As parents, we have all had those moments when we put food in front of our child and they look at it like we’ve just served them something completely unfamiliar. Sometimes it is simply picky eating. Other times, there may be something more going on.
That is why I wanted to share this information with Greatful Moments readers.
It can be easy to label a child as a picky eater, but pediatric feeding disorders affect about 1 in 37 children under age 5. The rate is even higher among vulnerable populations, including children with developmental disabilities and premature infants.
It can also take months for a pediatric feeding disorder to be identified and diagnosed. That delay can be difficult for both the child and the parent or caregiver, and untreated feeding disorders can lead to nutritional, developmental and psychosocial complications.
A new paper published in the Journal of Pediatric Health Care looks at methods for screening for pediatric feeding disorders in primary care. The research team was led by Asma Taha, a California State University, Fullerton nursing professor and pediatric nurse practitioner specializing in feeding.
What I especially appreciated about the information Dr. Taha shared is that she doesn’t simply tell parents what to watch for. She also addresses something many parents may quietly struggle with: the guilt and frustration that can come when a child has difficulty eating.
I asked Dr. Taha five questions about pediatric feeding disorders, what parents should watch for, responsive feeding and where families can begin when they need help.
Asma Taha Answers Our Questions
Asma Taha is a Cal State Fullerton nursing professor and pediatric nurse practitioner specializing in feeding. Please note that the responses are for general information and are not a substitute for advice from a child’s own healthcare provider.
Many parents may assume their child is simply a “picky eater.” What are some of the signs that could indicate a pediatric feeding disorder rather than typical picky eating?
Almost every parent has stood over a plate of untouched food and wondered, “Is this normal?” Most of the time, it is. Picky eating is a very common phase, and it usually peaks somewhere between a child’s first and second birthdays.
Kids who are just picky still tend to eat a decent range of foods (around 20 or more), keep growing along their usual curve, and wrap up meals in under half an hour, even if there’s some complaining along the way.
A feeding disorder looks a little different. You might notice your child eats only a handful of foods, gags or throws up often when eating, takes a very long time to finish meals, has trouble moving past purees or bottles, or isn’t gaining weight the way they used to. Picky eating is about what a child prefers. A feeding disorder is about what a child can safely and comfortably eat.
Kids who were born early or who have heart, breathing, tummy, or developmental conditions are more likely to have feeding challenges, so it’s worth keeping an extra eye on things.
What should parents pay attention to during mealtimes that might indicate it is time to speak with their child’s pediatric provider?
You know your child better than anyone, and what you notice at the table really matters.
A few things worth watching: How long do meals usually take? Does your child let you know when they’re hungry and when they’re full? Do you find yourself needing special tricks, like a tablet at the table or a very specific routine, just to get a few bites in?
Also notice what happens while they eat. Frequent gagging, coughing, a gurgly-sounding voice, or vomiting are all worth mentioning to your child’s provider. If your child is choking with every feeding or refusing all food and drink, call the same day.
And don’t forget to check in with yourself. If mealtimes have turned into a daily battle, that alone is reason enough to talk with your child’s provider.
One tip that helps a lot: jot down everything your child eats and drinks on a typical day before the appointment. It gives your provider a much clearer picture than trying to remember on the spot.
Parents can sometimes feel frustrated, guilty, or even blamed when their child struggles with eating. What would you like families to know about the causes of pediatric feeding disorders and the idea that these challenges are not simply caused by stubbornness or poor parenting?
I hear this from so many parents, and I want to answer it clearly: no. Feeding disorders are not caused by stubborn kids, and they’re not caused by bad parenting.
Eating is actually one of the most complicated things a child learns to do. It takes breathing, swallowing, digestion, muscle coordination, and the ability to handle all kinds of tastes and textures, all at once. If any piece of that is hard, eating can feel uncomfortable or even scary. A baby who had painful reflux, for example, may learn that eating hurts, so refusing food is actually their way of protecting themselves. Your child isn’t refusing food to defy you. They’re telling you that eating is hard.
If you’ve tried coaxing, bribing, or distracting to get your child to eat, please go easy on yourself. Those are things loving, worried parents do. Mealtime stress is part of a feeding disorder, not the cause of it, and it usually gets better as the real issues are addressed.
And if all of this has left you feeling anxious or worn down, that’s completely understandable. Your well-being matters too, and it’s okay to ask for support for yourself.
What is responsive feeding, and how can parents use it at home to create a more positive and less stressful mealtime environment?
Responsive feeding is a fancy name for a simple idea: tune in to your child’s hunger and fullness cues instead of trying to control how much they eat. Here’s the easiest way to remember it: You decide what, when, and where. Your child decides whether and how much.
In real life, that might look like:
• Serving meals and snacks at predictable times, with just water in between, so your child comes to the table hungry
• Keeping meals to about 15 to 30 minutes, with screens off
• Making sure your child is sitting comfortably with their feet supported
• Putting one food they usually like on the plate next to something new, with no pressure to try it
• Eating together when you can, so they see you enjoying different foods
It also means gently letting go of “two more bites,” rewards, and dessert deals. They’re so common and well meant, but they often make kids more anxious about food over time. It can take many relaxed exposures before a child is ready to taste something new, and every exposure counts, even when nothing gets eaten.
These ideas can flex to fit your family’s culture and traditions. There’s no one right way to share a meal.
For families who are concerned about their child’s eating, what would you recommend as their first step toward getting help?
Start with your child’s pediatric provider, and just say it plainly: “I’m worried about my child’s eating.” You don’t need proof or a perfect explanation. Your concern is enough.
Many offices use a quick six-question checklist about feeding, and your provider may set up a separate visit just to focus on eating. From there, they’ll look at your child’s growth, health history, and development. Some common culprits, like reflux or constipation, can often be treated right away, and that alone sometimes makes a big difference. If more help is needed, your provider can connect you with feeding specialists such as speech or occupational therapists, dietitians, or a full feeding team.
Feeding disorders affect about 1 in 37 young children, so you are far from alone, and the good news is they’re very treatable. Asking for help doesn’t mean you’ve failed. It’s one of the best ways to advocate for your child.
Why I Wanted to Share This
I think sometimes we are too quick to call a child a picky eater.
And I understand why. Children have preferences. They go through phases. One day they love something and the next day they act like we’ve never served it before.
But there is a difference between a child who simply doesn’t like certain foods and a child who is having difficulty eating.
What stood out to me most in Dr. Taha’s answers was the reminder that a feeding disorder isn’t about a child being stubborn or a parent doing something wrong.
That is something parents need to hear.
If your child’s eating has become a constant struggle, if meals take an unusually long time, if your child is gagging, coughing or vomiting while eating, or if you are simply worried about how much your child is eating, you don’t have to figure it all out by yourself.
You can start by talking with your child’s pediatric provider.
And as Dr. Taha said, “You don’t need proof or a perfect explanation. Your concern is enough.”
Sometimes simply paying attention, asking questions and speaking up can be the first step toward getting a child the help they need.
Please remember: The information shared in this article is for general information and educational purposes only. It is not a substitute for advice, diagnosis or treatment from a child’s own healthcare provider. If you have concerns about your child’s eating, swallowing, growth or nutrition, please speak with your child’s pediatric provider.
Learn More
The research discussed here was published in the Journal of Pediatric Health Care and focuses on identification, screening and referral for pediatric feeding disorders in primary care.
Thank you to Asma Taha and the Cal State Fullerton team for helping bring attention to an issue that many families may be experiencing without realizing that help is available.
