The Picky Eating Toddler & You

As promised, here is third and final blog post relating to feeding difficulties.

We all have experiences where our little ones refuse to eat their sweet potato that evening, or only wants to eat a portion of their meal…but when should you be concerned? When should we be worried if our child’s mealtime preferences are more than just a quirk? Below you’ll find a very quick overview of what to keep an eye on, and what you should do if you suspect your child is a Picky Eater. This by no means is the picky eater’s “bible” but I hope that it is informative and helpful to you to know if your child’s picky eating warrants professional help!

Red Flags of Picky Eating
– poor weight gain or weight loss
– ongoing choking, gagging or coughing during mealtimes
– ongoing problems with vomiting immediately before, during or right after mealtimes
– more than one incident of nasal reflux
– history of traumatic choking incident
– history of eating and breathing coordination problems with ongoing respiratory issues
– inability to transition to baby food purees by 10 months of age
– inability to accept any table food solids by 12 months of age
– inability to transition from the breast/bottle to a cup by 16 months of age
– has not been weaned off baby foods by 16 months of age
– an aversion or avoidance of all foods in a specific texture or food group (i.e. will only eat foods when pureed smoothly, or won’t eat any proteins, or won’t eat any orange coloured foods etc.)
– a food range of less than 20 foods (especially if these foods are being dropped over time by the child, with no new foods replacing those lost foods)
– crying/arching at most meal times
– it is difficult for every/anyone to feed the child
– family history of eating disorders

Why Is My Child A Picky Eater?
There could be a number of reasons as to why a toddler will present as a Picky Eater. It may be any one of the reasons listed below or it could be a combination of reasons.

Physiological
– oral motor weakness
– food allergies (some of these you may not know about as yet)
– reflux/GERD
– dysphagia/swallowing difficulties

Psychological
– traumatic experience in the past with certain foods (i.e. a choking episode, an allergic reaction etc.)
– history of being force fed
– traumatic experience orally (i.e. may have been intubated at birth with tubes through the mouth etc.)
– reflux (the knowledge that the food will hurt/burn when it is refluxed)
– anxiety and/or fear

Sensory
– heightened gag reflex
– oral defensiveness (doesn’t want anyone or anything touching the inside of their mouth)
– sensory defensiveness (this can include being defensive of seeing an undesired food or smelling an undesired food)
– sensory processing disorder

Behavioural
– frequent tantrums at mealtimes
– strong dependence on being “entertained” during meal times (i.e. watching the television etc.)
– general attention difficulties (i.e. is unable to focus for the short period of time to eat a meal).
– the toddler enjoys the reaction from the adults around him/her and continue to do it as an attention seeking opportunity).

Other Contributing Factors
– late exposure to solid foods (after 12 months of age)
– family history of picky eating/feeding disorders
– medical history (i.e. toddler may have been a premature baby etc.)
– developmental disorders (i.e. Autism Spectrum Disorder)

Picky Eater or Problem Feeder?
Typically Picky Eaters have two classifications – Picky Eaters and Problem Feeders, with “Picky Eaters” being the umbrella term for both.

Picky Eaters usually have…
– decreased range of foods that he/she will tolerate (however it is usually at least 30 different foods that he/she will eat)
– some foods may be lost due to “burn out” but will be re-gained after a break (i.e. won’t eat bananas after enjoying one daily for a month, but will start eating them again in a few weeks)
– able to tolerate new foods on their plate
– eats at least one food from most food texture/nutrition groups
– frequently eats a different set of foods at a meal than the rest of the family

Problem Feeders usually have…
– restricted range of foods (usually 20 different foods or less that he/she will eat)
– foods that are lost due to “burn out” will not be regained
– behavioural tantrums/melt downs occur when a new food is presented
– will often refuse to eat an entire category of food groups or textures (i.e. no solids, or no crunchy foods)
– always eats a different set of food at a meal than the rest of the family

What Do I Do?
If your child demonstrates red flags of picky eating, it is definitely worth taking him/her to see their Paediatrician. If there are concerns regarding weight gain, or regarding the range of foods that your child can eat, your Paediatrician will refer you to a Feeding Therapist. Usually this person is a Speech Language Pathologist or an Occupational Therapist but there are other allied health fields such as Physiotherapists or Dieticians/Nutritionists who may also be feeding therapists (in other jurisdictions). Keep in mind that there is no “cure all” for picky eating…each child is an individual and their needs are going to be unique. As a result, the team of professionals working with your child (Paediatrician, Nutritionist, Speech Language Pathologist, Occupational Therapist and whoever else may be working with your child) will try to take a very holistic approach to help your child overcome their battle with food!

I hope that this was informative and not too overwhelming!

Until next time,

Cayman Mummy

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