Helping the “Picky Eater” Handle Back-to-School

Eating is a full body sensory motor experience and feeding difficulties can be complex.

When my now 8-year-old child entered preschool for the first time at age 3, I remember being very worried if he would eat at school, how the separation would go and the beginning of toilet training. It was a time of building independence for him and for me.

At the time he had a limited repertoire of foods and became very irritable if he did not eat. Now after working with parents and children as a sensory integration occupational therapist for 25 years I have seen how common feeding challenges are. In fact research states that 20% of children from birth to 7-8 years of age will classify as having some type of feeding issue at some point in their lives. That is 1 in every 5.

As parents and educators, we are aware that there are times in development where children struggle more with the process of feeding. The research supports these times, 4-6 months, 12-14 months, 2-3 yrs., 5-7 yrs. and 9-11 yrs. In fact 50% of 2 year olds are often picky eaters, as many of us have experienced, however only a little more than half will grow out of it.

So why is feeding so challenging? Eating is the hardest thing we do as human beings. Eating involves 7 different areas of human function and all need to work correctly and together to get the job done. Pretty tall order!

Eating in the first 4-6 weeks of life is an appetite instinct. At 4-6 months, it is driven by primitive motor reflexes. But by 6 months and going forward, eating is learned behavior.

Below are the 7 areas that all need to be integrated for successful eating :

• Internal organs – all are used
• Muscular system
• All senses- sight, smell, taste, touch/texture, hearing ( the noises you hear in your head as you crunch), balance, Proprioception ( jaw movement), Interception ( blood glucose levels, satiation, stretch receptors in the stomach)
• Learning- history of learned behaviors related to feeding
• Developmental stage and individual learning style
• Nutritional status
• Environment

Children with eating/feeding difficulties before the age of 3 should NOT be considered to have behavioral problems. These difficulties are due to skill deficits and or physical problems in one of the 7 major areas listed above.

After seeing how complicated eating really is and how many areas could be challenged in the process, it is clear to see why the research supports that in actually only 10% of the cases, parents are the problem behind children with feeding challenges.

So how do we help our children eat at school and get the nutrition they need to focus and learn.

For children 18 months to 10 years of age a normal metabolism requires food every 2.5 to 3 hours. In order to eat the amount of food a child needs during meals they need approximately 20 minutes to attend to a meal. If physical activity such as recess occurs prior to sitting down to eat, research shows that children will attend and eat better.

Here are some tips for parents and educators as your child heads back to school:

1. Environment: Be aware of all the sensory experiences a child is exposed to when eating at home and school. If you can make modifications and adapt the setting that’s a great way to support eating. Occupational therapists can help identify inappropriate environment factors and create suggestions to the family on how to make corrections where it is feasibly possible to do so. When it isn’t, a child can be supported via a “Social Story”. With your child, write a Social Story that discusses where meals will be taken, what will be eaten, where the food might have come from, and what awesome changes happen in the body when you eat well. Collaborate with your child’s teacher before the school year begins by sending an email that includes the social stories you have created and the information you have gathered regarding how to increase successful eating for your child. Working as a team is key.
2. Experiencing eating together: Studies show that when an adult sits down with the child and eats a new food with them, modeling the behavior, the outcome has greater chance of success. Websites such as ChooseMyPlate.org are great resources. During this time the children benefit from the adults talking about the sensory qualities of the foods and nutritional qualities. Removing all values judgment such as, “this is healthy and this is junk food”, is best.
3. Look at Positioning — Does your child have good supported posture so that she can focus on eating instead of holding herself upright?  This is especially important for any child with developmental delays. Are her feet supported on the floor or on a bench so that her hips, knees and ankles are at a 90-degree angle?  Is the table at the right height so that her arms can rest comfortably without having to reach way up high?  Does she have adequate support at her trunk and back to keep her from feeling like she will fall out of the chair?
4. Play With Your Food! Make an effort to play with food that your child may be resistant to.  Being able to touch an unfamiliar or undesirable food is a big step in the right direction when the ultimate goal is to get that food into a child’s mouth.
5. Practice smelling foods: The sense of smell helps to create the flavors that we taste in food.  This is the reason that when we have a cold, nothing tastes quite right.  Keep in mind that when you heat foods, they smell stronger!  If your child is sensitive to smells, serve food at room temperature.
6. Always promote movement before meals: Activating the muscles and joints supports sitting for the desired 20 minutes children need to eat a meal.

Does the child move while eating?

Know How the Body Works — Think about the body awareness, coordination, and motor planning it takes to get your hand to your mouth!  Kids have to be able to grade their movements, using appropriate force and timing to be able to feed themselves. You may take this for granted, but for little ones, it can be tricky!  Check out the cups and utensils your child uses.  How heavy or light are they, and how does this affect the way they eat? Sometimes preschoolers need a little cheerleading and hands on help to get the nutrition they need, to have a successful day at school.

Kids are smart!  Provide them with the tools they need to feel comfortable, in control and empowered and they may just surprise you!  Remember that eating is a full body sensory motor experience and that feeding difficulties can be complex.

About the Author:
Melissa Idelson, OTR/L is the Director and Founder of the Child Success Center, one of the preeminent child development assistance facilities serving the greater Los Angeles area. Ms. Idelson, is one of the most sought after and well respected certified occupational therapists in Southern California and is endorsed and routinely referred by pediatricians, parenting counselors and trainers throughout the region.

Resources:
Child Success Center - Occupational therapists can answer questions and help.

SOS Approach to Feeding - Dr. Kay Toomey is a pediatric psychologist who has worked for over 20 years with children who don’t eat. She developed the highly effective, family-centered SOS Approach to Feeding to assess and successfully treat children with feeding problems, which is used by therapists worldwide.

Choosemyplate.org - Provides practical information to individuals, health professionals, nutrition educators, and the food industry to help consumers build healthier diets with resources and tools for dietary assessment, nutrition education, and other user-friendly nutrition information. Special activities, recipes and more to inspire kids to eat healthier and move more.