Picky Eaters Vs Problem Feeders

December 08, 2021

Sensory Processing Disorder (SPD) affects up to 16% of school-aged children in the United States (Zelman, 2014). SPD occurs when an individual’s brain is unable to process sensory inputs (touch, sight, smell, sound, movement, taste, body awareness, muscle contraction, etc.) properly and may register as hyper or hyporesponsiveness (over or under-responsive). It is a common factor in children with Autism, and is one of the four diagnostic criteria listed under restrictive or repetitive patterns of behavior on the DSM V: “Hyper- or hyporeactivity to sensory input or unusual interests in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).”

No two children with SPD are alike, however, they commonly demonstrate behaviors described as “picky eating” and many suffer nutritional deficits based on their limited diets. According to Kay Toomey, Ph.D., psychologist, and director of the SOS Feeding Solutions at the STAR Institute in Denver, Colorado, “Eating is the most complicated human behavior there is and involves all areas of human development. Research shows from birth to 8 years, 20 percent of all kids struggle with feeding challenges.” According to Toomey, there are two types of sensory-based feeding difficulties:

Picky Eaters:

  • Decreased range or a variety of foods but will eat = 30 foods or more
  • Foods lost due to “burn out” because of a food jag are usually re-gained after a 2-week break
  • Able to tolerate new foods on the plate and usually can touch or taste a new food (even if reluctantly)
  • Eats at least one food from almost all food texture groups
  • Frequently eats a different set of foods than the rest of the family, but usually eats with the family
  • Will add new foods to the repertoire in 15-25 steps on Steps to Eating Hierarchy
  • Sometimes reported by parents as a “picky eater” at well-child check-ups

Problem Feeders:

  • Restricted range or a variety of foods, usually less than 20 different foods
  • Foods lost due to food jags are NOT re-acquired
  • Cries and “falls apart” when presented with new foods
  • Refuses entire categories of food textures
  • Almost always eats different foods than the family
  • Adds new foods in more than 25 steps
  • Persistently reported by parents as a “picky eater” across multiple well-child check-ups

Treatment for sensory-based feeding disorders relies on a comprehensive evaluation and is individualized based on the child’s needs. Activities incorporate multi-sensory experiences to help children learn and increase tolerance to food textures, smells, appearance, as well as develop motor skills necessary for complete mastication of a variety of foods (strength, endurance, tongue lateralization, rotary jaw movements, etc.). It is also important to incorporate cultural and environmental routines and traditions to create a positive feeding environment for the entire family.

For more questions regarding your Picky Eater/Problem Feeder, contact your occupational therapist today!

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