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Are you concerned about the number of foods your child eats? Are mealtimes a struggle? Are you worried that your child is not receiving adequate nutrition? The following information is provided to help you understand more about the difference between picky eating, and disordered eating, sometimes called “feeding refusal”.

First, here are some myths about feeding refusal:

1. Children that have feeding refusal are just difficult children with difficult behaviors. FALSE
Children that refuse to eat often have good reasons: they may have aversions to food or past traumatic experiences associated with eating that makes them afraid to eat. Your goal should be to change your child’s eating experience from scary to enjoyable and pleasurable.

2. Children who have pediatric feeding refusal are just picky eaters. 
FALSE
Picky eaters will usually eat at least one food from most food categories/textures, and will touch/taste new foods. Your child is likely a picky eater if they have a mostly balanced diet with little nutritional concern.

Feeding refusal is not a feeding disorder caused by pickiness or preference. Children with feeding refusal have trouble gaining weight due to limited food intake. They may display a decreased appetite with accompanying behaviors of head turning, spitting out food, vomiting, and/or forced mouth closure upon the presentation of foods they dislike. Sensory aversions may accompany feeding refusal, which means that touching, smelling, and licking new foods may evoke strong resistive responses.

What can I do to help my child at home?
1) Start by integrating food into play at non-mealtimes, such as encouraging a restaurant-theme for dramatic play.
2) Allow your child to explore foods with their hands through painting with food or water play.
3) Expose your child to different food scents, starting with milder smells, such as bread or pasta, then gradually introducing stronger scents.
4) Finally, slowly transition your child to eating in the following order: Bringing food to the lips>licking>taking a small bite then removing>chewing and spitting out>chewing and swallowing Start with foods that are similar to ones that your child likes, and then you may attempt some non-preferred textures.

*Reward your children with praise, hugs and kisses when they behave appropriately – such as sitting at the table, tolerating new foods on their plate, or kissing a food they’re not yet ready to put in their mouth. You can also try rewarding your child with a bite of a preferred food after they have tried a new food, or allowing them to play a preferred activity after a successful mealtime. Positive reinforcement for desirable eating behaviors will encourage your child to behave the same way in the future.

More references:

–Love Me, Feed Me by Katja Rowell M.D
-Feeding Matters: https://www.feedingmatters.org
Written by: Taylor Viggers, MS, CF-SLP

(Special thanks to Devyn Jones, MS, CF-SLP, an Arizona-based speech-language pathologist for collaboration on this material)
Baird, E., Capeci, W., & Klein, J. (n.d.). A Group Approach to Pediatric Feeding. Lecture presented at ASHA – 2011, San Diego. Retrieved April 12, 2016, from http://www.asha.org/events/convention/handouts/2011/baird-capeci-klein/

Weaver, C., CCC-SLP. (2008). Evaluation and Management of Behavioral-Based and Sensory-Based Feeding Problems. Lecture presented at ASHA – 2008, Chicago. Retrieved April 12, 2016, from http://www.asha.org/events/convention/handouts/2008/1324_weaver_cori/

Williams, Keith E., Douglas G. Field, and Laura Seiverling. (2009). “Food Refusal in Children: A Review of the Literature.” Research in Developmental Disabilities 31.3 (2010): 625-33. Web. 7 Apr. 2016.