One of my sons asked me to take him out for fried cricket tacos several years ago. My other son is 16 years old and he still won’t eat a peanut butter sandwich — or any other sandwich — except ham on crustless, seedless bread. Sigh.
One is a good eater and the other is a problem feeder.
I was professionally humbled by my problem-feeder toddler
When my first son was learning to eat, I followed all the usual feeding advice. I avoided sugary and salty snacks and I didn’t give him any ‘kid food’ like Lunchables or boxed mac and cheese. He ate whatever we ate, and he was willing to try most things. No big deal, I’ve got this.
At the time, I worked as a pediatric dietitian. When parents complained to me about their picky kids, I gave them the standard advice about removing junk food from their child’s diet. I said their child would eat when they got hungry, and I reassured them that there was no need to worry unless the child lost weight or stopped growing well.
I really didn’t get it.
And then I had my second son. Before he even turned two years old, he was beyond picky. To compound the problem, he was also seriously allergic to both cow’s milk and soy.
I tried every trick in my book, to no avail. My child’s willingness to go without food was much higher than my tolerance for battling it out at the breakfast bar. We needed help.
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My child’s pediatrician didn’t hear me at first
I took my son to the pediatrician, who began to give me all the advice I would have previously given my own clients. I finally stopped her and said, “I really think we need a referral to feeding therapy at the local children’s hospital.”
She stopped and looked at me, a puzzled expression on her face.
“I’m a pediatric dietitian, and I’ve tried the Ellyn Satter method until I’m blue in the face,” I said. I had to tell her the name of the clinic and give her the fax number. I had come prepared. The doctor wrote the referral, and we were on our way.
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I took my child to feeding therapy
My son was evaluated by a team of therapists: a dietitian, an occupational therapist, and a speech therapist.
They determined that he was chewing and swallowing just fine and that he had age-appropriate skills for feeding himself.
He was also growing normally, and somehow he managed to take in the minimum recommended nutrients for his age. Despite that, I received a comment I’ll never forget from the dietitian: “So you’ve just thrown your dietitian training out the window and you let him eat anything he wants?”
I was already feeling like a failure as a professional and a mother, and that comment stung.
The occupational therapist taught me about food chaining
Every week for months on end, I took my son to feeding therapy. He sat in a high chair in a room with the clinic’s occupational therapist, and she worked to make him more comfortable around food.
The concept she used was Kay Toomey’s Sequential-Oral-Sensory (SOS) approach to feeding.
Basically, she took a food my son was already familiar with and tweaked it just a tiny bit. For example, he was willing to eat plain mashed potato, so she offered him mashed potato with a little sour cream added. He was willing to eat oatmeal with cinnamon, so she offered him oatmeal with nutmeg.
She also had us work through stages of familiarity with food:
- Allowing the food on the plate without having a tantrum
- Touching the food
- “Kissing” the food
- Licking the food
- Holding the food in the mouth but not chewing it
- Chewing the food and then spitting it out if needed
- Swallowing the food
I would prepare the food for the visit and then watch the therapist with my son through a little one-way window at the door of the therapy room. He was around two years old at the time.
It was a complete and total meltdown, every time. And then I’d take my messy dishes and my messy child and repeat the process at home for a week.
In my gut, I knew something was wrong
Other parents told me they’d had success with feeding therapy. It made logical sense to me, and the therapist worked hard to help us.
But we didn’t get very far. I was exhausted, and every meal was a battlefield.
We stopped going to feeding therapy after a year or so, and I continued introducing new foods by encouraging my child to explore them, using food chaining and the stages of familiarity. I tried to be patient, but I mostly felt frustrated, and the struggle continued.
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The real shift happened when he was around 7 years old. I let go of expecting him to become a ‘normal’ eater and fully accepted that he had a challenge I needed to work with, not against.
I no longer required him to eat what the rest of us were eating if he didn’t want to. He just had to come to the table for family meals.
I didn’t make special meals for him, because I’m not a short-order cook, but if he wanted to make himself something different from the food everyone else was eating, he was welcome to do that.
I asked him to be sure there was some sort of protein and either a fruit or a vegetable at each meal. Nine times out of 10, that meant a banana or a bowl of applesauce and some air-fried chicken nuggets, but it worked for him, so it worked for me. I gave him a multivitamin every day and then I let it go because dinner wasn’t the hill I wanted to die on.
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My son has never eaten a full slice of pizza or a bag of any kind of chips other than plain Lay’s, or a piece of candy that isn’t plain Hershey’s chocolate. So it’s not a matter of eating junk instead of real food, it’s a matter of being highly selective about the real food he’s willing to eat.
I’d be lying if I said his nutrition doesn’t bug me. It does. But he grew in spite of all those nuggets. I don’t live in his body, so I really don’t know what it’s like to be him, and I have to trust him when he says that even the smell of salsa makes him want to leave the room.
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The difference between picky eaters and problem feeders
If you’re a parent who’s ever experienced the frustration of trying to get your child to eat certain foods, you can feel my pain. Picky eaters are challenging, but problem feeders try your patience on a whole different level.
In my work, I’ve heard both parents and clinicians use the terms “picky eater” and “problem feeder” interchangeably. But there is a distinct difference between the two. There’s one set of techniques we can count on to pretty reliably work with picky eaters, and then there’s a different skill set that usually (but not always) works better with problem feeders.
If you and your child are struggling with feeding issues, here are five ways to determine which kind of child you’re working with:
1. How many foods is your child willing to eat?
Picky eaters are hesitant to try new foods, but they still have a relatively broad range of foods that they’ll eat. They may prefer specific textures or flavors, but ultimately they will eat multiple foods from different food groups.
Problem feeders eat only a narrow range of foods. They may only eat foods with similar textures or colors, and they may avoid entire food groups altogether.
Make a list of the foods your child is willing to eat. If the number of foods is less than 20, your child may be a problem feeder.
2. How strong are your child’s feelings about food?
Picky eaters may refuse to try some foods but be willing to try others. This might depend on the day, the way the food looks, or whether or not they’ve had a good nap.
Problem feeders consistently experience anxiety when presented with new foods. They may have a strong emotional reaction to foods that goes well beyond just a dislike of a particular taste or texture.
Problem feeders may scream or cry at the table when they’re hungry but can’t bring themselves to eat the food that’s put in front of them. They’re willing to lose their favorite privileges to avoid a food they don’t want to try.
3. Does your child have other sensitivities besides just taste?
Problem feeders often have sensory issues that affect their ability to eat. They may struggle with textures, smells, or colors in food that cause them discomfort. Their discomfort may be so strong that just looking at food makes them gag or vomit.
Often, problem feeders have sensory issues in other areas outside of feeding. They may dislike tags in clothing, loud noises, bright light, or the feel of certain textures under their feet.
(My no-peanut butter sandwich son still hates the feel of sand under his feet. A trip to the beach is one of his least favorite ways to spend time.)
Picky eaters may have preferences for certain textures or flavors, but they don’t experience excessive discomfort when eating certain foods.
4. Does your child have any nutrient deficiencies?
Picky eaters usually consume a relatively balanced diet because they still eat from all food groups. Maybe they won’t eat spinach, but they’ll eat another green vegetable. Maybe they won’t drink milk, but they’ll eat cheese or yogurt. It all balances out in the long run.
Problem feeders are more likely to experience significant nutrient deficiencies due to their highly limited food intake. They may only consume fruit and starchy foods, for example, leaving them without any sources of protein, iron, or calcium.
Does your child have anemia (low iron)? Are they dropping off the growth curve for height or weight? These are indicators of nutrient deficiencies that need to be investigated by your pediatrician, and they may also be complications of problem feeding.
5. Does your child’s eating affect their social life?
While picky eaters can be frustrating to deal with, their eating habits don’t usually impact their daily lives or the lives of their family members in any significant way.
Problem feeders may struggle with social situations that involve food, to the point that they refuse to go to an event because they’re uncertain whether or not the food will be ‘safe.’ They may avoid eating lunch at school. Or they might decide not to attend birthday parties if they feel like they will be the “odd man out” if they refuse the pizza, cake, and ice cream being served.
The bottom line
If your child is a picky eater, offering them a range of nutritious foods and involving them in meal planning, grocery shopping, and cooking can help cultivate healthy eating habits.
If you think your child may be a problem feeder, start with your pediatrician.
If you’re unsatisfied, press for a referral to feeding therapy. After reading about my experience, you might feel like it’s not worth it, but I’m glad we went.
I learned some valuable skills, and I also learned that if the feeding specialist couldn’t help my child to eat after an entire year, I wasn’t failing. I needed to take a different tack, for myself and my child.
Either way, my advice is to avoid fighting about food at all costs. The parent/child relationship is so much more important than what’s for dinner.
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Julie Cunningham is a Registered Dietitian and a Certified Diabetes Care and Education Specialist who sees clients at Nourish. Her book is called 30 Days to Tame Type 2 Diabetes.
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This post was previously published on medium.com.
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From The Good Men Project on Medium
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