I spend a lot of time writing and speaking about picky eating. When I say “picky eater” I am referring to a child who has picky behaviors but can learn to eat a broader diet and change the bad habits that are negatively impacting themselves and their families. However, when it comes to feeding disorders there is a continuum of severity. And many of you have children with more severe food aversions.
Approximately two-thirds of children on the autistic spectrum have severe food aversions which can impact their growth and development. While this population of children often has feeding aversions it is in no way limited to them.
Children with medical conditions that have caused pain when eating often have severe food aversions as do children with sensory integration dysfunction. Children with oral motor impairments may also have a severe fear of eating due to their inability to move food around in their mouth and safely chew and swallow.
Children with these severe food aversions are often referred to as resistant eaters or problem eaters.
The Wrong Advice Is Dangerous
As a feeding therapist who has worked with many children with severe food aversions it is scary to me to read information with no disclaimer that says children will eat when they are hungry and they will not starve themselves .
While typically developing children who are “picky eaters” will not starve themselves or make themselves ill, problem or resistant eaters might.
If there is any doubt whether a child is a picky eater or a resistant eat I always recommend seeking professional guidance from a feeding therapist.
Some Characteristics of Resistant Eaters
One of the characteristics of a resistant eater is the limited acceptance of food items. This is often the same with picky eaters but more pronounced and severe in the resistant eater. I have seen children with as few as 2 different foods in their repertoire. Often these children will start with more foods and begin to eliminate them over time.
They may suddenly eliminate a favorite food or bring back an old favorite. These children are also very aware of imperfections in foods, even their favorites such as dark spots, cracks, bumps etc. Some children will also eliminate whole food groups such as fruit and vegetables, or meats. However some resistant eaters will only eat from one food group they have chosen which is often carbohydrates, but can even be meat.
Children with oral motor impairments may only accept pureed foods that do not require chewing. These types of behaviors cause fear and frustration in parents and caregivers. It also causes judgment from extended family members and friends who have never dealt with a resistant eater.
Children who are resistant eaters may also gag and/or vomit when presented with new or disliked food. They may also exhibit extreme behavioral reactions which impacts everyone around them. For these children and their families any situation which food is involved can be scary causing avoidance and isolation.
Feelings Of Isolation
Parents have told me stories of feeling isolated in social situations when they are unable to explain their child’s food aversions to other parents. This often leads them to stop making these social plans in hopes of avoiding these awkward situations. They also express fear of leaving their child in a situation where food may be offered which can lead to social isolation for the child. And in many cases these children need the social experiences the most.
Just like picky eating, problem eating can be improved. However, the process is more complicated, ongoing and most often requires professional intervention with a feeding therapist. Children with severe food aversions will likely struggle with these aversions through adulthood.
However they can become healthier eaters with guidance. When parents begin to see early signs of picky eating and food aversions there are tips that will keep the problem from growing larger and out of hand. Often the best of intentions can unknowingly make a problem worse.
There is No Better Feeling
Just recently when in the company of a good friend and his child, watching his 2 year old eat broccoli and chicken, he exclaimed “There is no better feeling than watching your child eat a healthy meal.”
As I have said before, feeding disorders are all consuming to everyone involved. For those of you who have not had the experience of having a child with a feeding disorder, be supportive to those families you may come across in the future.
And for those of you living with food aversions in your family, change is always possible.
(if you would like your child to eat a broader diet and change the bad habits that are negatively impacting themselves and your family call (914) 488-5282 now to request a confidential consultation)
{ 49 comments… read them below or add one }
Do you have a list of feeding therapist in the Dallas Fort Worth area?
Hello! I have an adopted child who refuses to eat anything but bologna or hot dogs. Any attempt to introduce fruits and vegetables or more nutritious food, even a bite, is refused and a temper tantrum ensues.
I firmly believe that he would starve himself to death if he had only nutritious food to eat.
Do you know the right kind of food therapist we could contact in San Antonio, Texas.
Thank you!
Stephanie
Patrick,
I am sorry I do not have a list of feeding therapists in the Dallas Fort Worth area. I would suggest calling the local hospitals. Quite often they have feeding clinics and therapists with feeding experience.
Stephanie,
I would contact the hospitals and ask about pediatric feeding clinics. Often hospital based programs will have therapists with feeding experience.
Would you happen to have a list of therapists in the Chicago, Illinois area? Our daughter is 4 years old and I am very worried that she is a resistant eater. She goes all day at pre-school drinking only water. She refuses to eat anything and this has been going on for 9 months now. At home, she only eats pbutter and crackers and sometimes applesauce. We does take her vitamins — she drinks milk and ensure.
Angela,
For a list of therapists in your area you can contact ASHA. That is the American Speech and Hearing Association. You can also contact the local hospitals. They usually have therapy teams and are likely to have someone with experience with feeding.
I have two step daughters that we recently got custody of by cps and in the report it said that the kids were starved by the mom due to drugs. One of the girls is four and the other is seven. The four year old I have no problem feeding, but the seven year old is a battle every time. She doesn’t want to eat when is breakfast or lunch time or dinner, but if are not looking she stuffs her self with junk food or gets food and runs and hides to eat. Is this a sign of starvation or she just wants the junk food? Please I need advise. Thank you.
my 11 year old son after I read your page I believe he is a resistant eater . He has been having this problem since he turned almost 10 months old after having the hives .He was treat it by a Occupational therapist at AT children’s hospital Los Angles for the eating prob he was tagged as failure to thrive, and also went to an eating disorder program at the university of southern california UAP clinic department of mental health , but still have this prob. just worry so much about his future , any help in las vegas Nevada we live here now
My son is a resistant eater and is getting worse and worse. I am so stressed over his lack of nutrition. I am worried about taking him for therapy because he is very, very smart and if he knows that this is about his eating, he will refuse to participate. I also worry about spending large amounts of time and money and getting no benefit from the therapy. What is the success rate for children who are given this sort of therapy?
SJ,
Each program and therapist has a different success rate. I would talk to some of the hospitals in your area and look in to a feeding clinic or have them recommend a therapist or team of therapists who specialize in feeding. When I contact them I would ask then their success rates.
Children who are resistant eaters most often do not become “great” eaters however they can learn to be more flexible and eat healthier with the right type of intervention.
Thank you. We are waiting to hear back from his pediatrician for a referral to the local program. I will definitely ask them about this before we get too involved. I’ve been told that there is a waiting list, so I don’t know when we’ll even be able to get in.
SJ,
I hope it all works out! I would love to hear the outcome.
I have a 3 1/2 year old son who is a resistant eater. He will only eat Nilla Wafers, peanut butter sandwiches on wheat bread, hamburger buns, hot dog buns and doritos. I give him the mini wafers because he has a bad gag reflex and if he gets too much in his mouth he will vomit.
When I say he eats these foods it’s really not enough to amount to anything. He still sucks a bottle because that’s the only nutrition he gets. I put whole milk, pediasure and baby food in it. I get so aggravated when I try to talk to doctors because the first thing they tell me is to take his bottle away. I’m not going to starve my child. HE WILL NOT EAT. He is also not talking plain or saying as many words for most 3 year olds. Should I contact our local hospital as you suggested to the others above? Your help would be greatly appreciated.
Can you recommend any books that might be useful? I saw one called “Just Take a Bite: Easy, Effective Answers to Food Aversions and Eating Challenges” by Lori Ernsperger and Tania Stegen-Hanson. Would this be worth purchasing? We live in Bermuda and there are no food therapists here. My son is 8 and his range of food continues to get more and more limited. He is currently in the 50% for height and the 20% for weight, but we are worried that his growth will be affected if he continues to have such a restricted diet.
Hi, my child is a problem feeder who is extremely resistant to new or different foods (including different brands of familiar foods). She eats a small range of foods, and excludes all fruits and veggies. I wish I’d had more knowledge and support when she was younger. Now, she’s almost ten years old. Is she too old for any type of feeding therapy? Would SOS therapy be helpful in this type of situation? Thank you for an article that validates the reality of our struggle!
After reading your articles, I have determined my four year old son is a resistant eater. Like, everyone else we have tried everything. We feel isolated from family and social gatherings, due to the fact that we do not want to face the ridicule and judgement from others. I am so frustrated and do not want to take it out on my child, but being a single parent and dealing with something like this wears you pretty thin. Finding you gave me hope that there is a solution for this problem. I just do not know what to do next, should I send him to a therapist, or look for something more eating specific? Thank you for ANY advice you can offer.
I am glad I came across this. This completely describes my son. He will gag on certain foods like chicken. He started off eating chicken nuggets when he was smaller and now wont eat them. There are very few foods we can get him to eat and it is a real pain. Even some of the foods most kids like, he doesn’t care for. I have heard people say that kids will not starve themselves, but my son absolutely will. I don’t know what to do about this because a lot of the foods he prefers cannot be eaten on an everyday basis. He likes spaggetti, but I am afraid his stomach will suffer from too much of that. He likes hotdogs, but they are not healthy at all. He will also eat Ramon Noodles…something else very unhealthy. Dinner time is a nightmare.
spaghetti******** Sorry
Cris,
I would recommend seeing a child psychologist. Her eating issues are most likely emotional due to her past.
Rossana,
For a list of therapists in your area you can contact ASHA. That is the American Speech and Hearing Association. You may find someone who specializes in feeding. You can also contact the local hospitals. They usually have therapy teams and are likely to have someone with experience with feeding.
Jennifer,
I am sorry for my delay in responding. I definitely would recommend looking into an evaluation with a speech language pathologist. You can look into the local hospital as well as ASHA which is the American Speech and Hearing Association. They have a data base of local Speech Language Pathologists.
Judith,
I really like Child of Mine by Ellyn Satter. I love her philosophy on feeding children.
Heather,
I feel that it is never too late. The SOS program is great. The most important thing is to find a therapist who knows what she is doing and also one who you feel a good connection with. The right therapist for one child might not be the right therapist for another. Each child is different and I feel very strongly about this especially when it comes to something as sensitive as eating.
Jennifer D.,
Sorry for the delay in responding. There is always hope for change. There are several types of professionals who work with children with eating issues. The 3 most common include Speech Language Pathologists, Occupational Therapists and Psychologists. The most important thing is finding someone who you and your son are comfortable with and has experience with problem eaters.
Veronica,
He definitely sounds like he could be a resistant eater. When children have eating/feeding difficulties it is so stressful and I can hear how stressed you are in your message. If you were able to locate someone in your area who works with feeding I would recommend pursuing it. Even some simple changes can help relieve a little stress and improve everyone’s quality of life.
We finally have an appointment with the feeding team for our son. We will be going in next week. I’m so worried that he will just get worse once he knows why we are going. He is so stubborn and I expect him to get angry and just refuse to eat all together. I hope I’m wrong. Meanwhile, he is down to milk, juice, yogurt, applesauce, and bread. Sigh…
SJ,
I hope it goes well. Sometimes it can get worse before it gets better. Let me know how it goes.
Thank you, Isa – I will!
This is such a helpful article! I have never heard of the difference between picky eating and resistant eaters. I have been pulling my hair out trying to get my son to eat new things. I have been to a nutritionist and we didn’t get anywhere. My son currently only eats wheat saltines, and baby food. He is 3 next month. I have him on vitamins and mix them with his soy milk. He is allergic to egg, milk and peanuts. I need help – we live in the greater Cincinnati area, can you please offer me some suggestions on what I can do. Any help would be most appreciated!!
Hi Christine,
The Cincinnati Children’s Hospital has a feeding Clinic. Give them a call and let me know how it goes. Good luck!
Thank you for getting back to me Isa – I will let you know how it goes.
Also and most importantly thank you for getting this article out – it made me realize how serious this is, and it was great to see I wasn’t alone.
Christine,
I am happy to hear the article was helpful to you. I hope everything goes well.
My son was not diagnosed with autism spectrum disorder until he was eighteen years old! Maybe because he is very smart and always did well on school tests. He also was very verbal at a very early age, he spoke his first work at 7 months. But he is very awkward socially and has food adversions! When he was in kindergarten he threw up because a child sitting next to him was eating an orange. When he was very young, before kindergarten, I could get him to eat bananas and raisins. But since then he wont eat any fruits or vegetables and he is almost 22 years old. He was drinking the v-8 fusion drinks that count as 1 vegetable and 1 fruit per 8oz serving. But even that has dropped by the way side. We live in San Diego county, is there any help for him in our area? He has medi-cal. Also he has become quite obese and I’m so worried about him. From a loving mother, Teri
Hi, after reading your articles,i am truly conviced that my son needs both speech and feeding therapy, i live in westchester county. Do you accept insurance. Thank you
Hi Lara,
I would love to talk to you about your son. We don’t take any insurance however we will provide any information and codes to help you get reimbursed for the services.
Isa
You have no idea how much this article meant to me.
My child would be hospitalized before he would let a food he doesn’t like get into his mouth.
I feel like a terrible parent all. the. time. for giving in, but it’s not picky eating. It’s more.
I have yet to find a program here in ONtario, Canada that works with eating issues that do not have physical causes. It’s so very frustrating.
But thank you so much for writing this!
Dear Isa,
It was a great relief finding your website. I have been thinking that maybe I am responsible for my son’s difficult eating, but I just cannot watch him starve so I have been feeding him for years now. He was even difficult on the breast as a baby, taking over an hour to feed of one breast. He eats some variety of food like some fruits, veg purée if hidden in chicken soup, pasta, meat soup if very soft. He is 3 and a half and I am lucky if he actively eats a few spoons of his favourite food (chicken soup with pasta) before he just stops. I have to bribe him with something fun to do for a few more spoons, and then show him a good toy and feed him while he is distracted to get more food into him. He is skinny and always been constipated, which he takes movicol for. He has some possibly sensory processing problems but we are investigating this, but he is not autistic. I was wondering if I should keep feeding him or insist he eats on his own, and if no encouragement helps (it rarely does) just remove his food? So many people tell me I should let him starve for a while if he refuses to eat and he will learn to eat, they tell me I am spoiling him and it is all my fault… what do you think?
Hi Teri,
I do have a list of feeding clinics in CA. I am not sure how close you are to any of them.
Clinic 4 Kids
Addison Behavioral Resources
CSU, Sacramento
Center For Autism and Related Disorders (CARD) Specialized Outpatient Services (SOS) Feeding Clinic
Children’s Hospital of Orange County Feeding Program
California Pacific Medical Center, Kalmanovitz Pediatric Development Center Feeding Disorders Clinic
Pasadena Child Development Associates
Hopefully one of these places can meet your sons needs.
Isa
Reccewife,
I am glad to hear that my article was helpful to you. Check with the Pediatric Feeding Program in Montreal Children’s hospital. They may be able to recommend someone closer to you.
Hi Paulina,
Feeding disorders are very complex and there are no easy answers. I would not feel comfortable telling you what to do without seeing your son or talking to you further. In my opinion there is always a strong behavioral component to every feeding disorder. I often give parents the advice to give back control to their children when it comes to eating and what we usually see is an immediate decrease in food intake. However over time the amount of food the child will eat increases.
Patrick,
I do feeding in some areas of Dallas. You can also try Cooks, Children’s, and OCH Baylor. Good feeding therapists are hard to find in Dallas. Ask lots of questions and also may sure you have a clear home exercise program.
I, too, have a resistant eater. His doctor said she could refer us to a speech therapist for his pickiness but I’m concerned he needs more of a feeding specialist. Are they one in the same? Is there a feeding specialist near Commerce, Georgia?
thank you for posting this information for all to see! paulina and i are living similar lives. my son is 4 1/2 and i still have to entertain him during dinner, practically feed him or put the fork in his hand and basically distract him to get him to eat. i have to threaten to put him in the corner/time out so that he stays in his seat for a meal. his list of foods is short and foods he used to eat daily he refuses. items like scrambled eggs, bananas, apples are now on the “no fly” list. he refuses new foods to the point of covering his mouth and running into the other room. he will admittedly say he is scared of the food and i truly believe that he is. i have put foods out for him to cut, tear, squeeze and play with to become familiar, not forcing any eating just allowing him to play and possibly put to his tongue. i encourage him to smell, taste, but don’t force. i’ve introduced new foods 15 times in a row and he will still not even try to put it in his mouth. he is not autistic, he is not developmentally delayed in any other way. he will react to smells and even ask me to take my plate from the table because the smell is so intense for him. i don’t feel he is facing malnutrition but could see that becoming an issue down the line. he eats no fresh fruit, no fresh vegetables and only about once a week can i get him to eat breaded chicken. textures are inconsistent – he will eat oatmeal and dried green beans; soggy cereal and pita chips. if sick don’t even think about getting pedialyte in him. i’m not sure this isn’t an issue that he will grow out of but i am not sure. i just want to do what i can to help him now before this becomes a life-long problem. i’ve seen buzz words like food neophobia, sensory dysfunction and don’t know which is which. do you have any recommendations for services in the philadelphia area by chance? thanks for reading this.
Hi Isa Marrs,
Thanks for your very enlightening article. I have a 2 year old daughter whose daily diet consists primarily cereal (which I have to prepare with hot water and let cool). Sometimes she attempts savoury foods, but it still has to be a certain consistency (porridge-like) , she even would gag on mashed potatoes if its too thick. She WOULDN’T chew anything, even if I give her chunks of her pineapples, which she loves, shed only suck it or squeeze it in a bowl and drink it, if a tiny piece stays on her tongue – she’d use both hands to brush it off aggressively and would complain till its out of her mouth. If its any snack that’ll melt in her mouth like cheeseballs, she’d just lick it and toss it out later. If her food is too lumpy or thick, she’d gag immediately (and even vomit if she swallowed a little portion).
I try showing her chewing motions before shed just do some exaggerated motions but now she wouldnt even try. To make sure she gets the right nutrition, I add soya powder to her cereal for protein as her daily milk intake isn’t sufficient, give her vitamin C daily, and multivitamins (well kid syrup). Sometimes I’m successful in sneaking an egg yolk into her mashed potatoes too. However, she loves drinking anything.
For everything else, she’s developmentally okay, she sings along to barney songs – saying a few words at a time, imitates the kids activities etc. She knows parts of her body, attempts counting along from 1-10 etc (I checked babycentre Uk for milestones).
Please what can I do! I’m from and live in Nigeria, I haven’t heard of or seen any occupational therapists. The only related therapist I just discovered is a speech therapist 8hours away. http://www.jjcalvaryspeechtherapists.org/contacts.html
I found a yahoo Q&A that says a “Nuk® Massage Brush Set” and “Textured ARK Grabber XT” might help. I believe I’d be able to get her to use them as a routine the way brushing is, but dont even know how to use them.
http://www.superduperinc.com/products/view.aspx?pid=om320&view=#.USORKKVvCSo
http://www.superduperinc.com/products/view.aspx?pid=AG401#.USOZx6VvCSo
Please what advice can you give me? Right now I’m very worried, out of options and desperate. I really tried all I thought I could do, including things I’m not proud of (like forcing her to eat). Im worried she’d never learn to chew! and I’m also fed up with everyone talking, seriously, I really tried
Thanks a lot. Looking forward to your reply (sorry this had to be so lengthy, and I even had to caution myself from writing more!).
I have a 16 month old who has stopped eating everything all together. About 7 weeks ago he had the flu and of course vomited a few times and since that moment on he refuses to eat any solid foods. I took him to his Dr for his re-chk and she told me to wait 6 weeks to see if he will eat or gain any weight. His appt was yesterday and as I had told her, he had not gained 1 single ounce, but hadn’t lost any either. They only thing my son will take is whole milk. I have added pedisure to that for the first several days and he vomits that up. Then I started doing half and half, now he smells it and won’t take it at all. I try every food & juice we have over and over again. My son is 16 months and only drinking milk! The Dr called me this morning and wants to take an xray to see if there are any abnormalities. Please I need some advice. I live in Jacksonville, NC….thank you!
Tonya,
I only know of one feeding clinic in NC and I am not sure if it is near you. It is called Carolina Pediatric Feeding Dysphagia. I have a list of all the feeding clinics in the country and don’t have specifics. You definitely need to find a team to work with your child if medically he checks out fine. It is not uncommon for children to stop eating or more often eat less after an illness. However they usually return to normal after a couple of weeks.
Susan,
Some Speech Language Pathologists specialize in feeding. Many do not. I know of 2 clinics in GA however I am not sure if they are near you or not. They are Building Blocks Pediatrics and Happy Hungry Hippos Pediatric Feeding Clinic. I do not have specific information on these clinics as they are on a list I have of clinics around the country.
Susan,
Children’s hospital of Philadelphia (CHOP)has a pediatric feeding program. I would definitely pursue it.
desperatemum,
Unfortunately I do not know of any feeding clinics in Nigeria. There are many great feeding books on the market and I would recommend reading all you can. I would also be willing to do a phone consult if you were interested just to get you going in the right direction.