Why won’t my child eat and what to do about it
“Why won’t my child eat vegetables”? “My child will only eat while watching an iPad”. “My child doesn’t eat enough”. “My child is a fussy eater”. These are all common concerns raised by parents. But how do you know when to get a speech pathologist assessment for your kids?
Children develop their feeding skills significantly during the first years of life. In typical feeding development, children will transition from breast/bottle feeds alone to starting solids between 4-6 months (initially purees). In the first year of life, solid meals continue to be supplemented with breast/bottle feeds which gradually reduce in volume (amount) and frequency (how often). By one year old, children should be able to manage foods of a mixed texture, including soft table foods. They can chew their food. Children continue refining their feeding skills until approximately two years old, by which time they can manage foods of harder textures and have also developed more advanced skills such as using their tongue to sweep any foods stuck in their teeth or the sides of their mouth.
As children are learning to eat, they are enjoying newfound independence, such as learning to feed themselves (even when they can’t quite yet) and saying ‘no’ or throwing foods. Food refusal can be a normal part of behavioral development.
However, there are some red flags to look out for that may indicate something more is going on:
- Extremely restricted diets, including refusing entire food groups
- Significantly negative and big reactions to new foods being presented
- Significant choking, gagging, or vomiting during or after meals
- Ongoing issues with weight gain, including weight loss
- Significant medical history, including prematurity, reflux, food allergies, prolonged tube feeding, respiratory issues, cleft palate
So why then might children refuse to eat? There are many reasons, and often it’s not limited to just one:
- Pain or discomfort (e.g., from reflux, food allergies, or constipation)
- Immature oral motor and swallowing skills (the child doesn’t have the skills to safely manage their food and drink)
- Sensory processing issues
- Behavior and cognition
- Factors specific to the child, their family, and mealtime environments (e.g., home, day-care, school)
When it comes to family mealtimes, the parent’s role is to provide the food, and set the place and time to eat, while the child’s role is to decide what and how much to eat. Below are some general mealtime strategies that parents and families can implement at home to support positive, pressure-free family mealtimes:
- Create a social and enjoyable mealtime environment
- Establish a mealtime routine with clear rules
- Limit, or where possible remove, distractions during mealtimes (e.g., iPad, TV, toys)
- Ensure the child is in a supportive, well-adjusted highchair/chair
- Eat together as a family when possible
- Model positive behaviors and food choices
- Understand and respond to cues from your child about being hungry or full
- Always offer a combination of your child’s preferred and non-preferred foods to ensure they are getting a balance of diet quantity (how much they eat) while learning to explore and eat new foods.
- Offer and explore new foods with repeated exposure for your child. Make learning about new foods fun and playful (e.g., involve your kids in preparing food, play with food, and use special cooking utensils). Discuss and explore the different properties of foods (e.g., taste, texture, smell, sound, appearance).
- DO NOT be afraid of MESS! Learning to eat should be messy for young children
- Avoid trickery (e.g., hiding vegetables in other food/drinks) to maintain your child’s trust in you as their meal provider and mealtime partner
- Avoid negative discussion about foods (e.g., good versus bad foods)
- Manage any undesired mealtime behaviors consistently and calmly
We understand navigating your child’s feeding difficulties can be an overwhelming journey and often it’s difficult to know where to start. Know that if you’re concerned, it is never too early to reach out to a member of the feeding team, which may include a speech pathologist, dietitian, and/or occupational therapist as initial contact. Here at QPAH, several of our Speech Pathology Gold Coast team have additional training in the Sequential Oral Sensory (SOS) Approach to Feeding and Responsive Feeding Therapy. We offer assessment and therapy for pediatric feeding difficulties (0-18-year-olds),
Australian Government National Health and Medical Research Council Department of Health and Ageing
Responsive Feeding Therapy
Sequential Oral Sensory Approach to Feeding (SOS)
World Health Organisation
By Amelia Fidler – Certified Practicing Speech Pathologist