When Does Picky Eating Need Intervention? An Interview with EIRMC

We have partnered with Eastern Idaho Regional Medical Center to bring this valuable information to expecting mothers.

Is your child picky, or are they picky? And at what point does your child need intervention for their picky eating? I recently visited with Peter Nieman, a Speech-Language Pathologist (SLP) who works in Pediatric Therapy with EIRMC, about this very topic. 

Did you know that the average person needs ten to twenty experiences with a food to determine if they like it? While some of our children may not be willing to touch the broccoli on their plate, does that constitute a picky eater? According to Nieman, CCC-SLP, a child that is a picky eater is one whose level of pickiness affects their nutrition or weight. It can also be a child who avoids entire textures, food groups, and consistencies altogether. 

A picky eater needing intervention could also look like a child who can’t eat regularly to the point that family dynamics are tense, or they avoid social situations because of food. One warning sign to look for is the overall feeling when mealtimes come around. Are these moments of tension when you know there is going to be a battle every night? Does your child avoid attending birthday parties or field trips at school because they are unsure about the food situation? These are also signs that your child could benefit from therapy with an SLP. 

Other red flags could be children who do not want food touching other food when put on a plate, who want all food separated rather than incorporated into a meal, and who refuse multi-textured foods. For younger children, a red flag that your child may need therapy is that they are several months behind and not advancing in their food eating habits. 

A rough timeline for introducing foods is as follows:

  • Infants should be breast or bottle-fed only

  • 5 to 6-month-old children may start trying pureed foods, baby cereals, and other foods known as Stage 1

  • 7 to 8-month-old children can start having thickened food, also known as Stage 2

  • 9 to 11-month-old children can begin eating meltable solids and soft cubed food 

  • 12 to 14-month-old children should begin having mixed textures integrated and soft table foods introduced

  • 18-month-old children can begin having harder food as teeth come in

There are many reasons why your child might be a picky eater. They may have food aversions, may be lacking a skill, may have difficulty swallowing, or there may be safety issues triggered by different food. Your child could also have sensory issues which include not eating a food because of the taste, feel, smell, or look. There may also be a structural issue, where lips, jaw, tongue, teeth, palate, or overall mouth may not be able to handle certain foods due to lack of coordination, strength, or range of motion.

All of these hindrances toward eating freely can be addressed by a professional. If you feel that your child meets these red flags, get a consultation! Visit your child’s doctor and specifically ask for a referral to visit with an SLP at EIRMC, who can offer outpatient pediatric services to determine what your child needs to eat without fear. 

The process of having your child seen by an SLP is very simple. The beginning visit entails trying different foods to determine if your child can safely handle foods and textures. The SLP will also inspect your child’s mouth structures to ensure that there are no physical limitations. Then, an interview with the parent and child will be conducted to determine what foods your child will eat freely, what foods they will tolerate a few bites of, and what foods they will avoid entirely. From this beginning visit, the SLP will be able to determine the best course of action for your child’s continuing therapy. 

Therapy lasts about 30-45 minutes and can take place once or twice a week depending on need. Medicaid generally covers SLP services, while private insurances may cover a few visits. 

What can you do at home to help your pickier children?

  • Use the five senses as a game when introducing food – investigate why your child may not like a certain food item based on the way it smells, tastes, looks, texture, or even the temperature, and then try to offer that food in a new way based on their reactions. If they don’t like the temperature of cooked broccoli, try serving it raw. If they don’t like the texture, serve it in a new way or add toppings such as cheese. 
  • Set realistic expectations around food. You are their parent seven days a week and therapy is a special time set aside to practice and work on skills. If you want your child to eat three bites of food before they leave the table, that is fine. But try your best to not associate food with punishment, misery, or failure. 
  • Food has no moral weight to it. A child is not a good child or a bad child because they eat or don’t eat certain foods. 
  • Remain neutral about the way you talk about food or react to new foods. Your language, body language, and facial expressions can cause them to avoid food entirely. If you know that you have a pickier child, do not tell them that they won’t like something because that will ensure that they will not even try it. 
  • Have grace with newer foods. Use this food as a “bonus” where children are simply trying the food without any expectations around finishing it. Encourage them to try a bite, but go easy on asking them to finish the entire plate when it is their first few experiences with a food.
  •  You can offer a treat or dessert for hard work recognized, but dessert should not be a given for every meal. 
  • Recognize that your child interacting with food at all counts as something. Maybe at this meal, they cut up their food while they are investigating its texture or pick up the food to smell it. The next meal they may try taking a bite. Both are small victories!
  • Lastly, use language that encourages trying. Frame the experience as, “Hey! It looks like you’re still learning about this food. Maybe we should try it again on a different day!” 

If you have concerns about your child’s eating habits, please contact their doctor, and request a referral to EIRMC’s Pediatric Therapy. 

EIRMC’s Outpatient Pediatric Therapy services also offer one-on-one speech therapy, occupational therapy, and physical therapy to help your child develop the tools and skills they need, starting with premature infants all the way to children who are 21 years old with developmental needs. 

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Alex, mother to three rambunctious boys, belongs to the niche made-for-TV-movie market where a city girl marries a country boy. As such, she has developed a new appreciation for dirt biking, camping, hiking, and all other outdoor adventures. She loves anything artistic, but suffers from “jack of all trades, master of none” syndrome. You can find her at home working on one of a billion unfinished projects. Having all boys has been a blessing in disguise because her true loves are Harry Potter and Legos. Her sisters jokingly say she is the best “brother” they ever had.


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