When is Picky Eating More Than Picky Eating?

It can be quite common for most children to go through a stage of ‘picky eating’ or refusal of certain foods. However, if mealtime is becoming stressful or your child is beginning to consistently limit food choices, there might be something else going on. A child’s behaviors tell caregivers a lot about their eating.

Some Reasons Children Won’t Eat

  • Avoiding a physical response to something they ate (gagging, pain, vomiting, reflux, GI issues, allergies, constipation)
  • Poor oral motor or swallowing skills (choking, aspirating, poor muscle strength in mouth, overstuffing, poor coordination of muscles in mouth
  • Sensory processing problems (over or under responsive to certain textures, over or under arousal)
  • Learning or behavior including cognitive delays or difficulty processing

No matter the issue, if it persists, mealtime and eating can become not only stressful for caregivers, but also the child themselves. If mealtime is becoming difficult for your child or family, talk to your pediatrician or feeding therapist (speech or occupational therapist) about your concerns.

Signs of Picky Eating

  • Mealtimes are stressful
  • Children are hard to feed
  • Gagging/vomiting with certain foods or textures
  • Choking often
  • Difficulty transitioning from bottle to purees or purees to table foods
  • Losing weight or moving down on growth chart
  • Eating less than 10 foods per food group (protein, fruit/vegetable, starch) or doesn’t eat any food in one of the food groups

How to Help Your Child

Encourage Playing With Food

Children learn through play and exploration, which includes touching food and getting messy. They are getting input into their tactile, visual, gustatory, and sometimes, taste systems! This can also include allowing the child too cook, painting with food, sensory bins with food, playing with pretend food, etc.

Include Protein, Starch, and Fruit OR Vegetable at Meals

Your child may not eat all of these but offering them a combination preferred and a non-preferred expands their repertoire of foods.  The amount of food on child’s plate should equal 1 Tablespoon per food group per meal for age of child. For example – a 2 year old child should only have 2 TBSP protein, 2 TBSP fruit/vegetable, 2 TBSP starch at one meal.

Have Parents or Siblings Be Present During Mealtime

Children also learn through observation and demonstration. You are their best role model! Show them and tell them about the food – how does it look, feel, taste, smell, sound.

If You Offer Your Child Something and They Don’t Like It, Continue to Offer It Randomly

It usually takes at least 10 times of offering a food before one can decide if they like it or not. The rule changes to 15 times after a child turns 8 years old.

Make Eating a Fun Experience

If it’s often stressful and a child feels they are being forced to eat, mealtime has then become a negative activity.

Have a Learning Plate

If your child is too sensitive to have certain foods on their plate, have a “Learning Plate” at the table. Talk about all foods on the “Learning Plate”.

Structure Snacks and Mealtimes

Allowing your child to graze may make mealtimes more difficult.

When to Get Help

  • Your child is losing weight
  • Your child is having difficulty transitioning from bottle to purees or purees to table foods
  • Gagging/vomiting often (more than 1x/week), which is associated with mealtime or certain types of food
  • Your child’s repertoire is becoming more limited (eating less than 10 foods per food group or not eating one entire group of foods)

If these concerns persist despite optimizing the feeding environment and using the strategies outlined here, consult your pediatrician for guidance.  Further evaluation from professionals such as a Speech and Language Therapist, Occupational Therapist, Behavioral Health professional, and/or Dietitian may be recommended.


• www.feedingmatters.org/families
Questionnaire on feeding difficulties based on age
• https://www.choosemyplate.gov/health-and-nutrition-information
• https://www.choosemyplate.gov/preschoolers-picky-eating

Author: Bethany Ellwanger, OTR, graduated with a Masters in Occupational Therapy from the University of Wisconsin-La Crosse. She has worked in a variety of setting serving pediatric patients. Bethany has been trained in Sensory Oral Sequential Approach to Feeding (SOS Feeding) and has been working with children with feeding difficulties for over 5 years.