Table troubles: Picky eating may be a sign of bigger issues

By Christina Knott
Watertown Daily Times

Many parents at one time or another will struggle with getting their child to eat what he or she should — from refusing vegetables to avoiding certain smells or textures.

At the Arc of Jefferson-St. Lawrence counties, speech language pathologists Mary C.T. Runge and Dani E. Shirkey work regularly with children who have feeding or swallowing disorders, in which the infant or child avoids eating certain foods.

“Like they only eat mushy food. They only eat certain foods. They only eat foods that melt in your mouth. We see a lot of that,” Shirkey said.

Frustrated parents may feel their child is just being stubborn or lazy, but feeding or swallowing disorders may be genuine problems for infants and children that can lead to weight loss, malnutrition and problems with daily functioning.

“I think too a lot of families don’t realize there are problems feeding and there are things that can be done about it,” Shirkey said. “Like sometimes it’s just like, ‘Oh, that’s how he eats.’ Well yeah, but, it could be better.”

Children at risk for feeding disorders may include those with nervous system disorders, reflux or other stomach problems, premature or low weight at birth, heart disease, cleft lip or palate, autism, breathing problems, sensory issues, behavior problems or muscle weakness. Children who have been intubated are also at higher risk of feeding or swallowing disorders.

According to the American Speech-Language-Hearing Association, signs that may signal that intervention is needed for children include:

Eats only certain textures, such as soft food or crunchy food

Arches, cries, stiffens or falls asleep when being fed

Takes a long time to eat

Coughs, drools or gags during meals or has problems chewing

Has a gurgly, hoarse or breathy voice during or after meals

Not gaining weight or growing

“Between 2 and 3, if they’re not expanding their diet,” Shirkey said, “then it would be worth a look” at whether intervention is needed.

That’s the age when children start to pick out their preferences, Runge explained. Parents can start to see if children prefer fruits over vegetables or if they are avoiding a specific consistency all the time.

And if there is an issue preventing him or her from expanding their diet, “we have to teach the skills to get to other foods,” Shirkey said. Feeding disorders usually start with sensory or motor issues, but Shirkey said, as the child gets older, it can become a behavior problem. Children are less likely to try something that caused a problem for them in the past. This is why it can help to address issues early.

In addition to motor and sensory issues, Runge said something that can go overlooked is an allergic reaction to foods that may be causing the problem. She suggested following up with an allergist or an ENT to make sure there isn’t a problem internally that the child isn’t able to explain.

“The child may be avoiding a certain food because it’s causing irritation to their stomach or their esophagus,” Runge said. “And we don’t have x-ray vision and we can’t see that. And it may not be so severe that it causes them to cry or vomit or something like that; it might just be a little irritation so they avoid it. And it’s seen as, ‘Oh my kid just doesn’t like it.’”

If eating peas makes their stomach hurt, for example, children aren’t likely to want to eat peas.

Beyond that, parents may not realize some of their own eating preferences may be passed down to their children. Parents may need to do a better job modeling the behavior they want to see in their children.

“The parent says, ‘Oh, he never eats vegetables,’ and I say, ‘What vegetables do you eat?’” Shirkey said. If parents don’t eat vegetables or keep them in the house, they probably shouldn’t expect their kids to eat them.

“So that’s kind of a big thing too if parents aren’t eating something, the kids aren’t going to be exposed to it,” Shirkey said.

Another reason it is important for parents to model good eating habits is that, for a lot of children, exposure to new foods comes from trying something off their parent’s plate.

“If it’s something they’ve never had before but mom is eating it, that’s kind of a motivation for some kids and it’s not as high pressure as having it on their plate,” Shirkey said.

Even for adults, “If you’ve never had sushi before, you’re not going to go out and order a whole tray of sushi,” Runge said. “Like you might look at it, smell it, maybe take a bite.”

“Try one from your friend’s plate,” Shirkey added.

“What may seem like everyday food to us, ... it may seem more exotic to your child,” Runge continued.

For all children, introduction to new foods in a low pressure environment is key to broadening their palate, both Runge and Shirkey agreed.

“Just introducing a little bit at a time and not putting on that full expectation,” Runge said. Have them “try a little bit. You can always give them more” if they like it.

Sometimes children may hesitate to try something new for fear of what will happen if they don’t like the taste. In that case, it’s fine for parents to give children a place to put the food they don’t want to finish.

“This may sound disgusting, but ... have a cup, a red solo cup, that the kid can spit into,” Shirkey said. “If you want to, try it, and if we don’t like it, we can spit it out.

“That’s something that we all do. We try something, we pick up our napkin, and we spit it out. We’re just a little more discreet about it. And that’s OK.”

Runge agreed, “They’re going to be more likely to try it because they know if they don’t like it, they have a place to put it.”

Making food exploration enjoyable and fun is important for all children in broadening what they eat. For children with aversion to particular food textures, one idea Runge and Shirkey suggest is letting children explore food with their hands. Sometimes, it can be OK to play with food.

“Especially those kids that have had intubation or anything like that,” Shirkey said. “Taking away the pressure that surrounds eating and letting it be a playful experience can make a big difference.”

Parents can let children finger paint with pudding. Bring their cup and spoon into the bathtub and let them play and make a mess as they explore their food. Or bring their food outside and let them spill and make a mess without worrying about the floor. Using play can help children approach food with pleasure instead of anxiety.

“Feeding and eating is intrinsically motivating,” Shirkey said. “Kids make messes, and it’s okay.”

While parents generally mean well, there are some bad habits that can be hindering their children’s positive feeding behaviors.

For one, parents should avoid forcing children to eat all their food or to sit until their plate is clear. All of these can increase anxiety, which in turn decreases appetite.

“That’s just a lot of expectation,” Shirkey said. “We want (eating) to be calm and relaxing.”

Another thing parents should avoid doing is letting their children graze throughout the day instead of sitting down to a meal.

“When kids graze, they tend to just eat enough for the calories they’re about to burn off. They’ll eat one grape and run around for 20 minutes, then they eat one grape and a cracker run around for 20 minutes again. So in the act of grazing, they’re burning more calories,” Shirkey said.

Part of what makes mealtime so enjoyable is the social aspect of dining together.

“That’s where you can put the emphasis on meal time being enjoyable,” Runge said. “Like, food is enjoyable and social. If you don’t have that specific time and kids are grazing and running, you don’t get to target and focus on and develop those skills.”

When families don’t sit down regularly to eat together, children are also missing the opportunity to observe their parents’ eating habits and to try something new from Mom or Dad’s plate.

Eating on the run can also increase the risk of choking.

The danger of choking is one reason the Bright Beginnings preschool at the Arc of Jefferson-St. Lawrence has a policy to cut up grapes, hot dogs (lengthwise) and cherry tomatoes. Runge and Shirkey encouraged parents to do so as well.

“I would feel better about the world if (we cut up those foods) through age 5. I just don’t trust those little things,” Shirkey said.

“I was gonna say we’re kind of paranoid about it,” Runge said.

Finally, one of the most misunderstood aspects of feeding and swallowing disorders is the belief that children will eventually eat rather than starve themselves. Sometimes even doctors are unaware that this is not true.

“It kind of goes back to that, having the skills,” Shirkey said. “If you gave a 2-month-old steak, the 2-month-old is going to starve to death because the 2-month-old can’t eat steak. If the child can’t physically eat the food for whatever reason, they are going to starve.”

This goes for fluids as well, Runge said.

Children who depend on sippy cups won’t necessarily make the transition to regular cups if you took their sippy cups away.

“They can go several days without drinking anything,” Runge said. “Or if they only like milk in their sippy cup and one day you put water in that cup could sit there full all day.”

Parents who feel they’ve done all they can and need extra help getting their child to eat the way he or she should can reach out to their pediatrician for a referral to a speech language pathologist. Or, if the child is preschool aged, parents can make the referral themselves, Shirkey said. Either way, they shouldn’t lose hope.

“Ninety-nine percent of the time, there is some underlying factor, and the challenge is finding out what that factor is,” Shirkey said.