In occupational therapy we work to expand the variety of food that a child eats to improve overall nutritional intake. Some kids who are "picky eaters" have very strong preferences including specific brands, textures, colors, shapes, or flavors. When there are no concerns in the mechanics of eating (such as the ability to chew & swallow food), these sensory preferences can impact a kiddo's ability to reach their nutritional goals, take vitamins, or cause significant behavioral challenges when introduced to new foods.

Strategy to help overcome picky eating (due to sensory sensitivities)

One of the strategies occupational therapists use to grade the sensory input related to food in small steps is called food chaining. Food chaining is connecting a characteristic of a food that is preferred with the characteristic of a new food. Making subtle changes helps kiddos try something new without overwhelming their sensory system. It can also help us introduce new foods in a less intimidating way to help adjust to new foods. Food chaining is just one of many approaches to address meeting a child's nutritional needs & expand on the quantity, quality, & variety of foods in which they will eat.

Food Chaining Example: 

1. Pringle
2. Fries (Same flavor, different shape)
3. String cheese (Same shape, different flavor)
4. White veggie straw (Same color & shape, different texture)
5. Green veggie straw (Same shape/texture, different color)
6. Snap Pea Crisp (Same color/ texture, different shape)
7. Green fruit snack (Same color, different texture)
8. Green applesauce (Same color/flavor, different texture)
9. Green drink (Same color/texture, different flavor)

Why Food Chaining can help

• If a child is considered a "picky eater", food chaining is a fun & simple way to meet the child where they are rather than constantly trying to introduce entirely new foods
• Food chaining may help a parent identify qualities of food that a kid really likes (e.g. salty, crunchy, not green) and use that information to introduce new foods that meet those requirements to start expanding the variety of foods their child will eat
• Don't be afraid to play with your food! Get messy, create new things, draw on your faces, feed stuffed animals, make silly mixtures & just have fun with it.
• If a child still reacts to small changes to their food (e.g. only eating a food with a certain color spoon & not eating a food they like from another spoon) then it may be a good indicator to see an OT or SLP for a feeding evaluation to look at their child's sensory needs

Signs to Watch For & Things You Can Do

• Watch for very strong food preferences: If you start to notice that your child has very strong food preferences when they are young such as skipping puree baby food, not liking when foods have mixed textures or are lumpy, or does not eat foods that are soft & chewy it is important to make note of these aversions, selectivities, & preferences
• Eat with your child: It is important to eat with your child to provide opportunities for your child to interact with new foods even if they are not foods they like. Never underestimate the importance of family meal time
• Express concerns to a medical professional: It is important to express concerns about feeding to a doctor & to ensure that there are no underlying medical conditions or physical limitations contributing to "picky eating". A physician may recommend SLP or OT depending on a child's needs. An evaluation with a therapist will provide initial information needed to a therapist to use clinical reasoning to determine the best approaches and the recommended plan of care.  Therapists at PMC take a holistic approach to look at how the environment, the demands of the task, & a kid's physical abilities can all contribute to why a child may seem like a picky eater and address each of these areas. We can use a variety of approaches to help meet a child's needs and introduce new foods in a fun, playful environment. OTs & SLPs can also help facilitate food chaining & provide other strategies to expand a child's diet.

Shout out to Shannon Scott (occupational therapist) for sharing her knowledge and the Pediatric Movement Center's entire pediatric occupational therapy team for all their great work helping families with picky eating!

References:

• Research/data: Found in the book:
• Food Chaining: the Proven 6-Step Plan to Stop Picky Eating, Solve Feeding Problems, and Expand Your Child's Diet
• By: Cheri Fraker, CCC/SLP, Laura Walbert, CCC/SLP, Sibyl Cox, LD, RD, Mark Fishbein, MD, Shannon Cole Barker, ORL/L
• 2017, Da Capo Press