If mealtimes hold little joy for you because you have to struggle to feed your child, don’t despair. Your child may be a picky eater because of an underlying disorder which can be treated.
“Oftentimes picky eating habits may be due to underlying sensory issues. These issues are part of a bigger sensory processing problem that can affect the child’s daily activities,” says Sri Devi Mageandran, Speech Therapist at KK Women’s and Children’s Hospital (KKH).
This sensory problem makes it difficult for the child to manage and process the different sensations produced by food. The problem can be related to the look, the smell, the taste or even the texture of the food.
How do you know your child is a picky eater?
Ms Mageandran says there are some “red flags” which can point to a picky eater. You know your child is a picky eater when:
- He or she has difficulties transitioning from milk to semi-solid food by 12 months
- Your child has not been weaned off most forms of baby food by 16-18 months
- Mealtimes are neither easy nor enjoyable
- Your child has to be force-fed
- Your child avoids all foods of a particular texture or from a specific food group such as meats or vegetables
- Your child is eating less than 20 different types of foods of varying textures and tastes
- Your child needs distractions like TV, toys or videos in order to eat
- A meal takes longer than 20-30 minutes
Different causes of picky eating
Picky eating can be caused by various medical, sensory, behavioural or even oral motor factors.
However, picky eating is often due to a mix of behavioural and sensory issues, explains Ms Mageandran.
Sensory issue: “Eating is a sensory-loaded experience. You need to be able to tolerate the sight and smell of the food, the way its temperature, texture and taste changes as you put it in your mouth and eat it,” Ms Mageandran says.
Behavioural issue: Picky eating can also be caused by a previous negative experience with a particular type of food. For instance, fear can develop if the first time the child eats a food, he or she gags or chokes and the parent also reacts negatively, saying something like, “Oh dear, this is not good.”
The child can remember this fear the next time the food is presented.
Related to this is a parenting issue where the parent doesn’t know how to encourage the child to eat during mealtimes, or how to go about making mealtimes an enjoyable and positive experience.
“Often, parents end up scolding the child or forcing the child, which makes the feeding an even more unpleasant experience. This can cause the child to resist even more,” says Ms Mageandran.
Oral motor difficulty: Another reason for picky eating could be an underlying oral motor difficulty where the child actually doesn’t know how to move the food in the mouth or bite and chew on it. Or the child may have fine motor difficulties in handling the food.
Medical issue: Picky eating can also be caused by a medical problem such as gastroesophageal reflux disease (GERD) in which the stomach contents flow backwards into the food pipe, causing pain and discomfort. Children who suffer from this condition can develop an aversion to eating.
Treating picky eating
Picky eating can be treated by an occupational therapist (OT) who can assess and manage the child’s sensory difficulties and help unlearn bad mealtime habits that have been reinforced over the years. A speech-language therapist (SLT) can help a child with oral motor difficulties. Together, the OT and the SLT work on gradually facilitating the child’s acceptance of less preferred foods. Treatment can take weeks.
Through play and other positive means, the child is taught to accept a wider variety of foods and to eat without distractions. For instance, if the child is used to watching TV while eating, TV time can slowly be cut down from 30 to 10 minutes, in five-minute decrements.
“We identify aspects of the mealtime that can be improved and then we work with the parents to slowly make those changes. It’s a shared responsibility,” Ms Mageandran explains.
KK Women’s and Children’s Hospital (KKH) runs a Speech Therapy and Occupational Therapy (SPOT) feeding clinic for children who are fussy eaters. Set up in 2006, the clinic sees 16-20 picky eaters every week.
Therapy includes training the parents to reinforce positive mealtime behaviours. Parents can also expose the child to new foods, by serving the child the dishes they are eating at the dining table.
“Severe picky eating may result in the child not receiving adequate nutrition so they may end up losing weight and having reduced growth,” says Ms Mageandran. That’s why it’s important to treat the condition early, before it affects the child’s growth and development.