By: Chris Purgatori, MOT, OTR/L,
Kaufman Children’s Center for Speech, Language, Sensory-Motor, and Social Connections, Inc.

Many kids have strong opinions on food and will often be finicky at mealtime. In fact, there are very few parents who haven’t battled with their children over what and how much they need to eat. However, when a child’s selectivity spirals out of control and begins to affect their health, it’s time to investigate possible reasons for the picky behavior.
There are five main components that affect a child’s ability to eat, and can lead to significant feeding problems.
1. Sensory issues
Sensory-based feeding problems can be caused by a number of different issues.
• Food texture – Smooth foods and liquids (such as milk) are least alerting, do not evoke a strong reaction from the muscles of the mouth, and children will likely be less sensitive to those textures. Conversely, mixed textures, like cereal with milk, are most alerting, will evoke strong oral muscle reaction, and are most difficult to eat. Children tend to be more sensitive to those kinds of textures.
• Food temperature – Children are likely to be less sensitive to room-temperature foods, which are least alerting, and tend to be more sensitive to alternative-temperature foods. Try serving a favorite food hot for one meal and cold (straight from the refrigerator) the next meal, to vary the food temperature.
• Taste – Children are usually more likely to be willing to try bland foods like rice and mashed potatoes, which are least alerting and are the easiest foods to introduce to children. More alerting, sour foods like lemons, limes and other citrus fruits are more difficult for children to eat.
Put all of these factors together, and finding foods that your child likes can be an adventure. To help create a broader diet, offer the foods your child likes and then begin to slightly alter those foods. For example, if they enjoy elbow macaroni and cheese, and will only eat that particular shape, begin to toss in four or five pieces of a different shape (wheels, characters, etc.) Next time, add food coloring to the elbow-shaped macaroni. The changes with food should be slight, but just noticeable, to alter the texture, temperature, color or taste.
2. Oral-motor weakness
Oral-motor-based feeding issues can be caused by tone and strength issues. Since oral-motor development is dependent on gross-motor ability and will not exceed it, kids will need to achieve good coordination and movement in their bodies before they will achieve sufficient eating skills. Proper weight shift at the hips, achieved through the natural developmental progression of rolling, sitting up, crawling and walking – actually affects the child’s ability to chew properly. Occupational therapists refer to this as, “what you see at the hips, you see at the lips.”
There are many oral-motor exercises that can help strengthen the jaw, tongue and lips, and parents with concerns should contact their pediatrician or consult an occupational therapist or speech-language pathologist.
It’s important to note that oral-motor difficulties must be dealt with only after sensory issues have been attended to. In the end, good sensory input will result in good oral-motor output. The best outcomes result from the child’s engagement in a voluntary, purposeful activity in a positive environment.
3. Behavior-based problems
There are many different behaviors that can affect feeding: eating is painful for the child; the child gets the attention of their parents when they don’t eat; or eating is one of only a few things of which they have control.
If the child complains of pain while eating, or there is constant food refusal, the child should be checked out by their pediatrician for gastroesophageal reflux (GERD). Positive reinforcement (“If you eat this piece of lettuce, then you’ll be able to play 10 minutes of video games), and extinction or planned ignoring (“Mommy doesn’t hear crying, she only hears big girl words,”) work the best with behavior-based feeding issues.
Gradually work through the steps of eating. Start by having the child touch and play with the non-preferred food, then increase the difficulty: take a bite; take a bite and don’t spit it out for 2/3/4 seconds; swallow it; take bigger bites; eat larger portions; decrease gagging. Progress until the child is eating more or less on their own.
Keep in mind that behavior-based feeding issues can look a lot like sensory-motor feeding issues, so it is important to treat both aspects of feeding.
4. Medical issues
Gastrointestinal, cardiopulmonary and pharmaceutical issues can affect feeding, as well as prematurity of birth and visual impairment, when the child simply can’t see what they’re eating. However, the biggest culprit of medical-based feeding issues continues to be GERD. GERD in its simplest form is spitting up or vomiting, causing children to refuse food. If there appears to be medical issues interfering with feeding, it is important to consult your pediatrician for more options.
5. Family dynamics
Parents and caregivers are the most important and pivotal components in implementing feeding strategies. It’s important to clearly define roles: the parents or caregivers are responsible to provide the foods, while the child is responsible to eat and choose how much to eat. Most importantly, the child should feel as comfortable as possible when they are eating. Feeding is social, and feeling uncomfortable in the social situation can affect feeding. Parents and families should be open and adapt when necessary. Go slow with the child and make the children feel as comfortable as possible. Parents should offer children both preferred and non-preferred foods and avoid forcing children to eat.
Feeding a child who is a picky eater can be challenging, but it doesn’t have to be impossible. There are many tips, tricks and strategies to use when kids are orally defensive.

• If the picky eating seems to be sensory-based, encourage the child to play with foods to get used to them. Getting messy is OK!
• Encourage the child to get more involved with food preparation. Kids are more likely to try things if they help prepare the meal.
• Encourage the child to eat with other kids. In some circumstances, peer pressure is a good thing!
• Provide the child with small amounts of the foods Mom and Dad are eating, along with a food the child usually eats. This way, the child gets used to the foods being there and when they are ready to try them, they will.
• Have a consistent routine at mealtime so the child knows what to expect.
• Experiment with small, subtle changes in difficult foods. Sometimes just a change in temperature makes it easier to handle.
• Make a schedule for the meal, and write a list of the food items that need to be eaten before going to the next activity.

This Months Featured Authors and Vendor: Chris Purgatori, M.S., OTR/L of Kaufman’s Childrens Center
Chris holds a Bachelor’s degree in Kinesiology from Michigan State University and a B.A. in Health Science from Wayne State University. He went on to earn his Master’s degree in Occupational Therapy from WSU. Chris came to the KCC from a K-12 school system, where he worked with special needs kids and young adults. When he’s not coaching young kids in the OT gym at the KCC, Chris coaches high school boys varsity soccer.
About the KCC:  The Kaufman Children’s Center for Speech, Language, Sensory-Motor, and Social Connections, Inc. provides individual speech and language therapy, occupational therapy, sensory integration therapy, social skills instruction, and applied verbal behavior therapy for children from birth to 17 years old. We offer a warm, family-friendly environment, complete with private observation rooms where parents can follow along with their children’s progress. All members of our staff represent the highest standards of excellence in their field and are part of the KCC team because of their extensive expertise in pediatric therapy, outstanding clinical skills, and their warmth and insights into children. Located in West Bloomfield, Michigan, a northwest suburb of Detroit, the KCC is an award winning facility, recognized by the Michigan Speech Language Hearing Association with their prestigious Clinical Service Award.
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