Pediatric Feeding Difficulties

If you have a picky eater at home, we have a wonderful opportunity for you next Thursday, November 5th, at 8:30 am. This parent education session will focus on Food Selectivity and how to handle picky eaters, oral sensitivity, and other mealtime problems with your children. To introduce that session, we wanted to get more insight as to what Food Selectivity really is. Read the blog below, written by Dawn Jason, one of our Occupational Therapists, and Dr. Megan Hattier, one of our licensed clinical psychologists!

If you would like to attend the session, please RSVP to jlanglois@emergela.org.


Picky eating is a normal part of a child’s development. A child’s taste preferences are continually developing. However, it is estimated that about 25% of typically developing children develop a feeding disorder, which is defined as an inability or unwillingness to consume enough food to maintain one’s nutritional needs. Feeding disorders can range from mild (e.g., only eating a few different foods) to severe (e.g., requiring tube feedings to provide all nutritional support).

Common feeding problems may include: bottle aversion, failure to transition to solids, texture sensitivity, consuming only a limited volume, total food refusal, self-feeding skill deficit, mealtime problem behaviors, tube dependence, recurrent gagging/vomiting, and/or an oral motor deficit. If you suspect that your child’s feeding problems are more than just normal picky eating, it is best to first rule out any medical or physiological component (e.g., Gastroesophageal Reflux Disorder, aspiration, food allergies, Eosinophilic Esophagitis) that may be contributing to food selectivity/refusal.

Should a child continue to exhibit feeding problems after medical complications have been addressed, they may benefit from a feeding evaluation. We offer an outpatient interdisciplinary approach to feeding therapy with both occupational therapy and behavioral psychology addressing the child’s feeding problems from two different perspectives.

During a child’s feeding evaluation, an occupational therapist looks for underlying sensory, oral motor, and motor coordination deficits that may contribute to a pattern of food refusal. A report of a child only eating crunchy finger foods may be because they do not have the skills to chew tougher proteins. Some children may be unsuccessful in their ability to get the food to their mouth, and frustrations with their limited coordination may result in food refusal. A child’s mouth and face are full of touch receptors, so children who feel uncomfortable when they are messy may outright refuse food to prevent that sensation. Occupational Therapists work to address a child’s sensory defensiveness and reduced coordination while building the oral motor skills necessary to eat a wider variety of foods.

A child’s feeding problems may also be learned behaviors that they use to avoid having to eat new or non-preferred foods. Behavioral psychology addresses food refusal from a behavioral perspective. Food refusal may include: crying, screaming, covering their mouth, turning their head, pushing the food away, running away from the table, spitting out bites, throwing food, holding food in their mouth refusing to swallow, and aggression towards the feeder. Therapeutic recommendations often begin with providing structure, rules, and consistency to the child’s meals. Then, positive mealtime behaviors (e.g., remaining seated, taking a bite, finishing their meal) are praised and rewarded. All of our treatment decisions are based on the data we collect, scientific principles of Applied Behavior Analysis (ABA), caregiver input, and empirically validated treatments for food refusal. Through the use of behavioral strategies, a therapist will work with your child to increase oral intake while decreasing inappropriate mealtime behaviors. This is achieved by gradually and systematically introducing new or non-preferred foods into the child’s diet coupled with positive reinforcement.

By working as a team that begins with the child and their caregivers, we at Emerge work to address the sensory-motor and/or physiological reasons a child may be unable or unwilling to eat appropriate foods. Building positive adaptive responses to eating enables the child to demonstrate improved behavior at meals.