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The Experts' Guide to Picky Eaters

March 25, 2021
By Abby Cook, M.S. OTR and Ali Nevins, M.S., CCC-SLP

Are mealtimes a battle? Does your child have a limited food repertoire or only eat one brand of food? Desperately seeking tips for a successful family mealtime? The Stewart Center has some Picky Eater experts on staff to share their favorite tips and best practices from hands-on experience working with some of the pickiest eaters and their families.

The first question many families ask is: Who can help? Eating is a multisensory experience. As adults, we forget the many factors involved in eating because it is such a routine task for most of us, but eating is a surprisingly complex process. Both speech and occupational therapists can play an essential role in supporting positive change in even the pickiest of eaters. 

Abby Cook, M.S. OTR, and Alexandra (Ali) Nevins, M.S., CCC-SLP are part of The Westview School's Stewart Center team and are trained in the S.O.S. Approach to Feeding®. This approach is a sensory-based feeding intervention that moves students through a hierarchy of exercises designed to increase tolerance of various foods. The S.O.S. Approach to Feeding® was developed by Dr. Kay Toomey over 30 years ago. Her program has a high success rate in the diversification of diets of picky eaters.  

Because eating uses every sensory system, from visual and tactile to vestibular and interoception, a multisensory approach to feeding therapy is the start to a recipe for success. Pun intended. The Stewart Center therapists are trained in evaluation and assessments and the facilitation of individual and group feeding therapy.

When it comes to feeding therapy, a speech therapist, like Ms. Ali, can assess and support the development of a child's oral motor and feeding skills, mechanisms of chewing and swallowing, oral motor structure as well as protecting the airway during the swallow, biting, and chewing phases of eating. 

An occupational therapist (OT), like Ms. Abby, can help to develop a child's fine motor skills and coordination needed to move food from plate or hand-to-mouth. Skills such as grasping, utensil use, postural control, and musculoskeletal strength for positioning during eating are necessary for successful feeding. An O.T. can also observe and assess environmental factors, modify or make changes to support optimal focus and attention to eating. Both speech and occupational therapists will consider all of these factors when working with children with food aversions to identify how to best help an individual child. 

Today, we want to offer some quick tips that you can implement at home now. When dealing with a picky eater, it is essential to examine three things – the environment, language, and behaviors we model. Start with a quick check by asking yourself these questions:

- Is there a smell or taste that is overwhelming or underwhelming to your child? 
- Is the environment overstimulating? 
- Is there background noise during mealtimes, such as television or music? 
- Does your child have the opportunity to watch a sibling or parent eat and model typical feeding behaviors? 
- Can your child manipulate a utensil successfully? 
- Do you find yourself saying two more bites, and then you can go (i.e., play, watch tv, or play the IPad).

Try these tips to skip those mealtime battles and help your kiddo expand their palate and self-feeding skills.  

Set Up for Success: Check Your ENVIRONMENT

- Seating tops the list of important environmental factors for a successful mealtime. Think 90-90-90. Hips, knees, and elbows should be at 90-degree angles while seated for eating. Stick to a sturdy chair or highchair at the table. 

- Provide appropriately sized utensils at mealtime, and use fun phrases to initiate utensil use during mealtime like "Catch the food on the fork." 

- Keep food portions small – especially with new foods. The new color, smell, or texture may be overwhelming! Always provide at least one familiar food item for your child to eat. Make sure to have some new options to try exploring, but a safe food should be just that - one that feels "safe."  

- Keep regular mealtime routines to lower stress and keep expectations clear for everyone.

- Have your child throw away their uneaten food items in the trash. This gets them one step closer to interacting with food, even if it is to throw it away. 

- Limit both visual and audible distractions during mealtime. Television, music, and iPad can detract from your child's ability to observe typical eating and self-feeding. 

- Model it! Eat meals together as much as possible. Children need to see visual models of typical eating behaviors. 

Hungry for LANGUAGE. While your focus may be on what should be going in your child's mouth, what comes out of yours matters just as much. 

It might be time to flip the script if you have said one of the following to your picky eater: "Clean your plate." "You have to take two bites to leave the table." "Good job eating that." "Finish your food before (i.e., T.V. or Dessert)." These phrases can unwittingly up the anxiety during mealtime. 

Instead, use some alternate words/phrases that keep mealtime stress-free and fun.

- In response to, "I'm not going to eat that!" ask, "What can you do with the cheese stick?" It helps to give an example: "Can you make a mustache or wiggle it like a wobbly worm?"

- "What can you catch on your fork?" 

- "Does that food have a big flavor?" 

-Encourage your child to say, "I'm still learning about that." instead of "I don't like that!" 

Your mother may have said, "Don't play with your food!" but when it comes to a picky eater, it might be time to change your BEHAVIOR around eating. 

- Model eating and be PLAYFUL! Make food fun! Make it ok to "play" with your food. Parents can model food interactions that go beyond simply eating; encourage play during mealtime. Some examples of play can include: placing food on body parts, making a noodle into a worm, using crackers to build a sandwich, digging for gems in jello or pudding, and using food as a mustache or a long tongue. 

- Avoid forcing your child to take a bite or a drink of something. This sets up an unwinnable power struggle. 

- Avoid tricking your child with foods or beverages. As therapists and parents, we need to build and maintain a child's trust-related to food and drinks. When we "sneak" a new vegetable or drink into a familiar dish or a preferred cup, it can disrupt trust and turn a child off from a preferred food altogether. 

We hope that these tips help you gain confidence and avoid some pitfalls at mealtime with your picky eater. If you want to learn more about Individual or Group Feeding therapy, please reach out to The Stewart Center. Our team is passionate about working with our picky eaters, supporting their families, and having fun with food.

If you are interested in learning more, contact The Stewart Center at 713-973-1830.

Additional Resources:
Instagram: 
@kids.eat.in.color 
@sosapproachtofeeding 
@solidstarts 

Websites and free resources: 
sosapproachtofeeding.com/start-here-parents/ 
www.solidstarts.com 

Parent & Caregiver Workshop (Free Full parent workshop video) 
Learn from Dr. Toomey (the founder of the SOS Approach to Feeding) about why children don’t eat well and practical strategies for improving mealtimes in your home through the introductory video “When Children Won’t Eat (and how to help!). 

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Alexandra (Ali) Nevins, M.S., CCC-SLP is a Licensed Speech-Language Pathologist with the Texas Department of Licensing and Regulation and obtained a Certificate of Clinical Competence through the American Speech-Language-Hearing Association. Ali completed her Bachelor of Applied Science Degree from The University of Mississippi and received a Masters of Science in 2018 from Yeshiva University at The Katz School. In New York City, Ali worked as a clinical extern in the school system as well as at New York Neurogenic Speech-Language Pathology, P.C. Ali has been working full-time as an SLP at The Stewart Center at The Westview School since 2018. She has received continuing education training in SOS Approach to Feeding ® and Social Thinking ®

Abby Cook, M.S., OTR is a ‚ÄčLicensed Occupational Therapist with the Texas Board of Occupational Therapy Examiners and obtained certification through the National Board for Certification in Occupational Therapy. Abby completed her Bachelor of Arts degree in Psychology and Family Studies at St. Olaf College in Minnesota, and received a Master’s of Science in Occupational Therapy from the University of New England in Portland, Maine in 2017. Once in the Houston area, Abby started her OT career in Early Childhood Intervention for Brazoria County and has been full-time with the Stewart Center at The Westview School since 2018. Her continuing education training includes SOS Approach to Feeding ® and introductory coursework in The DIR/Floortime Approach®.

jackie says:
March 25, 2021 01:32 PM CST
Amazing tips! Thanks for all that you all do!

Mimi L. says:
March 25, 2021 02:51 PM CST
I love the rephrasing of questions and statements. It really takes the pressure off of you and your child. I also never thought of the 90-90-90 positioning before. So important! Thank you!

Penny K says:
March 26, 2021 10:03 AM CST
I have a 16 year old on the spectrum, and I can still use these strategies. Thanks for the refresh!