When to Seek Help for a Picky Eater

What is Normal Picky Eating versus Problematic Picky Eating? 

There is no official definition of picky eating that I have found in my research or through trainings, but Kay Toomey, PhD, pediatric psychologist and creator of SOS Feeding Approach, defines it as a child who eats about 30 foods, but can still tolerate new foods on their plate and eats from most food and texture groups. 

Problem feeders are children that eat 20 foods or less and have trouble tolerating new items on their plate (even after exposure). 

Red Flags to Watch For:

In addition to significantly limited diet and resistance to having new items on their plates, these are some things to watch for at home.  These symptoms are for different types of feeding and swallowing disorders, including problematic picky eaters.  If you see these symptoms, you should discuss your concerns with an appropriate medical professional.  Suggestions for help are listed below. 

  • Difficulty accepting new textures of food
  • Preference for only one specific brand of a food or product (will only eat Yoplait Strawberry Yogurt and not any other kind, will only eat Bell and Evan’s Chicken Nuggets)
  • Food needs to be the same shape all the time (everything they eat must be a circle)
  • Foods need to be all one temperature or one texture only (won’t eat anything cold or frozen, won’t eat anything crunchy or chewy only things that are very soft or mushy)
  • Avoidance behaviors to specific foods and textures (gagging, vomiting, blocking a spoon with his hands or closed lips, crying, pushing food away, leaving the table, etc.)
  • Digestive or bowel issues such as diarrhea, constipation, excessive bloating or loose stools (that are ongoing, not short term with an illness)
  • Arching or stiffening of the body during feeding/eating (more often seen in young children, babies)
  • Coughing or choking during feeding
  • Difficulties chewing; especially noticeable when children transition from purees to solids
  • Being very irritable/fussy during or after feeding
  • Taking a really long time to feed (more than 30-45 minutes)
  • Frequent spitting up (infants and young children)
  • Getting sick often with pneumonia or other types of chest infections
  • Gurgly, hoarse, or breathy voice that is not how they usually sound
  • Less than normal weight gain or growth (your pediatrician can tell you how much weight gain/growth is appropriate)
  • Lots of loss of food or liquids from the mouth
  • Coughing, gagging, or throwing up during or after meals
  • Over-stuffing his mouth with food
  • Pocketing of foods (food stuck in the cheeks or gum areas in the mouth for long periods of time, especially once a meal is completed)

Who Can Help Me?

If you suspect that your child is having difficulty eating, contact your pediatrician right away. Your pediatrician will examine your child and address any medical reasons for the feeding difficulties, including the presence of reflux or metabolic disorders.  Your doctor may refer you to see a specialist such as a speech-language pathologist, occupational therapist, allergist, or a gastroenterologist.   

Picky Eaters and Problem Feeders are often referred to either a speech-language pathologist or an occupational therapist.  Occupational therapists (OT) usually focus more on sensory based feeding disorders and difficulties with self-feeding, while speech-language pathologists often focus on all types of feeding and swallowing disorders. 

A speech-language pathologist (SLP) who specializes in treating children with feeding and swallowing disorders can evaluate your child and will:

  • Ask questions about your child’s medical history, development, and symptoms
  • Look at the strength and movement of the muscles involved in swallowing
  • Observe feeding to see your child’ s posture, behavior, and oral movements during eating and drinking
  • If additional and specific medical information is needed, an SLP can perform special tests, if necessary, to evaluate swallowing, such as:

Modified Barium Swallowchild eats or drinks food or liquid with barium in it, and then the swallowing process is viewed on an X-ray.

Endoscopic Assessmenta lighted scope is inserted through the nose, and the child’s swallow can be observed on a screen.

Sometimes these tests are completed through a hospital or private clinic


What Treatments are Available?

Treatment varies greatly depending on the cause and symptoms of the feeding or swallowing problem.  Based on the results of the feeding and swallowing evaluation, the SLP or feeding professional may recommend any of the following:

  • Medical intervention (e.g., medicine for reflux)
  • Direct feeding therapy designed to meet individual needs (Provided by SLP or OT as deemed appropriate, usually once a week for a determined amount of time)
  • Nutritional changes (e.g., different foods, adding calories to food)
  • Increasing acceptance of new foods or textures
  • Food temperature and texture changes
  • Postural or positioning changes (e.g., different seating)
  • Behavior management techniques
  • Referral to other professionals, such as a psychologist, physical therapist, or dentist

Are There Conditions that Contribute to Picky Eating?

The following are some causes of feeding and swallowing disorders in children:

  • nervous system disorders (e.g., cerebral palsy, meningitis, encephalopathy)
  • gastrointestinal conditions (e.g., reflux, “short gut” syndrome)
  • prematurity and/or low birth weight
  • heart disease
  • cleft lip and/or palate
  • conditions affecting the airway
  • Autism
  • cardiac conditions
  • head and neck abnormalities (including Torticollis, Plagiocephaly)
  • muscle weakness in the face and neck
  • multiple medical problems
  • respiratory difficulties
  • medications that may cause lethargy or decreased appetite
  • problems with parent-child interactions at meal times


Disclaimer:  This information is not intended to be a substitute for seeing a professional in person.  If you believe that your child needs medical attention or an evaluation, you should call the appropriate professionals as soon as possible.