The Facts About Difficult Eaters

It is tough to know how a child will react to foods being introduced into his or her diet. A child may happily accept one food while rejecting the other—or reject all foods entirely. It is important for parents and caregivers to keep these myths and facts in mind about children who are difficult feeders.

Myths

• If children are hungry enough, they will eat. They will not starve themselves.
• Children only need to eat three times per day.
• Eating is easy.
• If a child is not eating, they are just acting.

Facts

• Messy is good. Allow a child, especially very young children, to experience the food by seeing, touching, smelling and tasting the food.
• Everyone has preferences and no one person likes all foods and food textures—including children.
• Children should be praised for trying a food, even if they don’t love it because positive reinforcement yields positive behavior. Yelling and other negative behaviors showing the caregiver’s frustration will not encourage the child to eat more food.
• The normal reaction to new tastes is rejection.
• Children under age 8 need to be presented with and eat a new food 10 times before it’s a regular food.
• Children over age 8 need to be presented with and eat a new food 15 times before it’s a regular food.

For children who struggle with feeding, the speech therapists and occupational therapists at CHOC work to evaluate and create a treatment plan for each child that takes into consideration the child’s specific oral-motor, sensory, behavioral and developmental needs. There are three main goals of feeding therapy:

• Improve the child’s feeding skills.
• Increase the amount of nutritional foods the child eats.
• Make mealtimes enjoyable for both parent and child.

When should I contact my child’s doctor?

• Difficulty accepting new foods and/or textures.
• Wet sounding vocal quality while eating. (If the child’s speech is “gurgly” it could be a sign of aspiration or “going down the wrong pipe.”)
• Poor weight gain.
• Coughing, choking or gagging during feeding.
• Feeding periods longer than 30 to 40 minutes.
• Lack of coordination when sucking and swallowing.
• Food refusal or fear.
• Negative behaviors during mealtimes.
• Unusual/low muscle tone in mouth or face.

How do CHOC specialists help my child who is struggling with eating?

• Individualized feeding and/or swallowing therapy. A trained therapist works with each child one-on-one to follow a treatment plan based on an initial evaluation and the therapist’s recommendations. The therapist works closely with the patient’s family to encourage caregivers to do many of the same things taught by the therapists at home. As the child makes progress, he or she may be transitioned to a small feeding group to add the challenge of eating with peer interaction.
• Increasing acceptance of new foods or textures. The therapist presents the child with preferred and non-preferred foods based on their sensory properties (i.e. look, smell, taste).
• Modifications to position and posture for eating. The therapist will work with the child to ensure he or she is positioned properly in a chair for all meal times. Proper positioning will improve attention and concentration during meals.
• Behavior modifications and management. The therapist educates each child’s family on how to increase desirable behaviors during meal times by ensuring that interactions between the caregiver and child are appropriate and understood by the child.
• Referral to other professionals, such as a psychologist or dentist. A multidisciplinary approach is important to make sure that all the child’s needs are being addressed. If the child has an underlying condition contributing to their feeding difficulties that is not being addressed, progress with feeding will be limited.

Where can my child get feeding or swallowing therapy?

You should request an authorization for a swallowing or feeding evaluation at CHOC from the child’s primary care physician, allergist or gastroenterology doctor or nurse practitioner. Once the Rehabilitation Department obtains the authorization, they will schedule the child for an evaluation based on their triage process. The triage process looks at the medical acuity of the child. For more information, please call 714-509-4220.