Eating/Feeding in Children (Part 1)

For some children and families meal time and eating in general can be a challenge! It is difficult as a parent or caregiver to see a child uncomfortable at mealtimes or eating a limited diet, especially if siblings or other children don’t have the same difficulties. As OTs we can assist with routine around meal time, fine and oral motor skills required for eating and feeding, and sensory preferences for foods. We would always refer to a paediatric nutritionist for specialised  nutritional support, or a speech pathologist if there are concerns with swallowing or other oral motor abilities. 

 

To provide some support we have collated some helpful tips that can assist you in starting the problem solving process of why your child might be presenting with aversions or limitations around food. 

 

 Reason’s Why a Child Won’t Eat

• Are they in pain?

Pain can be less obvious and hence may be overlooked in terms of challenges with eating. Examples include:

• Stomach/gastrointestinal pain

• Sore throat

• Retching/gagging

• GER

• An acute illness such as otitis

• Side effects of medical procedures

• Are they in discomfort?

Discomfort may be due to internal issues and not obvious or clearly articulated by the child. Discomfort, including digestive issues, could be greatly impacting a child’s eating or food tolerance. Examples of discomfort include: 

• Nausea

• Allergies

• Constipation

• Fatigue

• Stomach distension

• Congestion

• Renal conditions

• Do they have immature motor, oral motor and/or swallowing skills?

If a child has not developed the appropriate skills in order to eat the food presented to them this could significantly impact their eating abilities and preferences. Some indicators of this may be:

• Choking

• Aspiration

• Poor oral strength

• Overstuffing of mouth

• Immature tongue and/or tongue coordination

• Oral processing problems

• Balance problems

• Poor mouth to hand coordination 

• Do they have sensory processing problems?

A huge aspect of food is the sensory component, and challenges in this area can be a huge contributor to picky eaters and problem feeders. Examples of sensory processing in relation to food include: 

• Being under or over reactive, seeking, or under aroused to visual, tactile,  taste, sound and smell

• Does your child prefer only one texture of food? (Crunchy like crackers or dried noodles, mushy like purée or mashed vegetables, liquid like yoghurt or smoothies, soft like bread & cakes)

• Does your child “eat a rainbow” or just one colour? It can be common for children with feeding difficulties to only consume one colour, such as the well known “white diet” 

• Is your child specific about the brand and packaging of the food they consume? Do they insist on one flavour and branding of biscuits, or can they eat any brand of that flavour?

• Having sensory based movement problems

• Interception challenges (unable to know and respond to internal hunger or fullness cues)  

• Discrimination problems

• Do they have learning and/or behavioural challenges?

Some of the following factors can impact a child’s ability to eat at the expected level for their chronological age:

• Impaired learning capacity

• Cognitive delays

• Information processing problems

• Communication difficulties or delays 

• Being in the midst of a developmental shift in cognition

• Being in the midst of a developmental independence stage

• Are there other nutritional factors involved?

Factors related to the nutrients of food could also be influencing a child’s food preferences, hunger and ability to eat include:

• Being calorie deficient

• Metabolic disorder

• Absorption disorder

• Inadequate macro-nutrient ratios and/or composition

• Inadequate micro-nutrients

• Are there other factors influencing why a child will not eat or their eating is impacted?

The below are also other important considerations in challenges with eating:

• Difficult temperament

• Anxious/fearful

• Low affect

• Highly distractable or hyperactive

• Developmental age, in comparison to their chronological age

• What is going on in the environment around the child?

The environment in which a child is engaging in eating or experiencing mealtimes can play a significant role in their preferences and willingness to eat. Consider some of the following, and how this could be impacting on a child if they are having challenges with food:

• Lack of exposure to a variety of food or limited food availability 

• Allowed to graze all day, so not actually hungry when it comes to main meal times

• No feeding schedule, or inappropriate schedule for age or skill level

• Lack of structure to meals, or no exposure to a ‘normal’ meal routine

• Chaotic/disorganised/distracting household or eating environment

• Toys/TV/IPad/Games/Technology during mealtimes

• Seating arrangement at the table is not appropriate/posturally supportive

• How are the parents modelling and influencing food choices and meal times?

We all know that parents play such a huge role in influencing what a child does in all aspects of their life, and eating and food is no exception. Some of the below factors that parents might do could be contributing to challenges in this area:

• No positive reinforcement, or modelling of appropriate eating behaviours

• Are parents addressing eating and making positive comments or giving positive reinforcement about the child’s eating? 

• Modelling poor eating behaviours and/or personal dislikes

• Are parents modelling trying new foods? 

• Restricts diet due to fears of weight gain, extreme fears of lack of weight gain, or focuses primarily on weight gain (if under weight) rather than interactions

• Inappropriate developmental expectations

• Expecting a child to eat independently before they are developmentally ready to, or preventing a child from eating independently with an adult continuing to feed them 

• No clear limits on the child due to fear or guilt about medical or emotional fragility of the child

• Punishing, tricking or coercing child at meal times

• We strongly discourage this, and traditional negative reinforcements at mealtimes (“if you don’t finish your dinner you won’t get dessert”) 

• Distracts child to try and get them to eat, or repeatedly interrupts them while eating with constant questions or instructions

• Everyone eats at their own pace, especially children. Let them eat at their own pace and reduce time pressures or infliction of anxiety where possible 

• Lack of education around the best nutritional choices for their child based on skill level

• Everyone has differing levels of education or perceptions of nutrition. There are many resources available outlining the recommended nutritional intake for children at different developmental stages and ages. Your OT can support you in finding these resources. 

• Inconsistent parenting, especially with mealtimes and routine

• Set goals and work towards them consistently. Children are clever and will remember if one parent/caregiver uses a particular strategy and another uses a different method. 

 

As you can see this is a HUGE list – and it will most likely be a combination of many things that is influencing a child’s success with food and mealtimes. As Occupational Therapist’s we can work with you to try and address and work on one thing at a time to try and improve and enable food and meal times to be a positive experience, in order to make progress!

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