“Picky Eaters”

Presented by: Molly Pierce, OTR

Sensory Feeding Challenges

• Food aversion

• Picky eater

• Small appetite

• Oral sensitivity, hypersensitive gag reflex

• Food Phobia

• Infancy/Toddler, preschool, school aged children

Infant Toddler

• As infant may present with poorly organized suck, swallow pattern.

• Reflux, medical complications

• Poor state regulation

• Sensory sensitivities to touch, sounds, oral, tactile, movement

• Early satiety

Strategies for the Infant

• Sensory oral preparation• Non nutritive suck• Nipple modifications• Flow adjustment; thickening vs nipple change• Positioning; swaddling, side lying• Environmental changes• Treatment of Reflux• Feeding Schedule

Strategies for the Toddler

• Tactile Oral exploration; finger foods, sensory spoon; oral stimulation

• Lateral placement of foods

• Offering variety of textures; puree, fork mashed, building texture

• Recovery bites of smooth after texture, alternate.

• Offer flavorful foods

Strategies for Toddler (cont)

• Modeling eating, biting, chewing• Drinks offered at end of meal.• Shared control; First – Then, All Done Bowl• Meal schedules; 3 meal and 3 snack, G-tube

feeding after oral feeding.• Sensory Behavior strategies; First – Then,

Motivation

• Daily oral hygiene

Strategies for Preschoolers

• Sensory Behavior Program– Introduce the “My Plate” program; small serving

for each food group– 1-2 bite rule; All Done bowl– Repeat presentation of foods (up to 10-15

exposures)– Creating consistency, structure and mealtime

routines (3 meal, 3 snack) – Tactile exploration of foods– Can use drink to help swallow foods

Strategies for School Age and Older

• Kids often have anxiety, sensitivities to food tastes/textures, and may have history of dysphagia and/or reflux.

• What works:• Scheduled meals and snacks• My Plate – tool to expand the diet and teach the

importance of eating a balance of foods. • Www.myplate.org

My Plate

• My Plate is FDA’s program for balanced nutrition

School Age (cont)

– Offer 1 small serving of food from every category; 2 Bite rule

– “All done" or “Learning” bowl – Food rating chart It can be empowering for kids to

rate taste/texture of foods. – Keep track of new tastes/foods on a sheet of paper

and monitor changes over time.

Food Rating Chart – Tool for Empowerment

 

Foods Tried

Date I like it It’s OK I don’t like it

       

       

       

       

       

       

       

       

       

       

School Age (cont)

• Develop reinforcement options - so many bites of new/non-preferred foods earns a sticker, screen time, etc.

• The Sneaky Chef: Simple Strategies for Hiding Healthy Foods in Kids' Favorite Meals

– It is better to develop a child’s palate for eating the healthy fruits and veggies.

• Parents decide WHEN, WHAT and WHERE foods– Child decides whether or not to eat, and how much.

Avoid Power Struggles.

• Treatment for Anxiety – CBT, medication