About 3 percent of kids suffer from severe selective eating, to the extent that they can't eat out at a restaurant, said lead researcher Nancy Zucker, an eating disorders specialist at Duke University Medical Center in Durham, N.C.

Severely selective eaters are more than twice as likely to be diagnosed with depression or social anxiety, when compared with kids who'll eat anything, according to findings published online Aug. 3 in the journal Pediatrics.

Alaina Everett, a Cook Children’s licensed psychologist in Denton, says severe picky eating can be treated from a psychological/behavioral perspective as well as through oral-motor and sensory therapies and trying new foods for children who have severe selective eating can be terrifying.

“The fear is only intensified when parents make threats or express anger and frustration,” Everett said. “In our psychology department we emphasize the belief that kids do well if they can. Likewise they will eat well if they can. But there are obstacles that get in the way. Whether the original issue is a sensory processing disorder, oral-motor weakness or a gastrointestinal problem, all these kids have one thing in common, anxiety.”

From a psychological standpoint, these kids have had unpleasant experiences with food and the lingering trauma may be real. This is especially true for well-meaning moms who hide veggies in their kids’ favorite foods. If you have a seriously picky eater, Everett says this strategy will back-fire big time.

So how much anxiety can meal time actually cause?

“It is not uncommon in my practice to see children cry, scream, hide under the table, and quite literally shake at the sight of a novel food or when asked to join me at the table,” said Amanda Fyfe, a speech-language pathologist at Cook Children's in Arlington and Mansfield. “The anxiety severe picky eaters cope with is real and it can be intense. These kiddos often have months or years of negative food experiences fueling this fear, and unraveling it takes real work on everyone’s part. “

Fyfe says severely picky eaters:

• Have a significantly limited food repertoires (think 10 foods). These foods are probably similar in some way, although figuring out the rhyme or reason to what your little guy will or won’t eat can be mind boggling. It may be that his safe foods are the same color or have the same texture.
• Frustrate us with behavior that makes mealtime at home a catastrophe and eating out unheard of. He may refuse to eat with your family or cry and scream at the sight of the casserole you’ve so lovingly prepared.
• Refuse foods based on ALL sensory properties, including appearance, smell, texture, and taste. A picky eater may not even tolerate an offensive food on his plate. The sight of a non-preferred food may cause gagging, retching, and vomiting. Eating is more than simply chewing and swallowing. Interacting with, smelling, touching, and tasting are ALL important steps in the eating process. And disruption can occur at any step.
• May struggle to meet nutritional demands

“A child will not eat the broccoli and pork chops if you wait him out. He just won’t,” Fyfe said. “In fact, he may grow more and more rigid in his food selection because he IS hungry and grumpy. If a food or experience causes a child stress, discomfort, or pain, he will avoid it, plain and simple.”

Fyfe says these children are hypersensitive to foods in ways most of us might not even consider when planning our meals. Foods have to pass many tests before deemed acceptable for consumption, believe it or not, and severely picky eaters really put their meals to the test.

The first and possibly the most important test his dinner must pass? What it looks like. Children are acutely aware of the color of the food and may question why the color, shape, or size changes from bite to bite or from meal to meal. In addition, they might become overwhelmed by the smell of a particularly pungent food (think roasted broccoli, guys) and lose all ability to even consider tasting it. The texture of yogurt or pudding may cause a gag with incredible force. All of these reactions to food can lead to increased behavior disruption and meal time chaos.

“They can taste everything,” Everett said. “Zucchini pasta does not fool anyone and they are likely to stop eating pasta altogether. Presenting motivators like extra video game time can help, but it doesn’t solve the underlying anxiety. The scenario will just repeat itself when the next new food is presented.”

If your child shows signs of extreme picky eating, you will need some help. Talk to your child’s pediatrician about scheduling a feeding evaluation with a speech-language pathologist to determine the origin of the feeding woes and develop strategies to improve the eating experience for the entire family. A child psychologist may also be used if necessary.

http://www.npr.org/sections/health-shots/2015/08/03/428016725/could-your-childs-picky-eating-be-a-sign-of-depression

https://childhealthanddevelopment.files.wordpress.com/2012/03/kaytoomey.pdf

About the author

Amanda Fyfe is a speech-language pathologist at Cook Children's in Arlington and Mansfield. Speech/language pathologists focus on oral motor, speech, language and communication skills to enhance development, restore function and to prevent disability from pediatric conditions, illness or injury. Click here to find the closest Cook Children's Rehabilition Services near you.

She is obviously looking for some sort of action on my part other than my smiling and nodding affirmatively. Since she’s my number one girl, I’ve learned the idiosyncrasies of her developing speech and know exactly how to handle this request. But to the layperson (or even Daddy or Grammy), I’m fairly certain I would need to come to the rescue with my toddler translator skills.

Mamas, I know you’ve been there. Your 3 year old launches into a monologue you find equal parts incomprehensible and adorable. Adorable, that is, until the tantrums and frantic attempts to understand and obey her demands kick in. In my practice, I have observed some masterful decoding mamas and some skillfully adaptive little ones navigating the waters of communication breakdown. Let’s talk a little bit about speech sound development and when to fret.

Articulation is the movement of the tongue, lips, soft palate and jaw to make speech sounds. It’s also the driving force behind your toddler’s incomprehensible speech. As parents, we are so excited when our little bundles of joy begin talking, but oftentimes, that excitement is quickly replaced with frustration when we realize we can’t understand a lick of what they’re saying.

An articulation disorder occurs when a child has difficulty forming speech sounds, most likely due to a structural or motor-based deficit. Most children tend to have some difficulty with certain speech sounds. Because creating sounds is challenging, he may substitute easy sounds for tough ones (think dumb for thumb), delete sounds (ha for hat), or distort problematic sounds (this is most often noted when children have a “slushy” quality). An articulation disorder occurs if these substitutions continue past the expected age.

Are all sounds created equal? In short, no. Children master sounds gradually. Most children can pronounce all of the speech sounds of English correctly by age 8. While each child’s speech sound acquisition is different, the following are age ranges in which most children master certain sounds:

• Introducing the “early birds”: Most wee ones will use m, n, y, b, w, d, p and h correctly between 18-30 months. That may explain why mama, dada and ball are frequently reported as first words.
• Not to be outdone, the middle of the road sounds includes: t, ng, k, g, f, v, ch and j. You may hear your little one utter these sound appropriately as early as 2 or as late as 6 years of age.
• Finally, the late bloomers include: sh, zh, r, s, z and th. This final pack of sounds contains the frequent offenders when it comes to articulation disorders. They are challenging for children to master and can wreak serious havoc on the clarity of their speech. We expect children to master these sounds between the ages of 3-8. (Based on Shriberg, 1993)

As children get older and learn new speech sounds, they gradually become easier to understand by a wider variety of listeners. Developing clear speech is a journey for our littles, albeit a frustrating one at times. And like all journeys, no two are equal. Some children are clear as a bell by their second birthday while others need a bit more time. As parents, we typically understand our babes before the rest of the world and therefore, are awarded the esteemed role of toddler translator. In many situations, one parent has a better handle on their child’s speech sound system than the other. But, as a general rule of thumb (or rule of “fum” if you happen to be a toddler):

• By 2 years of age children can be understood by familiar adults most of the time.

• By 3 years of age children can be understood by unfamiliar adults most of the time.

• By 4 years of age children can be understood by unfamiliar adults almost all of the time.

• By 5 years of age children can be understood by unfamiliar adults all of the time.

(Based on Flipsen Jr, 2006)

Although a continuum exists when it comes to speech sound development, there are a few red flags to be mindful of when chatting with your child.

It may be time to check in with your pediatrician regarding an evaluation with a speech language pathologist if your child:

• Uses only vowel sounds and a few consonants or shows limited babbling at 18 months.
• Seems to have a “slushy” (think mouth full of marbles) quality to his speech.
• Is difficult to understand and has a history of frequent ear infections.
• Leaves off the beginning or ending sounds of words (hatàha).
• Leaves off entire syllables of words (pa for purple).
• Is not understood by people outside his immediate family by age 3.
• Seems to be frustrated by his difficulty with speech or appears hesitant to interact or respond to peers or adults.

So what can you do to help him along?

Above all, it is important to always show your child you value WHAT he is saying regardless of HOW he is saying it. Always reinforce his attempts at striking up conversation with you! When you hear one of those adorable substitutions, help him to learn by repeating it correctly (If he says “tar” you can say “yes! A car!”) and moving on with the flow of conversation. Play face to face with him so he can watch the way your mouth moves to make sounds. Emphasize beginning and ending sounds in your own speech so he can hear them and begin to realize they are part of the word, too. If all else fails, ask him to SHOW you what he needs. And take comfort in the knowledge that this process is a gradual one.

Oh, and my daughter? She wanted to watch Frozen on the big T.V. and relax a little bit. Obviously.

1. Shriberg, L.D. (1993). Four new speech and prosody-voice measures for genetics research and other studies in developmental phonological disorders. Journal of Speech and Hearing Research, (36), 105-140.

2. Flipsen, P., Jr (2006). Measuring the speech intelligibility of conversational speech in children. Clinical Linguistics and Phonetics, (20) 4, 303-312.

3. http://www.asha.org/public/speech/disorders/SpeechSoundDisorders/

About the author

Amanda Fyfe is a speech-language pathologist at Cook Children's in Arlington and Mansfield. Speech/language pathologists focus on oral motor, speech, language and communication skills to enhance development, restore function and to prevent disability from pediatric conditions, illness or injury. Click here to find the closest Cook Children's Rehabilition Services near you.

The obsessively clean freak with a dozen napkins at meals and the dust pan and broom standing by! I see the crumbs falling to the floor, the grape jelly graze the side of the chair, and the sticky fingers raking through the hair as my daughter enjoys her meal.

As a feeding therapist, I know as her skill in feeding develops so will the awareness of her fingers, hands, face and mouth. 

I MUST wait until she is finished before I attack with my arsenal of cleaning supplies. Sitting with her, eating with her, and having fun with her while she explores her dinner are the best things I can do as a parent.

Maybe you’re wondering, “Will my walls always be covered in food splatters?” or “Why does she continue to refuse foods I know she should be eating to have a well-rounded and varied diet?” “Does everyone’s baby require a bath after each and every meal?” “Is it normal for more food to be in her hair than in her mouth?”

Take comfort, mama. You are not alone in your exasperation when it comes to feeding your child while trying to maintain some semblance of tidiness in your kitchen.

Did you know that a baby’s mouth and hand have the highest number of sensory receptors per square inch than any other part of the human body?

That means the mouth and hands are the most sensitive parts of the body when it comes to what the brain can take in and learn.

So what does this all mean for your dinner table? Put away the fine china and good linens and get ready to embrace the mess. Researchers in the UK "found that playing with food may actually help kids overcome a fear of new flavors and eat a more varied diet, a small study suggests."

Children need the chance to explore new foods and textures with all five senses. In a perfect sensory world, your little one should have the opportunity to touch, smell, and taste new foods unabashedly. So, set the paper towels aside and join in the fun!

Your child will “learn” both good and bad habits depending on the mealtime experiences they are afforded.

For instance, if your child is given peanuts and experience an allergic reaction, he will most likely begin to refuse peanuts!

Alternatively, if broccoli and green beans are offered during a family meal in a way that is fun and supportive, you might find your little guy eating them with gusto! But, don’t be disheartened if he turns his nose up at beets the first time you present them.

Research has shown children may instinctively refuse new foods to survive simply because they are new. In addition, it can take up to 15 presentations before a food is deemed worthy in your child’s eyes. However, with good exposure, no illness or bad consequences, and repetition, children will learn many foods are safe to eat!

What can you do to help your child become a magnificently messy and healthy eater?

1. Make meal times a routine at the table, in their chairs, with NO distractions.
2. Allow your child to explore the foods that you’ve given him with the opportunity to say, “I don’t like this” without consequences.
3. Don’t set your sights on the spoon: allow him to eat with his hands!
4. Let him PLAY! Think finger painting with yogurt or building a tater tot tower.
5. Relax while he digs in and gets his hands dirty. He is learning about the different properties of the foods we eat when he touches, smells, tastes, and looks at the foods that are on his plate.
6. Keep offering the foods you desire him to eat. Remember, experts have found it may take your child 15 times of trying a food to decide how they really feel about it.
7. Lead by example! Tuck into the meal with your child. It is important for our littles to see us eating the same things we are asking them to eat.
8. Try to have as much fun at the table as possible while still enforcing the rules of “manners”. Talk about your day, talk about your food, smile, laugh, and make faces in your cheese. 

Your child may not have developed the oral motor or sensory skills to support a healthy, well-rounded, adult-like diet. Be on the lookout for the following feeding “red flags”:

• Drowsiness or sleepiness at every feeding.
• Poor oral tolerance (spits food out, shuddering, gagging, vomiting)
• Able to chew but prefers liquids
• Frequent gagging
• Coughing and/or choking

If one or more of these signs describes your child, consider talking with your pediatrician about your concerns and a possible feeding evaluation.

Satter, E. (1987). How To Get Your Kid To Eat…But Not Too Much. Boulder, CO: Bull Publishing Company

About the author

Melanie Van Noy is a speech pathologist at Cook Children's.Speech/language pathologists focus on oral motor, speech, language and communication skills to enhance development, restore function and to prevent disability from pediatric conditions, illness or injury.

You may be thinking, “Am I the only parent in town dealing with dinner drama every night?”

The answer is no. It is reported 25 to 45 percent of typically developing children experience feeding and swallowing problems, while a staggering 30 to 80 percent of children with developmental delays struggle with mealtime (Arvedson, 2008).

Now for the million dollar question: what causes feeding problems? There are several factors that can impede a child’s ability to develop a happy, healthy relationship with food, including: sensory processing disorders, gastrointestional complications, prematurity, and dysphagia.

Food should be fun. And for most of us, it is just that. But children may not see eye to eye with us when it comes to mealtime, causing this to become a stressful time for the whole family. Little ones can be incredibly stubborn when it comes to food choices.

Most parents have described their children as picky eaters at least once or twice. However, it is important for parents to know the difference between “picky eaters” and true problem feeders and when to seek assistance.

Picky eating can be a typical stage in normal development. Ready for the skinny on picky eating?

A picky eater will typically:

• Accept approximately 30 foods. That may sound like a lot, but it’s really not.
• Tolerate a new food on his or her plate and may even taste it once or twice. This new food may become a new favorite. But then again, it might get tossed on the floor. This truly depends on the child’s sensory reaction to the food in question.
• Eat meals with his or her family, but requires different preferred foods.
• Eat only one food from each food texture category (puree, crunchy, solids,etc).
• Consume one preferred food consistently, and then suffers “burn out” and refuses to eat this food for a period of time (picky eaters will usually begin to accept this food again after a brief break).
• Eat new foods after frequent exposure.

So, how can you nudge your picky eater toward the leafy greens and save your sanity? Here are a few simple suggestions for success at the dinner table regardless of whether you’re serving pizza or brussel sprouts.

1.Develop a routine and stick to it. Offer meals and snacks at about the same time each day

2.Don’t force feed or bribe your child to eat. This will likely increase refusal behaviors or even worse, bring on a power struggle.

3.Offer a variety of foods, including 1 to2 of your picky pumpkin’s favorite items, at the family meal.

4.Persistence is key! Remember not to shy away when he shudders at his first taste of peas. You may need to offer those peas up to 20-25 times before he will tolerate them.

5.Explore food with your child. Talk about the way it looks, smells and feels. Invite her into the kitchen to help you prepare the foods. Bring her along to the grocery store or farmer’s market to choose a new fruit or vegetable. Star fruit? Why not?! Eggplant? Coming right up!

6.Make it fun! Serve fruits and veggies with dips. Use cookie cutters to make a Shamrock Sandwich for St. Patrick’s Day or Santa for Christmas. Eat dinner by candlelight. Serve breakfast for dinner. Better yet, have everyone put on their coziest jammies for a pancakes and PJ’s party. Get creative!

7.Practice what you preach! This means you, parents. If you want your little ones to eat salad for dinner, you will need to dive into that bowl of greens yourself and forgo the drive-thru on your way home. Our children are always watching and learning from our actions and habits.

8.Don’t become a short-order cook. If your child refuses the family meal, it can be tempting to head back to the kitchen to whip up the macaroni and cheese he is coveting. Resist! This may promote picky eating.

Now, let’s get down to business. While picky eating can be frustrating, it is a typical stage in normal development. However, problem feeding is a true disorder that requires specialized assessment and/or intervention and is downright disheartening for parents. A child that does not eat well can evoke feelings of anxiety, fear, and helplessness, leaving caregivers struggling for a solution.

A problem feeder may:

• Eat fewer than 20 foods.
• Refuse the bottle/breast or drink a small amount and then refuse during infancy.
• Refuse an entire texture category (for example, a problem feeder may refuse to eat all pureed foods).
• Not accept new foods on his plate and may cry, scream or tantrum at the sight of a new food. Problem feeders may even gag or vomit at the sight of an offensive foods.
• Be unwilling to try new foods, despite multiple exposures.
• Eat the same food over and over, but once he experiences “burn out,” he will most likely not go back to eating that food. This will cause him to slowly, but surely, shrink his group of tolerable foods.

If your child is showing symptoms of problem feeding, talk to your child’s pediatrician regarding a feeding evaluation by an occupational therapist or speech-language pathologist. A thorough evaluation is necessary to determine the best course of individualized treatment for your child.

Hang in there, parents. There IS hope! Our feeding therapists are trained to help your child with a wide array of feeding difficulties.

References:

http://www.asha.org/PRPSpecificTopic.aspx?folderid=8589934965§ion=Incidence_and_Prevalence

http://www.sosapproach-conferences.com/articles/picky-eaters-vs-problem-feeders

Resources for Parents:

www.feedingmatters.org

www.yourkidstable.com

About the author

Amanda Fyfe is a speech-language pathologist at Cook Children's in Arlington and Mansfield. Speech/language pathologists focus on oral motor, speech, language and communication skills to enhance development, restore function and to prevent disability from pediatric conditions, illness or injury. Click here to find the closest Cook Children's Rehabilition Services near you.