When to Seek Help for ‘Picky Eating’

In our last blog post, we described picky eating habits and how you can help your child be a more adventurous eater. But what if there’s more going on than what is on the surface? Specifically, picky eating habits that appear behavioral may in fact have a physiological basis. . Physiological factors that could be causing picky eating habits may include (but are not limited to): dysphagia (disordered swallowing with or without aspiration/choking), acid reflux (also known as GERD), food allergies or sensitivities, and limitations of the musculature required for feeding, including the tongue, jaws, and lips. It’s important to work with your child’s pediatrician to rule out any of these medical concerns that could be contributing to your child’s picky eating.

Risk Factors During Infancy/Early Childhood
There are some risk factors that occur during infancy and early childhood that, in conjunction with picky eating habits in later childhood, could point to the presence of physiological factors. If any of these factors apply to your child, we recommend you consult with a healthcare professional who is trained in feeding development, such as a speech-language pathologist. Factors that occur in infancy and early childhood that can cause picky eating include:

  • Difficulty coordinating the suck/swallow/breathe pattern
  • Weak or shallow latching on to breast or bottle
  • Making clicking sounds or being a noisy eater
  • Difficulty managing flow rate while feeding during infancy, requiring smaller nipple size or liquid-thickening
  • Choking and/or gagging during feeds
  • History of intubation, such as during illness, surgery, or NICU stay 
  • Painful breastfeeding (for mother)
  • Required special positioning for feeds as an infant, such as side-lying or upright
  • Challenges with typical solids progression
  • Acid reflux or colic 
  • Excessive drooling
  • Sleep difficulties, such as apnea  
  • Prolonged thumbsucking or pacifier use 
  • Recurrent ear infections or illness, such as strep throat, persistent cough, or congestion that last longer than a couple of weeks 

Additional factors that may be contributing to picky eating habits include: 

  • Sensory factors such as sensitivity to textures or the feeling of being “messy,” chewing sounds, or strong smells 
  • Fine motor skills, including hand-to-mouth coordination and utensil use 
  • Visual skills such as challenges with figure-ground perception 
  • Postural stability, especially neck and trunk control or core strength 
  • Strength and range of motion of the oral-facial muscles required for feeding 
  • Swallow and gag reflexes 
  • Coordination of jaw, lips, and tongue, which is required for safe feeding 

When to Seek Professional Help
If your child has had two or more risk factors listed above and continues to demonstrate picky eating habits, it may be time to seek professional help. Other signs that may warrant a visit  to your child’s pediatrician include:

  • Your child is not meeting growth milestones due to their restricted diet 
  • Your child is not getting all the necessary nutrients from an oral diet 
  • Your child’s restricted diet is causing limitations to their ability to attend social events, such as birthday parties, sleepovers, field trips, etc. 
  • You have concerns regarding health and safety around mealtimes, such as if your child is demonstrating signs and symptoms of dysphagia. Signs include coughing during mealtimes, wet vocal quality during and after mealtimes, choking and/or gagging, watering eyes, painful swallowing
  • Other sensory concerns are present as well including aversions to texture, visual, proprioceptive, vestibular, auditory, and olfactory input 

Who to Call for Help

If you have any questions or concerns about your child’s eating habits, the team at BRAINS can help. Our speech-language pathologists have a proven track record and would be happy to schedule a free consultation call with you. Contact us at 616-365-8920 today.