By Amanda Grigg, MS, OTR/L, Pediatric Occupational Therapist

Although it can be challenging to accommodate for picky eaters, it is “usually a temporary behavior and is a part of normal development in preschool children,” (Lam, 2015). However, if picky eating is becoming a barrier to the family dynamics and routine, we recommend talking to your pediatrician. This way, you can rule out any medical concerns, which could include food allergies or gastrointestinal challenges. A pediatrician can then refer you to occupational therapy or speech therapy for individualized assessment and treatment. 

 When is picky eating a concern? 

• Your child is not gaining enough weight. Typically, the pediatrician will bring this up with you at your child’s well-checks if their growth is not following the typical curve. 
• Your child is eating fewer than two options in each food group. We expect young children to be hesitant to try new foods, prefer their favorites, and only want a few different options for proteins and vegetables. 
• Your child is holding food in their mouth, swallowing without chewing, or drooling excessively. This may indicate poor oral motor skills that could lead to choking and should be addressed by the pediatrician. 

As adults, we tend to have a black and white perspective on feeding: they ate the food, or they didn’t. However, focusing on the steps within feeding (see the hierarchy below) can make mealtimes feel more attainable by seeing the small progress rather than feeling like a pass/fail attempt. For example, if a child does not want to eat something, they may be comfortable at least giving it a kiss before placing it in an “all done” container!! If they’re not ready for that, simply placing it on their plate or a plate next to their main meal can help become more accepting of that food’s sensory characteristics. 

When a child is picky with their foods, there is often a component of sensory processing involved. For more information on sensory processing and the 8 sensory systems, here is a review. The sensory systems most often involved in eating include: 

• Taste 
• Smell 
• Touch (textures, temperatures) 
• Proprioception (chewing, crunching) 
• Vision 
• Interoception (feeling hungry, thirsty, or full) 

Differences in Sensory Input Responsiveness in Picky Eaters

Children who are over-responsive to sensory input taste and detect more flavors and textures than others. They may have only a few items in their diet, typically chicken nuggets, macaroni and cheese, peanut butter and jelly sandwiches, or goldfish. When children are over-responsive to oral sensory input, they tend to prefer foods that are consistent each and every time they are eaten, which end up being processed foods. When thinking of fresh fruits and vegetables, blueberries are great examples of food that can taste and feel different within the same batch. They may be sweet, sour, firm, or soft from bite to bite. On the other hand, a cracker or goldfish will have the same color, texture, and taste each time they are eaten. 

Children who are under-responsive to oral sensory input may choke frequently or seem like they are not chewing their food. They may be drooling more than other children their age and be disinterested in eating. If a child is detecting fewer flavors and textures, they may have a harder time feeling what is in their mouth, which could make it more challenging for the tongue to keep the food in the mouth for effective chewing while also coordinating a smooth swallowing pattern. They may perceive foods as bland and do better when eating something more alerting, such as citrus or spices.

What can you do at home? 

• Play with food!! This can be outside, in the highchair, or at the table. If you’re concerned about waste, save a small spoonful of food you make for yourself and present it on your child’s plate during mealtime or playtime. If your child gets upset with messy hands, use tools such as paintbrushes, spoons, or forks to explore the food. 
• Don’t force foods!! Eating a new food can be stressful, especially for children who are already hesitant. Let your child take time to explore food before deciding to eat it. According to multiple sources including Jo Cormack, it takes multiple exposures for a child to accept new foods.  
• Have a snack plate out during the day with some preferred foods along with newer foods – even just seeing and smelling the new foods helps to increase exposure and likelihood they will try something new. 
• Increase flavors and oral input by 
  • • Provide carbonated water as a “warm-up” for the mouth before eating 
    • Add spices to increase flavor 
    • Add citrus to foods or water to increase flavor 
    • Incorporate crunchy foods with strong flavors, like bell peppers 
    • Present sour foods/candy in small amounts 
    • Drink smoothies or yogurt from a straw to increase use of cheek muscles 
• Make mealtime a social experience by maintaining a routine when possible. If your child does not even like sitting at the table due to food anxiety, incorporate a fun busy activity such as a puzzle, coloring, or painting on construction paper with water. 
• Separate textures: Mixed texture foods, like casseroles, are the most common foods refused by children, because they have a combination of tastes, textures, and smells. If possible, separate the foods in a deconstructed manner. This way, they are much more likely to eat at least one or two components of the meal rather than none at all. 

Summary

Don’t hesitate to reach out to your pediatrician or local therapy clinic for more information on getting started with feeding therapy. Early Childhood Intervention services can be of great assistance from 0-3 years old, then private or home health therapy agencies after your child turns 3. For additional information and tips on easing the stress of picky eaters, check out the blog from Kids Eat in Color or find recipes and resources at Mom to Mom Nutrition Blog.

 Additional Sources 

• Cormack, Jo. (2019, January 8). “How many times does your picky eater need to try a new food before they will like it?” Jo Cormack. http://www.jocormack.com/2019/01/08/how-many-times-does -your-picky-eater-need-to-try-a-new-food-before-they-will-like-it/ 
• Children’s Therapy Solutions, Inc. (2022). “Feeding.” https://childrenstherapysol.com/feeding-therapy/ 
• Lam, Jason. “Picky eating in children,” Frontiers in Pediatrics, (3). doi: 10.3389/fped.2015.00041 
• Serbinski, Katie. (2018, March 1). “The Deconstructed Family Dinner.” Mom to Mom Nutrition. https://momtomomnutrition.com/nutrition/deconstructed-family-dinner/