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  • Anna Chmiel

Does Your Child Have Difficulty Eating

Many children go through phases of picky eating or may need assistance to safely eat meals, but at what point does this “phase” indicate something more serious going on? Many parents expect their child to grow out these stages, but not all kids do. In fact, around 20% of typically developing children (infants, toddlers, and school aged ) are diagnosed with a feeding disorder. Both Speech-Language Pathologists (SLPs) and Occupational Therapists (OTs) play an important role in diagnosing and treating feeding or swallowing problems.

SLPs assess and treat difficulties with oral strength, coordination, and swallowing. Some will also work with children who have sensory based needs.

OTs assess and treat difficulties with sensory feeding and fine motor skills associated with eating.

What does a feeding disorder look like?

Feeding disorders may look different from one child to the next. One child may have sensory aversions, or not want to touch, smell, see, or taste food. Another child may have motor difficulties, or challenges with jaw, lip, or tongue strength or movement. Generally, we can categorize feeding difficulties as dysphagia (difficulty with strength and movement in feeding) or a sensory feeding disorder (picky eating).


Dysphagia is a medical term to describe difficulty with feeding or swallowing and breathing. Symptoms can include choking, coughing, wet vocal qualities during or after feeds, breath changes, watery eyes, facial grimacing, changes of breath rate with feeds, and failure to gain weight. An SLP may recommend an MBSS (modified barium swallow study), a change in food textures, differing thickness of liquids, changing the feeding source (bottle, nipple, utensils), or other techniques to assist with safe drinking and eating.

Sensory feeding disorder:

Children with sensory feeding disorders may only want one kind of food, from one place, prepared in the same way. Maybe you make chicken strips at home and your child throws a fit because the food wasn’t from McDonalds. These children have great difficulty changing their routine and generally refuse to try new foods. Some signs include disrupting social events that involve feeding, challenges eating at restaurants with the family, or problems eating lunch at school.

Typical v. Atypical picky eating:

Atypical picky eating may include..

– Poor food variety (20 or less)

– Stops eating preferred food and will NOT attempt to eat again

– Has meltdowns(i.e. crying, screaming, intense negative behaviors) when introduced to new foods or non preferred foods

– Refuses particular types of food (i.e. texture, food group, color, size)

– Always eats different food than rest of the family

Typical picky eating may include..

– Poor food variety (30 or more)

– Stops eating preferred foods but will try again at another time

– Attempts to try new foods

– Eats with the family but may eat different food

*List provided by Dr. Kay Toomey, Pediatric Psychologist

Other indications of need for a feeding evaluation:


– Difficult and stressful feeding

– Limited or no weight gain

– Difficulty introducing pureed or solid foods

– Gagging/vomiting often


– Challenging behaviors (i.e. not sitting in the highchair, throwing bowls/food/utensils, grazing)

– Underweight or failure to thrive

– Able to eat in one environment but not another

– Food allergies that limit ability to try new foods or social engagement

– Unwillingness to eat in busy environments (i.e restaurant, school)

– Wanting to try new foods but signs of anxiety during feeding

If you are a parent whose child has difficulty feeding and you have concerns that it is not just a phase, talk to your pediatrician and ask about a feeding and swallowing evaluation with a speech language pathologist or occupational therapist. Early intervention can allow for safe feeding, proper nutritional growth, prevent problems down the line, and ultimately give your child the best outcomes to be a happy and healthy eater.

Written by: Liana Martinez, M.A. CCC-SLP


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