Featured Article: "Picky Eaters"

Having a picky eater can bring frustration, anxiety, and disruption to mealtime. Do you feel as though you have to plead, bribe, or guilt your child into eating certain foods? Some children do not like specific flavors, textures, or temperatures of food. Does your child complain that his/her food has too many lumps, is green instead of yellow, is too hot or too cold, or is one brand name versus another, resulting in slightly different tastes? These children may show signs of oversensitivity in or around the mouth, resulting in an aversive reaction to specific sensations. These children may demonstrate spitting, coughing, refusal of food, holding food in the mouth, gagging, or vomiting when introduced to a certain food/texture, or simply when provided with stimulation in or around the mouth. Many times, children dislike tooth brushing, face washing, or oral play. Children who demonstrate oral sensitivity may have restricted nutritional intake due to their limited array of foods and textures. Children may also have delayed oral motor skills because they develop these skills as they are introduced to a variety of age appropriate textures in their diet.

Oversensitivity in or around the mouth may result from past experiences in infancy. Many times, infants born prematurely or with medical difficulties have experienced negative oral stimulation from medical procedures done within the hospital. An oversensitivity may also result from absence of oral feeding for a period of time. These children may not have had the appropriate stimulation in or around the mouth, resulting in oral defensiveness. Children who have general sensory concerns may also exhibit oral sensitivity due to overall sensory issues. A child’s feeding history with oral sensitivity may include the following: difficulty sucking from a nipple, difficulty progressing from the nipple to pureed food, difficulty progressing from pureed food to table food, and only accepting a few foods (liquids, smooth, or crunchy).

Through a team approach, occupational therapy and speech therapy can provide intervention for children with oversensitivity in or around the mouth. An occupational therapist or speech therapist can help provide parents with the necessary information needed to help their children advance with feeding, which will help improve their growth and development. Occupational therapists may begin with overall sensory preparation to the body by providing tactile (touch) or proprioceptive (body awareness) input, and then progress to oral desensitization. Occupational and speech therapists also work with children who may demonstrate delayed oral motor skills or oral motor weakness. Therapists can work on lip movement/strength, tongue movement/strength, and jaw movement/strength. Both professionals can also evaluate and treat children with swallowing difficulties. Occupational therapists and speech therapists work with children and their families to gradually adjust food textures, temperatures, and flavors, and to improve their overall oral motor skills, to increase the acceptance of foods and ultimately enhance their growth and development.

Case-Smith, J. & Humphry, R. [2001]. “Feeding Intervention”. In, J. Case-Smith, Occupational Therapy for Children [pp. 463-466]. St. Louis, Missouri: Mosby, Inc.

Article written by Stacie Berck, OTR/L