Why won’t they just EAT?

Feeding is often viewed as a simple process that children should naturally know how to complete. However, feeding is actually a multistep process that requires a variety of skills. If there are difficulties in one or more areas (e.g., adverse medical history, motor delays) children often develop challenging behaviors which increase their avoidance of food. In addition, when there are difficulties in any of these areas, they often disrupt the entire family. This three-part series will provide an overview of eating challenges and its impact on families. Approximately 13% to 22% of children will be described as picky eaters at some point during their childhood. Picky eating can also become a chronic problem, as roughly 40% of children were reported to have difficulties lasting more than two years (Mascola, Bryson, & Agras, 2010). Moderate to severe selective eating was associated with more psychopathological symptoms (e.g., anxiety, depression, ADHD) in addition to more family dysfunction (Zucker et al., 2015).

There are several areas to consider if your child is having difficulties, with the first being medical. Have there been difficulties with feeding since birth? Possible reasons include acid reflux, constipation, GI issues, acute illnesses, respiratory disease, and other sources of pain and discomfort. Hypotonia, which is low muscle tone, can impact postural support, which in turn can impact breathing. The coordination of eating and breathing may be difficult for children with hypotonia. Oral and motor skills must also be considered. Some questions to consider: Does your child have steady head control? Tongue lateralization? Trunk support? Proper lip closure? A pincer grasp? Consult with your child’s primary care physician if you have any of these concerns.

Sensory differences can also play a role in children’s difficulties with eating. Visual—do they look away when food is presented? Smell—do they cough, cover their nose, or have watering eyes? Tactile—Is there frequent hand wiping or finger splaying? Taste—Do they gag, shudder, or splay their lips? Auditory—Do they startle easily with noises or covers their ears during meals? If children display an immediate reaction to food placed in their mouths, it may be texture. If the response is delayed, it may be due to taste.

While an eating difficulty may have began with an underlying medical cause, even after a medical issue has been resolved, learned behaviors can continue maintaining the difficulties. Some questions to consider when determining if the eating difficulties are compounded by learned behaviors: How long have the problems been occurring? Do these behaviors occur across all environments and with all caregivers? Do they feed themselves? If not, who does? Are there any problems in this area? It is also often helpful to look at what may maintain the behavior. Is your children being given access to preferred items, i.e. a tablet, if they leave the dinner table? Is your child eventually being given a preferred food if they refuse to eat their meal?

Feeding Matters provides a free online questionnaire that addresses a variety of topics related to your child’s eating. This survey can assist you in considering various aspects of your child’s eating and identify if there are areas of concern that warrant further consultation with a medical professional. If so, consult with your child’s primary care physician. The Feeding Matters Infant and Child Feeding Questionnaire© can be accessed at http://questionnaire.feedingmatters.org/questionnaire

Check out next week’s blog for more information about creating positive mealtimes.


Mascola, A., Bryson, S., & Agras, W. (2010). Picky eating during childhood: A longitudinal study to age 11-years, Eating Behaviors, 11(4), p. 253-257.

Zucker, N., Copeland, W., Franz, L., Carpenter, K., Keeling, L., Angold, A., & Egger, H. (2015). Psychological and psychosocial impairment in preschoolers with selective eating, Pediatrics, 136(3), e582-e590.

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