The Picky Eater

 Jane Shook, M.S., CCC, SLP

Kathy Lester, M.S., CCC, SLP

Sandra was determined her child would eat only the healthiest, most balanced meals. She insisted that Matt eat at least one bite of every food prepared before he could leave the table. Eager to please at age three years, he dutifully put a spoonful of black-eyed peas in his mouth, gagged and threw up onto the table. The next day the smell of the carrots on his plate made him scream, “Take them off!” Normally an obedient child, Matt was a terror at mealtime. Sandra could not understand how he could overstuff his mouth with a baked potato, but refuse to even try mashed potatoes. By age four years Matt’s diet consisted of honey oat cereal rounds,  peanut butter sandwiches with the crust removed, broccoli tops, green beans if steamed from fresh pods, tacos without lettuce or cheese, and Parmesan cheese. He wanted ketchup to dip almost every food except breakfast cereals.  Matt was more than just a picky eater.

 Intense reactions to taste and textures usually have an underlying cause of over sensitivity in the mouth area. We all have differences of opinion about  food preferences according to taste, smell and texture, but extremes that limit diet and cause unseemly behavior signal that there may be an oral sensory dysfunction. The extreme cases are easily recognized, such as the child who refuses all solids and subsists on liquids only such as Pediasure or milk and juice. Some children prefer only one texture of food such as pudding - like pureed foods or crunchy snack foods. Other cases are not as easily identified and may evolve over time until mealtime becomes stressful for all.  If eating becomes a time of  anxiety or worry, then it is time to seek a professional evaluation.

Many parents wonder “How much of this is just a behavior problem?”  Sam refused to eat the food prepared for the rest of the family and communicated his displeasure by throwing his food across the table, spitting, hiding bites in his napkin or under his plate, and tantruming regularly at mealtime. His behavior was a part of the problem that was causing an unpleasant atmosphere for the whole family. Every behavior has an underlying cause, and if the underlying cause is unrecognized, the behaviors escalate over a period of time.

Don’t expect your child to be able to explain why she is reacting to certain foods. She doesn’t have the discrimination ability nor the verbal skills to explain. You must become a detective to determine the source of the aversion.

Some of the underlying causes for these behaviors include:

• An undiagnosed physiological problem such as gastro-esophageal reflux (stomach acid moves up into the esophagus), aspiration (food or liquid enter the airway instead of esophagus), or other digestive disorders

• A dietary problem arising from food allergies or food intolerance (most common are allergies to dairy and wheat products)

• Elimination problems like constipation or diarrhea

• Oral sensory issues like hypo defensiveness or hyper defensiveness which can create a gag response to certain textures, smells or tastes

            A professional evaluation of the “picky eater” begins with the caregiver taking a seven to fourteen day diet log. The speech pathologist or Occupational therapist specializing in feeding therapy will then observe the child eating and drinking, take an oral-sensory  and  oral motor analysis. Your therapist may make medical referrals to rule out some of the physiologic problems such as aspiration, reflux and digestive disorders.

A feeding specialist could be either a speech pathologist or an occupational therapist with feeding as a specified area of expertise. You may call the speech therapy department of your local children’s hospital, your pediatrician, otolaryngologist, or your insurance company for a referral. The American Speech Language and Hearing Association has a list of speech pathologists in your area who specialize in feeding and/or oral motor desensitivity training. ASHA Action Center phone number is (800) 498-2071, or visit the ASHA web site at www.asha.org

Sandra sought out therapy for her son, Matt which consisted of a combination of oral pressure techniques, experimentation with flavors and textures, and a structured behavioral program. The behavioral program took the pressure off Sandra to force her child to eat.  It taught Matt to make choices about his diet and accept consequences such as missing out on his nightly glass of chocolate milk. Matt is now eating most of the items on his plate at mealtimes. He eats the same diet as the rest of the family, and the whole family has a greater awareness of nutrition and balanced healthy meal planning. Matt continues to insist on cutting the crust off peanut butter sandwiches and eats only the tops of broccoli. While Matt continues to be somewhat picky, overall his diet is healthy, and mealtime is much more pleasant for the entire family.

Feeding Specialists, Kathy Lester, M.S., CCC, SLP and Carolyn Falk, OTR, will be speaking at the November SI-Challenge Quarterly Educational meeting with more specific information oral motor sensitivity and feeding problems. There will be an opportunity for you to ask your  questions to the experts.