Written by: Melissa Miller, CCC-SLP

It is common for children with Autism and other developmental, emotional, or behavioral difficulties to have limited food preferences.  Symptoms may go as far as vomiting, refusal to eat, interference with psychosocial functioning, malnutrition, dependence on nutrition supplements and weight loss. This can be stressful for many parents who are trying to keep their children adequately nourished. 

So, how does a parent determine if their child is a “picky eater” or has a feeding problem that requires intervention?

The Sequential-Oral-Sensory (SOS) Approach to Feeding identifies key differences between a “problem feeder” and a “picky eater”. For example, problem feeders may have less than 20 foods in which they consistently eat and if they “burn out” on a food, they will not eat this food again. Picky eaters will have more than 20 foods in their food inventory and if they “burn out” on a food, they will typically eat it again after a few weeks.

Problem feeders may refuse entire food groups or texture groups (fruits, meats, puree) whereas picky eaters will eat at least one food from all food and texture groups. Problem feeders will often have “meltdowns” when new foods are introduced, whereas picky eaters typically tolerate new foods on their plate, even if reluctantly. To learn more about this approach, visit https://sosapproachtofeeding.com/. 

Treating children with feeding disorders is often a multidisciplinary approach. Parents concerned with their child’s feeding should always consult a pediatrician or a licensed professional. These specialists may include the physician, dietitian, occupational therapist, speech language pathologist or psychologist. 

It is our job as parents and professionals to work together in order to create a trusting environment to show children that meal-time can be enjoyed and celebrated. The child decides how much they are willing to eat and how they will interact with certain foods. This may sound controversial, but adults make these independent decisions every day. For example, some adults choose not to interact with fried insects, while others treat them as a delicacy. The more a person interacts with a food (being around the food and watching others enjoy the food in a no pressure environment) the more likely they are to  try it. It is also our job as adults to create a trusting environment filled with opportunities for children to explore foods and learn what they enjoy. Keep in mind, it can take up to 10 separate taste trials of a food before a person forms a taste preference for that food.

Creating a comfortable learning environment for feeding can sometimes be tricky. Along with consulting your healthcare provider, you may find the following tips helpful when introducing foods to your child. 

Tips for expanding your child’s palate, with trust:

1. Begin with meal time peace. Having a “no pressure zone” during meal times is very important to allow your child to begin exploring different food “offers” and options on their own. When anxiety increases, adrenaline starts pumping and hunger diminishes. If the parent is no longer having a pleasurable meal-time, likely neither is the child! 
2. Routines. Routines establish predictability during meal-times. Kids know what to expect, and therefore there are no surprises. Allow them to help prepare the meal and set the table. Provide assistance when necessary. 
3. Bring on the fun! Exploring new things together can be fun and functional for kids. Maybe their pancake (familiar food) has a banana mouth (new fruit). Maybe they can use “silly dippers” (apple slices or textured spoon) for their peanut butter or jelly. Maybe they can crush up crackers and make “snow” (familiar food) and sprinkle it on something new. Using cookie cutters can also be fun for little ones to add in new shapes and sizes to familiar foods. 
4. Allow for many opportunities, or “rehearsals” to explore and interact with different types of foods. This does not need to be completely exotic or expensive. It can be as simple as different colors, sizes and shapes of noodles. A rehearsal can even be watching a family member eat something new. They are still interacting with that new food if they are watching you enjoy it and smelling the new scent.
5. Start with the familiar. If your child loves goldfish, teach them that goldfish can be different colors, they can be served whole, or crunched up on top of macaroni. They can go “swimming” in soup. It can also be beneficial to pair favorite foods with new foods when you introduce something new. 
6. Pay attention to how your child reacts; if they are grimacing, pushing the food away or trying to leave the table, that is your cue that they are no longer comfortable with how they are interacting with the food and this experience is becoming negative. Take it a step back and make sure they are comfortable and having fun. 
7. Remember, do not pressure your child to eat if they are not ready. You can offer foods, but should not demand. You can show them it is “So yummy!” by eating it yourself and adding in many types of positive sounds. Keep them engaged with the food by asking them different questions about the food (shape, color, smell, texture). The more rehearsals they have with foods, the more they may eventually become curious enough to give it a try. 
8. Safety: Keep in mind that what you offer your child needs to be developmentally appropriate and safe for him/her to swallow, especially if they currently have or have a history of a swallowing disorder.

Red flags:

• Choking, gagging or coughing during meals
• Crying or arching back during feeding with wet sounding cries
• Problems with vomiting
• Weight loss or difficulty with weight gain
• History of difficulty swallowing or breathing or ongoing breathing difficulties
• Not accepting solid foods by 1 year or not accepting puree foods by 10 months of age
• Less than 20 different types of foods eaten 

Is my child a candidate for intervention? 

If you have concerns about your child’s feeding, please alert your physician and speak to a professional. Keep a food journal to track his or her eating behaviors and a 3 day food log, and bring these observations to your child’s healthcare provider. You can find further resources on our website, including scheduling an appointment (here). You can also visit the American Speech, Language and Hearing Association website to read more about feeding disorders in children here, or the University of Florida Center for Autism and Related Diseases (UF-CARD) here. 

Finally, check out Lunch and Learn on Picky Eaters & Problem Feeders and Beyond Chicken Nuggets: Strategies for picky eating on our Progressive Pediatric Therapy YouTube Channel for more information!