How to Feed a Picky Eater

If you missed the beginning of our conversation, check out Picky Eaters and How to Handle Them

We continue asking questions, and our guest expert is  Katja Rowell, M.D., a family doctor specializing in childhood feeding and Jenny McGlothlin, MS, CCC-SLP, a speech pathologist and pediatric feeding therapist a few questions. Together they recently published a book  Helping Your Child with Extreme Picky Eating A Step-by-Step Guide for Overcoming Selective Eating, Food Aversion, and Feeding Disorders.

How can parents help their picky eater?

There are ways parents can support nutrition while working on routine, and other steps that help with picky eating. The fruit has many of the same fiber and micronutrients as veggies and may be more readily accepted. Maybe put some frozen blueberries in a little bowl and some sliced banana out with the Nutella toast. Don’t ask, just set it on the table and he can choose. Sit with him and enjoy some fruit with your breakfast.

Sauces and condiments, or adding crunch (think freeze-dried veggies and fruits) can help some children. You could offer similar but more nutritionally dense foods (e.g., whole wheat bread or crackers vs. regular, dark chocolate almond butter vs. Nutella). Providing a variety of foods within a routine is crucial; if children are allowed to get a little bit hungry, foods tend to be more appealing, and they are more likely to branch out.

Is feeding therapy possible?

As a Speech-Language Pathologist (SLP) specializing in feeding development and disorders, including extreme picky eating or ARFID, Jenny provides feeding therapy to hundreds of children and their families. There are a variety of approaches to quality treatment, but when we are attempting to facilitate something that is so rooted in a child’s sense of control and bodily autonomy, we have to approach it with trust and responsiveness. Imagine that the child knows his body better than anyone else and any behavior or refusal is the child’s communication that they aren’t ready for that particular food. Being responsive to those communications helps the child navigate the often scary and unfamiliar foods so that they can feel safe and listened to. In this post, Jenny describes how feeding therapy can be accomplished with a relational focus that is crucial for building trust. Feeding therapy can best deal with oral-motor or significant sensory challenges, or when there is extreme anxiety around food if the parents need help.

Many children we work with have tried and “failed” feeding therapies. If therapy is still attempting to make a child do something they don’t want to do, and parents note increasing resistance, fights, gagging or vomiting, it’s not helping. Many children, even with extreme picky eating, particularly if there are no significant oral-motor problems, don’t need therapy. Typical picky eating certainly doesn’t warrant the time, hassle and cost of therapy, and may even make eating worse if the child resists all the attention and focus on her eating. However, parents need more information and support to help better their children at home. It’s why we wrote our book; it gives parents of children on the spectrum of picky eating, from typical to severe, precise steps to turn things around, suggests words they might say in the heat of the moment, teaches parents how to support appetite, stop fighting over food and actually help their child discover their curiosity and desire.

Are there any tricks you can advise our readers to try with their picky eaters?

There are many strategies and tips that can support your child’s eating and his relationship with food. Our immediate goal is to promote appetite and decrease conflict and anxiety— which kills appetite. Our first tip is to establish structured meals and snacks. In our book, each of our five STEPs gets its chapter to walk parents through scary transitions when it feels like children can’t be trusted with eating. The book includes three foundational chapters to 1) help you understand what ‘normal’ is 2) understand your child’s challenges and 3) understand your role. Building on this understanding then, we explain the five steps, each described in detail in their chapter.

• Step 1: Decrease stress, anxiety (yours and your child’s), and power struggles
• Step 2: Establish a routine
• Step 3: Enjoy pleasant family meals
• Step 4: Build skills in “what” and “how” to feed
• Step 5: Strengthen and support oral motor and sensory skills

In chapter 7, we review ways to build on familiar foods and flavors and branch out to new foods. Sadly, there is no one trick, or rule, or sneaky cookbook that will help children branch out. It’s all about setting the stage, parents providing routine and pleasant meals and snacks with a safe food or two, not pressuring or trying to make a child eat (which often invites more resistance) and then allowing the child to discover his appetite and curiosity in his own time.