation, obtain a desired object and/or interaction, or because the behavior feels good (swinging, rocking, etc). If you are in a power struggle with your child, ask yourself the question, “Has she been given a choice or am I telling her what to do?” Giving a child power does not mean letting her rule the house; it’s understanding that she gets to choose but you control the options from which she’s choosing.
Another healthy way to empower a child would be to let him help plan the meal and/or cook with you so he feels he has contributed – it’s also a great way to give positive attention. If you’re continuing to see undesirable mealtime behaviors, it is important to remain consistent in your consequences. For example, if a child continues to refuse to eat her vegetables then stand strong in your decision of “no dessert” or “no snacks before bed.” Consistency teaches concepts. Giving in on your consequences is only teaching your child to be persistent with their behavior because they will eventually get what they want.
One thing to keep in mind is it’s not until around age seven that children recognize the value of doing something they do not particularly like but know will be good for them. Prior to understanding this concept, using this justification for them to eat simply won’t work.
In truth, the cause of your child’s picky eating could be a combination of two or more of the above factors.
Your child’s behaviors at mealtime could be a learned result of how to deal with a medical, oral-motor, and/or sensory complication. Poor oral-motor skills can easily lead to sensory aversions to textures they cannot handle. Medical discomforts can also lead to sensory aversions and/or refusal behaviors. It is common to see behaviors as a coping strategy for medical, oral-motor, or sensory issues.
Many children struggle with feeding. When in doubt, your speech-language pathologist and occupational therapist are great resources to help determine underlying causes. Many of our therapists at Kid’s Creek Therapy have feeding experience and some are trained in the Sequential Oral Sensory (SOS) approach to feeding. If you or someone you know would like to learn more about how we can help your child, contact us for a free consultation.
Marissa Habeshy, MS, CCC-SLP
Jessica Orlick, MS, CCC-SLP
Photo Courtesy David Goehring/Flickr
