Levine Children’s Hospital and the Smarty team are thrilled to re-introduce you to Michelle Yoder, OTR/L, Center Manager of Carolinas Rehabilitation Pediatric Therapy Pineville and occupational therapist. Michelle was a Smarty Mom a couple years ago, and we’re so excited to re-connect with her. She’s got great advice on how to figure out the difference between a picky child and a child who really has a problem with eating. Thanks, Michelle!
Help us understand the signs of a picky eater versus a problem feeder.
Picky eating is very typical for toddlers, but we become concerned when a child eats less than 20 different foods. Problem feeders show strong emotions surrounding food. They may exhibit avoidance, crying, gagging or vomiting when presented with food. They often skip or avoid certain food groups, and are very opinionated about the color, taste, texture and shape of the food.
At what age child should a parent start to really be concerned with eating?
Picky eating can start as early as the first year, but many children begin exhibiting behaviors and preferences between 19 and 24 months. That said, it’s really less about age, and more about the child’s feelings and behaviors about food, the family dynamic surrounding meals, as well as ongoing poor weight gain on the growth curve, weight loss, frequent choking, gagging and/or coughing during meals.
Is there a correlation between spitting up/reflux as a baby and being a problem feeder as a toddler/young child?
There definitely can be as children may connect and associate the pain of reflux with eating. For instance, they begin to associate the bottle with pain, and then no longer want to eat. This then becomes a learned behavior. They have learned from past experiences that food may cause discomfort, and this establishes a negative association with food.
What is the correlation between sensory processing disorder and problem feeders?
Many children with sensory processing disorders exhibit defensiveness to various sensory input, including tactile (touch), oral (mouth), auditory (sound), olfactory (smell) and gustatory (taste). These senses all play an important role in eating. Young children finger feed, so if they cannot stand to touch the food, this will override their desire to eat. Some children have auditory sensitivities and cannot stand the sound of others chewing or the forks scraping the plates. The smell of broccoli or other strong foods such as fish causes some children to gag or avoid eating. Lastly, for some children, the feeling of certain foods in their mouths causes unfavorable behaviors such as spitting the food out, gagging or vomiting. Sometimes children with sensory processing disorder lack the motor planning skills for effective manipulation of and chewing of food. So, if it is really hard to manage what has been placed in their mouths, they are not going to have a positive experience with eating.
If your child is showing signs of having legitimate food issues, what are some resources parents can access?
Seek support from your local occupational therapist or speech therapist who specializes in sensory-based feeding challenges. Other parents can be helpful in providing playdates for social modeling and to establish positive experiences surrounding snacks and meals.
What are some tips to wrangle a picky eater?
– Get their wiggles out before coming to the table. Have them perform heavy work using their large muscle groups where they might push, pull, lift or carry objects.
– Keep a consistent snack/meal schedule and avoid grazing throughout the day.
– Minimize distractions: turn off the television, and leave the toys in the playroom.
– Don’t give high-calorie drinks at the beginning of the meal.
– Encourage everyone to stay at the table while others eat.
– Do not prepare separate meals.
– Kids love to dip! Present condiments for dipping.
– Smoothies are a great way to add some fruits and veggies! Let them pick out a fun straw to suck from.
– Consider the presentation of the food.
– Keep portion sizes small.
– Try divided plates or even fun ice cube trays.
– Experiment with color and shape. Our kids typically like dry, crunchy, stick-shaped, bland colored food. Consider presenting non-favored food items with similar color and cut into a familiar shape. Fruits and veggies are easy to cut into a stick-like shape. Cookie cutters always make things look more interesting, too!
– If your child wants a certain food item off of their plate, have them first explore it- touch it, smell it, lick it, touch it to her lips. Then, have them place it into a clear bowl right in front of their plate.
– Talk about and describe the food by its characteristics: it’s cold, it’s crunchy, it’s wet, it smells…
– Explore non-food items that provide oral input: blow bubbles, blow whistles, vibrating toothbrush, oral massager, chewy tubes, edible sensory bins.
– Children need repeated exposure, so offer the food at least 10 times before determining whether or not the child really likes or dislikes it.
– Because these are learned behaviors, positive changes may feel really slow. Hang in there!
At what point do you bring in a nutritionist for a picky or problem eater?
If the child is showing weight loss or regression on the growth chart, that’s when you to involve a nutritionist. A nutritionist can help identify strategies to maximize caloric intake and work with families if there are any vitamin or mineral deficiencies.
Michelle graduated from The Ohio State University in 1995. She is Ayres Certified in Sensory Integration as well as Interactive Metronome Certified, and is a Certified Infant Massage Instructor. Michelle has also received John Barnes Myofascial Release Training and is trained in Therapeutic Listening, Neuro-developmental treatment, Sequential Oral Sensory Approach to Feeding (SOS), Oculo-Vestibular Dysfunction, Handwriting Without Tears, and The ALERT Program. Michelle has worked in pediatrics for 18 of her 21 years as an occupational therapist. Michelle also co-developed the Fundanoodle Handwriting Development Program and is the Membership Co-Chair of the North Carolina Occupational Therapy Association.
Michelle says, “I love working with the pediatric population because children are intrinsically motivated to play, and through play, we can achieve our goals and accomplish great things! Michelle’s two children, Sydney (14) and Owen (10), keep her husband Matt and her very busy. Her family loves to travel and she enjoys watching and facilitating her children’s growth and development because, as she states, “Child development never ceases to amaze me!”
Carolinas Rehabilitation Pediatric Therapy
Children who experience issues with problem eating require special care to build positive relationships with food and mealtime. The outpatient pediatric program at Carolinas Rehabilitation works with children of all ages. For more information and to find a location near you, please visit the Carolinas Rehabilitation Pediatric Therapy page.