How do I Know When to Be Concerned About my Child’s eating?

One of the biggest questions I get, from parents and other professionals alike, is “how do I know when to be concerned?” As you learned in my picky eating post, picky eating is very common! So how does a parent know what is “normal picky eating,” and what is truly cause for concern? Below I will share some important signs and behaviors that are cause for seeking out further evaluation.

1. You are worried, concerned, or stressed about feeding your child. This seems almost too simple to mention but is often the most important comment that gets me concerned. I tell my parents all the time that they are the expert on their child. Let me repeat that-YOU are the expert on your child! Feeding your child should not be the biggest stressor in your life, it shouldn’t scare you or worry you. If you, as the parent, are feeling in your gut that there is a problem, you should seek out the help of a professional who specializes in pediatric feeding. If anyone brushes off your concerns without hearing you out, seek out another professional. If there is nothing wrong, the feeding therapist should be able to alleviate your fears or concerns by explaining typical feeding for your child’s age and helping you to feel more comfortable feeding your child.
2. Your child gags, chokes, coughs or vomits during meals. Some gagging or coughing is normal when a child is first learning a new texture. Ensure your child is the appropriate age for the texture and that bite sizes are appropriate. (As an aside it is not recommended to give whole grapes, hotdogs, popcorn, nuts, marshmallows, or other hard to chew food that could lodge in a little throat before age 3). I become concerned when a child gags often, at all meals, and most bites. I worry when a child vomits often at mealtimes. Choking is always a cause for concern, either that the child isn’t ready for that food/texture, or that there is a problem with their motor skills for eating.
3. Your child has restrictive eating. Your child eats only a few foods, refuses entire classes of foods, refuses to try any new foods, or always eats the same couple of foods. Many toddlers and preschoolers go through the “only chicken nuggets/mac and cheese phase.” Just keep offering new foods and don’t stress too much if they are willing to occasionally taste or eat new or other foods. I often get children in therapy who only eat 1-2 foods. Despite parent’s attempts, they have eaten only these foods for months (or sometimes years!). When parents attempt to use a new plate, or even show them a new food, the child becomes upset, cries, sometimes vomits. If you are concerned that your child is not getting enough volume or variety, it may be time for a feeding evaluation.
4. Your child is not advancing textures. As I said earlier, some difficulty with a new texture is normal as the child gets used to it. I usually recommend an evaluation when a child continues to have difficulty, or refuse a new texture beyond a few attempts. This often looks like a toddler who refuses, or gags with, solids, or a 9 month old who coughs or gags with pureed baby food.
5. Your child has lots of behaviors or refusals. Some of the refusal behavior I see often is pretty noticeable. I often see a child who turns their head away or clamps their mouth shut after only a bite or two. Sometimes children put their hands or bib over their mouth, bat away the spoon, or arch away from the food. I become concerned when a child gets upset when first placed in the high chair, or at the sight of a bottle or the food. These are all signs that the child is associating the food with something negative, like pain, discomfort, or difficulty.
6. Motor problems with food. By age 3 children can manage most food textures. Babies of 6-9 months should be able to eat pureed baby food from a spoon after a few attempts. I recommend a referral if the child pushes the food out with their tongue, and is unable to keep the baby food in their mouth. 9-12 month olds should begin to chew easy to chew foods that melt or smash (like puffs or banana) with a munch pattern (up and down) even without teeth. I’m concerned when they hold the food in their mouth, smash it with their tongue and the roof of their mouth, or just spit it out whole. Gagging is often a sign of motor problems as well. Sometimes my parents describe whole pieces of food in the bowel movements when a child is swallowing pieces whole.
7. Your child coughs with liquids. Everyone has water “go down the wrong pipe” sometimes. Its a concern when this happens often, interferes with meals, or affects the child’s respiratory health or the amount they drink.
8. Parents are concerned. Oh wait, did I already say this?! That is because I think it’s important! Listen to your gut!

*If you are concerned that your child may have a pediatric feeding disorder because they are displaying any of the above signs, please have a conversation with your doctor. Explain your concerns or show them this blog, and ask for a referral to a pediatric feeding specialist. Speech-Language Pathologists (SLP) and Occupational Therapists (OT) are usually the professionals who may have advanced training in pediatric feeding and/or swallowing. To find an SLP in your area, check out this website: https://www.asha.org/profind/ make sure you ask if the SLP has pediatric feeding experience. If you are in Ohio and would like to schedule an appointment with me, call 419-577-1057 or 419-271-4015. Physicians can fax referrals to 567-429-2046, or email brightideas.speechtherapy@gmail.com