By Ms Merlin, Speech Therapist, Vellore

Feeding problems are common in childhood and all children experience some form of picky eating. It usually coincides with developmental growth periods when the child starts to exert control and may show independence through eating habits.

In some children however, picky eating habits evolve into a pattern of eating selectivity and may progress to an eating problem or feeding disorder that can result in poor growth, failure to thrive and malnutrition.

A child who is a picky eater can be selective about many things including variety, brand, textures, smell or presentation. The child who does not or cannot developmentally improve may progress to more dangerous feeding behavior such as complete refusal of food.

Assessment

Assessment of the child with persistent feeding difficulty includes a focused feeding history and assessment, evaluation of growth and nutritional status, and an understanding of how much it affects family time.

Red Flags for Picky Eater

  • Child eats only preferred food
  • Child drinks most of his or her calories
  • Child uses distractions when eating
  • Child eats food camouflaged in other foods or liquid
  • Meals are lengthier — more than 30 minutes

Red Flags for Feeding Disorder

  • Failure to thrive
  • Weight is affected — underweight or overweight
  • Development of eating is delayed and feeding behaviors of picky eating continue beyond the child’s developmental age
  • Family structure and functioning are negatively affected
  • Child is anatomically or developmentally unable to eat safely by mouth
  • Feeding style and child temperament mismatch

The diagnostic process for a child with a feeding disorder includes assessment of anatomy, examination of the esophagus and upper GI track, and a complete nutritional assessment.

Strategies for Children with Eating Disorder

Impaired Oral Intake: Consider a calorie boost, supplements, multivitamin high calorie formulas, juices etc.

Impaired Appetite: Set regular times for meals and snacks. Consider appetite stimulant for a child who is older than 2 years and underweight.

Impaired Meal Time Structure: Limit length of meals to 30 minutes. Sit the child in the same chair for meals. End meals on parents’ terms.

Impaired Oral Sensory Processing: Introduce new foods multiple times and come to the re-evaluation by an early intervention specialist.