Eating / Feeding

 picky eater versus problem feeder?

At Helping Hands we take a multi-disciplinary approach to feeding therapy. Our speech and occupational therapists are trained in the SOS feeding approach. Both disciplines will screen and/or assess your child to determine what treatment approach is best for your child. 

As adults, many of us love to eat. There are many children who love to eat and explore different foods. However, there are many children out there whom parents may consider to be “picky eaters.”  According to statistics, 25-35% of typically developing children, and 40-70% of children with chronic medical conditions or those born prematurely have feeding and/or swallowing disorders.

There definitely are children who prefer to eat certain foods over others and may appear to be “picky”. However, there are other children who will only eat certain foods, and these children may be considered “problem feeders.” According to Dr. Kay Toomey, who developed the Sequential Oral Sensory (SOS) Approach to feeding, one aspect of a “problem feeder” is a child who has 20 or less foods in their repertoire.

What are the risk factors for feeding and/or swallowing disorders in children?
  • History of reflux
  • History of constipation
  • Failure to thrive, poor weight gain, or weight loss
  • Arching or stiffening of the body during feeding
  • Recurrent pneumonia
  • Difficulty coordinating breathing with eating and drinking
  • Difficulty or inability to transition to baby foods
  • Difficulty transitioning to table foods by 1 year of age
  • Extreme food selectivity
  • Difficulty tolerating foods of certain texture, color, and/or temperature
  • Diet that consists of less than 20 foods

There may be several reasons as to why your child may have difficulty with a variety of food items. Eating is the one activity that children participate in that requires each of their organ systems and each of their sensory systems to work together. If there is a break down in one of these areas, eating can become challenging. In addition to possible medical reasons impacting feeding (constipation and reflux are just two examples), examples of other “break downs” that may occur may include some of the following: sensory deficits (including tactile, visual), high/low muscle tone, core weakness/postural instability, distractibility, and deficits in oral motor skills.  Your child may also exhibit food sensitivities, intolerances, or allergies to foods which affect their feeding and ability to try new foods. 

What can be done?

Consult with an occupational therapist or speech therapist to determine if a comprehensive evaluation of your child's feeding abilities is warranted.  During the assessment, the therapist will assess your child's oral motor skills, sucking/chewing skills, postural control, ability to look at, touch, and taste different textures, while presenting foods in a non-threatening manner. 


There are several opportunities within your child's day to target feeding skills. Some strategies that may help feeding and meal time become a more positive experience for your whole family include:

  • Encourage your child to "play" with less preferred foods. For example, if you have a child who has difficulty with textures such as pudding, yogurt, or applesauce, you may engage in finger painting with these food items.
  • Encourage other tactile sensory play with items like play-doh, shaving cream, finger painting, etc.
  • Be sure to offer to your child what you are having for a meal. Do this in small amounts, and possibly even on a separate plate than the one they are eating from. This allows the child to be exposed to the food, yet does not require the child to eat the food. This helps facilitate positive interactions with new and possibly challenging foods.
  • Help warm up your child's mouth by engaging in oral motor activities (such as horn blowing, bubble blowing, lip pops, tongue clicks, etc…) in order to prepare the mouth for the motor and sensory experience of eating.
  • Use positive language at meal and snack time.
  • Provide structured meals and snack time. These should occur at the same place (i.e. table) and at similar times during the day. Do your best to have your child sit for meals and snacks, and not walk around, and periodically take bites of food.
  • Involve your child in meal preparation, and choose what the family will have for a meal on occasion.
  • Praise and reinforce positive food behavior that your child demonstrates.
185 S. Marley Rd. New Lenox, IL 60451