Mealtime Challenges: Tips to Help a ‘Picky Eater’

Hopebridge Speech Therapist Discusses Warning Signs and Ways to Combat Feeding Struggles

Scour the internet and you’ll find tons of photogenic lunchbox ideas on Instagram, “eat the rainbow” feeding tips for fussy eaters on Pinterest, and parenting advice like, “if you eat it, they’ll eat it!” on Facebook. While it is helpful to make nutrition fun, mealtime is not always that simple … especially if your child has autism spectrum disorder (ASD) or another feeding-related diagnosis.

What’s a parent to do when eating (or the lack of it) goes to the extreme? We turned to Hopebridge Speech-Language Pathologist Jennifer Starr for advice on building healthier eating habits for children who need a little extra support. As part of the autism centers’ interdisciplinary Hopebridge 360 Care model,* Jennifer helps children communicate and socialize through speech therapy at Hopebridge, but much of her role also covers feeding and swallowing therapy.

In addition to tips families can follow at home, Jennifer first outlined some of the key warning signs for parents. While not all-encompassing, atypical eating behaviors may be an early sign of autism or another disorder that requires medical attention, so it is important to be aware of what goes beyond “picky eating” and discuss any concerns with a pediatrician.

6 Signs Your Child May Benefit from Feeding Therapy

1. Gagging
   Gagging now and then is not an immediate cause for concern, as many infants and young children may experience this while trying new foods. It becomes an issue when it is repetitive, leads to vomiting, is no longer a rare occurrence, or the gag reflex takes over with a wider range of foods.
   
2. Eating only one or two textures
   All children have preferences when it comes to food, many of which involve texture, but if a child is too selective when it comes to textures, it could be a sign of a broader feeding disorder. Most commonly, children struggling with hypersensitivity seem to prefer dry, crunchy foods such as chips, crackers or dry toast, and will not eat anything that appears slimy or sticky.
   
3. Limited accepted foods
   Diets that are too restrictive can be dangerous because they limit nutrition and can lead to other behavioral-related challenges. Like many milestones, acceptance develops over time, but if a 5-year-old will only eat chicken nuggets and buttered noodles – especially if they will only eat certain brands or shapes of these items – feeding therapy should be considered to broaden their palate and nutrient intake.
   
4. Intolerance to touching food
   Sometimes, feeding challenges occur before the food is even in their mouth, such as when children become distressed when they get food on their hands. Some children have strong sensory-related aversions to having pudding, spaghetti sauce, applesauce or other similar items all over them, which may result in other maladaptive behaviors, like tantrums or throwing food.
   
5. Food pocketing or over-stuffing the mouth
   This sign is not always as easy to notice, but can be more dangerous. This appears after a child is finished with a snack or meal, but still has five or six Goldfish crackers or a piece of meat in their mouth, for example. This is a sign of sensory dysregulation and can be a choking hazard, especially if parents are not aware of it.
   
6. Poor coordination with chewing and swallowing
   Coordination while feeding comes with time, so we do not expect to see it in young infants who are just beginning to eat. As children get older, however, watch to see if they lose foods or liquids anteriorly. If they put food in their mouths but it keeps coming back out, then there may be lip closure issues that require more attention.

When it comes to feeding, Jennifer notes that developmental age should be considered.

“A typically developing child may be further along than a child on the spectrum, but I always recommend parents talk to their pediatricians about feeding challenges that arise,” said Jennifer. “It is better to get an evaluation and not need the services rather than waiting for the complication to become worse and lead to malnutrition or more difficult habits to break.”

Mealtime Tips for Parents of Children with Feeding Challenges

Feeding therapy, which often approaches eating from the lenses of a speech therapist and an occupational therapist, can have a major impact on mealtimes. This type of therapy can help children increase tolerance, improve food selectivity and build the skills needed to work their way toward lower stress dinners and better nutrition. Even more importantly, feeding therapy can sometimes be life-saving, depending on the challenges at stake.

Through Hopebridge360, feeding therapy is customized and targeted to each child’s needs. Though it is important to have a program that is tailored for your child, Jennifer also outlined a number of ways parents can help their child down a path of healthy eating, starting at home.

1. Never try to force-feed a child.
   Forcing a child to eat can make oral-sensory and feeding aversions much worse. It also contributes to distrust. “I recognize feeding times can be overwhelming. I had a premature baby and know how stressful it can be to have an underweight child, especially with doctors harping on the parent to increase nutrition. It is really difficult to take a step back, but force-feeding is not the answer,” said Jennifer.
   
2. Eat with your child.
   Mealtime should be a social activity. If you can, gather around the table together as a family. Make the environment as low-stress as possible, avoid distractions like TV and tablets, and pull back on expectations.
   
3. Serve as an example.
   Parents probably hear this a lot, but it is important to set a good example at the dinner table. Even if you do not enjoy something, we do not recommend talking about how much you hate the texture or smell of broccoli. Use encouraging words and actions.
   
4. Present something new at every meal.
   Offer your child a new or non-accepted food at every meal. “It’s fine if you want to give your child mac-and-cheese and chicken again, but offer something like celery on the side. If they cannot accept it on their plate, set it on another plate next to it. They will see the color and texture, potentially smell it, and maybe even grab it. If they want to taste it and do not like it, it’s perfectly fine to allow them to spit it out in a ‘no’ bowl as a low-pressure way to try something new,” said Jennifer.
   
5. Encourage them to work on acceptance.
   Along with presenting something new, give children a chance to get used to the food. Success is not just chewing and swallowing; there are a number of successful steps toward consuming a new food. “For example, how does watermelon look, feel and smell? Once they grasp those sensory experiences, have them work their way up to touching it. Maybe they give it a kiss. It may sound ridiculous, but just that acceptance to oral vicinity is significant. Little by little, they will have gone from not being able to stand having it on their plate to putting it against their mouth,” Jennifer advises.
   
6. Incorporate food into playtime.
   Teach them to have fun with food! Starting with reading is a good idea. There are a number of books, like The Very Hungry Caterpillar, which provide exposure and help with acceptance of food. Then build a whole day around it. For instance, if reading Dragons Love Tacos, ask your kid questions about what the dragons put on their tacos, help them make their own tacos, and have a taco party. Sensory play is also beneficial. If your child has an aversion to slimy foods, take a pudding cup and dump it on their high chair tray. It may shock them at first, but hopefully they will eventually play with it and get messy. Allow them to squeeze it, mash it and explore it without pressure. Let them experience the senses first; consuming tends to come later.
   
7. Don’t give up.
   This is easier said than done. Parents often the strategies through therapy, only to get frustrated and give in to their child’s preferred foods. Unfortunately, this isn’t going to help with expanding their food repertoire, so try to stick with it, even though it is difficult. The payoff will be worth it.

Learn More

If you have a child battling over breakfast, lunch or dinner in your own home, do not wait to get help. Please get in touch with us online to schedule an evaluation or learn more about how Hopebridge approaches feeding therapy through our 360 Care services* so we can ease your stress and help your kiddo build a healthier future.

*Informed consent was obtained from the participants in this article. This information should not be captured and reused without express permission from Hopebridge, LLC.