Mealtime Feeding Challenges

Sensory:  According to Chris Purgatori, MOT, OTRL, an occupational therapist, “Sensory-based feeding issues are the underlying factor to most feeding difficulties in children. The combination of food texture, temperature, and taste can be off-putting to kids, and cause frustration.” Children with sensory challenges like familiar, simple foods. Many of which do not contain the nutritional components that might help them meet milestones and improve other cognitive behaviors and feelings.

Try to include their favorites and begin slowly to introduce tiny amounts of other foods. It’s not foolproof, but it’s an important first step. As an example, Chris suggests that “if they enjoy elbow macaroni and cheese, and will only eat that shape, toss in four or five pieces of different shaped macaroni (wheels, characters, etc.)” I would suggest throwing tiny amounts of peas and carrots or a healthy puree to the mix, like avacado or butternut squash. The changes in texture, temperature, color or taste should be slight but noticeable.

Allowing children to help choose foods at the grocery store and to let them help prepare the meal, exposing them to different textures, smells and tastes is another way to take the mystery out of unfamiliar foods.

Oral-motor issues are problems related to tone and strength issues. Kids need good gross motor coordination before they will be sufficiently ready to eat or feed themselves.

Most suggest addressing the sensory issues first as good sensory input will result in good oral motor output.

Try oral-motor exercises that can help strengthen the jaw, tongue and lips, and contact an occupational therapist or other specialist for support.

Behavior issues affect feeding as well. Positive reinforcment has worked for us in many cases, but in many, the sensory issues are just too ingrained. It is so stressful to parents when kids won’t eat. I have always told my older children that I am not running a deli. What I make, is what is available. I had to give that up for Andrew. I make his food separately-which is usually reasonably healthy and add a cheese stick, greek yogurt, mandarin oranges or lace his bean and cheese quesadilla with ground flax or sneak in some kind of miniscule protein. He eats veggie pouches in lieu of the whole veggies. Not what I would choose, but it took the argument out of mealtime and helped him feel more in control and happier at the table. As I mentioned in yesterday’s post, I am not above bribery (aka positive reinforcement, haha), and will offer screen time if it will get him to try something.

Some experts (not that we aren’t at this point) suggest to gradually work through the steps of eating. Allow childrent to child touch and play with the non-preferred food, then increase the difficulty: take a bite; take a bite and don’t spit it out for 2/3/4 seconds; swallow it; take bigger bites; eat larger portions; decrease gagging. Progress until the child is eating more or less on their own. I have not tried this, but I’m willing to practice!

Chris says “Keep in mind that behavior-based feeding issues can look a lot like sensory-motor feeding issues, so it is important to treat both aspects of feeding. The best outcomes result from the child’s engagement in a voluntary, purposeful activity in a positive environment.”

Medical issues such as gastrointestinal, cardiopulmonary and pharmaceutical issues can affect feeding, along with prematurity of birth and visual impairment, when the child simply can’t see what they’re eating.

A major component of medical-based feeding issues continues to be GERD. GERD in its simplest form is spitting up or vomiting, causing children to refuse food. For us, its the chiari malformation, and we have never completely pinpointed what happens that makes some textures appalling and others acceptable.

Definitely reach out to pediatricians and consult therapists if this continues to be a problem.

Finally, family dynamics are one of the hardest feeding difficulties to deal with. Parents and caregivers are the most important and pivotal components in implementing feeding strategies. Many parents tend to feed their kids foods that the parents like. Or like me, completely cave and let them eat their beloved pb&j sandwich in their school lunch every day for 11 years. When I am not there to see what is happening, I opted to send what I knew he would eat. Then try to do a better dinner or healthier snacks.

One way to mitigate is to give your child options, including foods that the parents don’t regularly eat. It’s also important to clearly define roles: the parents or caregivers are responsible to provide the foods, while the child is responsible to eat and choose how much to eat. This goes against my personal grain, but in hindsight, it’s good advice.

Help your child feel comfortable when eating and remember that the social aspect is also incredibly important. If we make it a battle ground, no one has a pleasant experience.Most importantly, the child should feel as comfortable as possible when they are eating. Plan to adapt and be open when necessary. Make dinner time a place where they can also gain your positive attention.

Parents should try to avoid forcing children to eat. Present children with both preferred and non-preferred foods and let the child choose. When children feel like they have control over the situation, it’s easier for them to try new foods.

General tips: (source:

“If the picky eating seems to be sensory-based, encourage the child to play with foods to get used to them. 

Getting messy is OK!Encourage the child to get more involved with food preparation. Kids are more likely to try things if they help prepare the meal.

Encourage the child to eat with other kids. In some circumstances, peer pressure is a good thing!

Provide the child with small amounts of the foods mom and dad are eating along with a food the child usually eats. This way, the child gets used to the foods being there and when they are ready to try them, they will.

Have a consistent routine at mealtime so the child knows what to expect.

Experiment with small, subtle changes in difficult foods. Sometimes just a change in temperature makes it easier to handle.

Make a schedule for the meal, and write a list of the food items that need to be eaten before going to the next activity.”

2 thoughts on “Mealtime Feeding Challenges”

  1. Great info… I wish I had this 21 years ago when we began our sensory integration nightmare with food. It’s still a struggle with an expanded list of possibly 12 acceptable foods but regularly eats exactly the same food everyday now for decades. Supplements have been a saving grace & definitely encourage getting real professional help. There is a difference between a picky eater & a child with sensory food triggers. Both child & parents need help. Following much of your advice in this article did get us from him refusing to sit at the table with us to at least enjoying mealtime together even if he was eating something different. Win-Win!

    1. Nothing is fool-proof. As parents, we often wake up in a new world everyday. Andrew is getting better about trying new things, but textures are still a huge struggle.

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