When Picky Eating Might Be Something More: Feeding and Swallowing Disorders in Children

Some kids will eat just about any food. Avocado? Check. Cottage Cheese? Yes, please. Mushroom pizza? Bring it on.

Other kids are picky. They'll feed their peas to the dog or hide rice under their salad and hope you won't notice.

Still other children have feeding and swallowing issues that can make eating stressful, even painful. Research suggests that 25 to 45 percent of children fall into this category. The incidence is even higher in kids with developmental disorders.

If you are concerned about feeding issues in your child, we're here to help. In this article, Julie Quasny, a speech-language pathologist with Franciscan Health Outpatient Rehabilitation Schererville, helps families recognize the red flags of feeding and swallowing disorders and explains how therapy can make a difference.

What Are Feeding And Swallowing Disorders?

Quasny: Feeding issues are often sensory and related to food textures and smells. Swallowing problems are more mechanical, and involve the muscles used to chew and swallow. Many children experience a combination of both.

We often see feeding and swallowing problems in children with conditions such as autism, Down syndrome, cerebral palsy or other syndromes that affect muscle tone and coordination. However, a child may also have dysphagia (difficulty swallowing) without any known underlying diagnosis.

What's The Difference Between A Typical Picky Eater And A Child With A Feeding Or Swallowing Disorder?

Quasny: The biggest difference is that children with a feeding or swallowing disorder do not gain weight or meet developmental milestones. If your child eats very little day after day or avoids certain food groups entirely and starts to fall off their growth curve, it may be time to look deeper.

In contrast, a picky eater might turn down vegetables one day and eat them the next. But they still meet their growth milestones and get enough nutrition overall.

What Are Some Other Red Flags, Aside From Not Gaining Weight?

Quasny: Eating can be very uncomfortable for children with a feeding or swallowing disorder. You might notice that they choke or gag frequently at mealtimes. Or perhaps they have trouble chewing or only eat soft foods. If eating becomes a daily struggle for your child, that's a red flag. Mealtime should not be a source of ongoing anxiety.

At What Age Should A Child Be Able To Eat A Variety Of Textures And Foods?

Quasny: Swallowing and feeding disorders can arise in infancy or later in childhood.

It depends on each child's development, but generally, by the time a child can walk independently, they should have the oral motor skills to manage different textures. They may need help if they struggle to chew, move food around in the mouth or swallow safely.

How Can Feeding And Swallowing Disorders Affect A Child's Development?

Quasny: These disorders can affect many aspects of development — social, emotional and physical. A child who dreads mealtimes and snacks may begin to develop emotional distress and anxiety around food. They might feel left out at birthday parties or family dinners. Physically, the lack of proper nutrition can delay growth and development.

What Does A Feeding Evaluation Involve?

Quasny: If you have concerns about your child's feeding or swallowing abilities, it's a good idea to see a speech-language pathologist for an evaluation. We will observe your child eat a variety of foods — some they usually eat and others they avoid.

The goal is to understand what's happening:

• Are they struggling with texture?
• Is posture a problem?
• Do they have difficulty chewing or swallowing certain consistencies?

From there, the therapist will make recommendations, suggest changes to try at home and schedule a follow-up. In some cases, a single visit and some minor changes are enough. Other children may need ongoing therapy. If the speech-language pathologist thinks your child needs to see a different type of specialist, they'll provide a referral. For example, if your child's weak core strength affects their feeding, a physical therapist can help.

What Advice Do You Have For Parents Of Picky Eaters?

Quasny: I encourage parents to focus on three responsibilities: what, when and how.

• What — Offer three foods from three food groups at each meal. Always include one food the child doesn't typically prefer.
• When — Serve meals and snacks every 2.5 to 3 hours to build appetite. Avoid grazing.
• How — Keep meals predictable. Sit in the same place, give advance notice that it's mealtime, and make sure the child is seated properly — feet flat, knees and hips at 90 degrees.

And let your kids explore food with their hands. Exploring can help them get comfortable with new textures. Kids are more likely to put something in their mouths if they've already touched it.

What Are Some Common Myths About Feeding?

I hear a lot of myths and misconceptions about feeding. Here are some of the most common.

• "If they're hungry enough, they'll eat." False. Some kids physically can't eat due to motor or sensory issues.
• "Eating is the top priority." Actually, breathing comes first, followed by posture. A child who struggles to breathe or sit upright won't be able to focus on eating.
• "Children only need three meals a day." Not true. Kids need to eat five to six times a day, including snacks.
• "You can only eat certain foods at certain meals." If we follow that, we'll lose opportunities to feed the child a variety of foods.

Concerned About Your Child's Eating? We Can Help.

If your child struggles with eating, it's natural to feel worried. Franciscan Health is here to help. We can provide a complete evaluation with treatment recommendations. The first step is to talk to your pediatrician and ask for a referral to a speech-language pathologist.