Difficult Feeding Behaviors in Children

Frequently Asked Questions (FAQs)

One of the keys to successful and stress-free feeding experiences with children of all ages is the maintenance of a division of responsibility between parents and children. It is the parents’ responsibility to offer safe and nutritious food choices during set meal times. It is the child’s responsibility to decide how much to eat and whether to eat at all. Negative feeding behaviors often arise (or become more evident) when this division of responsibility is not respected (Satter, 2000).

Feeding my toddler is stressful. Is this the way it is supposed to be?

Feeding and mealtime should never be stressful for you or your child. If feeding is stressful, get help now. The earlier you identify feeding problems and seek help, the easier they are to resolve because there is less time for associated behaviors, behavioral problems, and/or inappropriate feeding patterns to develop which will have to be “undone.” Younger children are also often more willing to participate in feeding activities and make faster progress than older children.

What is typical toddler or preschooler feeding behaviors?

Regardless of his or her size, the following are healthy eating behaviors that you should see in your child by the time they are in preschool:

 Enjoys eating and sits at the table throughout the entire meal 

Is interested in trying a variety of new and different foods

 Does not become upset when presented with new or unusual foods

 Accepts less than favorite foods and is able to refuse undesirable foods politely without tantrums

 Will eat in a variety of settings without discomfort

 Appetite and food preferences may vary from meal to meal

 Pays attention to their body’s feelings of hunger and fullness to know what, when, and how much to eat

 Is able to eat the family meal without requiring short order cooking

My toddler eats a lot one day and then almost nothing the next. Is this typical?

Yes. As your child is learning to read his or her own indicators of hunger and satiety, his or her intake will fluctuate. Look at the “big picture” of what your child has eaten for the day or the week. The important part is that you are providing nutritious (and age-appropriate/safe) choices that allow your child to eat enough over the course of a day or week to support growth and development. If you are concerned because your child is not eating an adequate amount or variety of food, you should seek help immediately. Parents’ “gut” feelings are often correct. If you feel like something is wrong, or if feeding feels stressful, discuss your concerns with your pediatrician and ask for a referral for a Feeding Evaluation.

When should I be concerned?

You should be concerned and seek help if your child is exhibiting any of the following:

 Mealtime tantrums or refusal to sit at mealtime

 Unable to eat appropriate volumes of food

 Delays in or refusal to feed or self-feed

 Requires distraction, bribes, or forcing to eat

 Refusal to accept new or non-favorite foods on the plate

 Multiple food dislikes and strong food selectivity

 Difficulty in accepting a variety of foods and food textures

 Unable/refuses to eat age appropriate foods

In addition to the above behaviors, the following behaviors are commonly indicative of oral sensori-motor feeding and/or swallowing difficulties and should be formally evaluated:

 Current or history of gagging, choking, vomiting, or congestion associated with eating

 Gagging or vomiting at the sight/smell of any foods

 Unable to advance to age appropriate foods

 Elimination of a class of textures or foods (e.g., only eats smooth purees, white foods, or crunchy foods)

 Aversive feeding behaviors including tantrums, batting arms, turning head away, refusals and locking lips

 No desire to eat. Some children will not eat when they are hungry because they may never be hungry.

What are some complicating issues that may be contributing to my child’s feeding behaviors?

Some of the most common issues related to challenging feeding behaviors we see at Pediatric Feeding & Swallowing Associates include hypersensitivities to certain tastes/textures/smells, decreased oral motor coordination for age-appropriate feeding, delayed or dysfunctional feeding skills, refusals, and swallowing dysfunction. Often interfering factors such as digestive difficulties, constipation, reflux and food allergies/intolerances are present. Such issues may cause discomfort with eating and over time can become the cause of food refusal, texture selectivity, and challenging mealtime behaviors. If left untreated, behavioral problems will most likely develop.

My toddler has to have control of his or her intake at mealtimes or will refuse to eat. What should I do?

Why is your child “demanding control”? This question needs to be thoroughly addressed from a medical and clinical perspective. Children demand control when they feel out of control or things don’t feel right. They may want to eat but eating for them is a negative experience. It is important to develop healthy feeding experiences for your child so that he or she does not feel the need to take control. It is very appropriate for toddlers to show their “independence” in feeding as well as other areas of their development. Research and clinical practice have proven that children learn to eat a variety of foods and take responsibility for their own eating when they are regularly offered a variety of nutritious foods in a no-pressure environment and allowed to make healthy choices. Children have shown us that when healthy, if we follow their lead, they will maintain a healthy growth curve and develop into the adult shape that was meant for them. Children who are demanding mealtime control or have mealtime stress need a complete evaluation in order to identify and resolve these issues.

What if my child has reflux and feeding difficulty? Children with reflux are often overly sensitive to tastes, texture, and smells. Under the supervision of your feeding therapist, select foods that are safe and appropriate for his or her feeding skills and that he or she feels comfortable with. Your child needs a lot of good feeding experiences. At Pediatric Feeding & Swallowing Associates we help you work towards gradually introducing “new” and more advanced foods in the least stressful and safest ways. Children with oral sensori-motor feeding difficulties need consistency, predictability, and support to make their meal times positive and nurturing. They also need to have the same feeling of independence and control over whether or not and how much to eat that all children need.

Should I bribe or force my child to eat the things he or she doesn’t like? No. Bribing or rewarding a child for eating is never a long-term solution. If you bribe or reward your child to eat, he or she will always expect that reward. Soon you will need to up the ante. In order for a child to be successful with eating, he or she needs to tune in and listen to his or her own feelings of hunger and satiety. Even tiny infants recognize and communicate their feelings of hunger and fullness. It is the caregiver’s job to read the cues, respect them, and respond to them. When a caregiver imposes a different cycle of hunger/satiety, infants and children do not learn to follow their own internal cues. If they don’t feel safe communicating their feelings of hunger and fullness to their caregiver, they will be unable to regulate their own eating, always relying on an external cue. If children do not learn to regulate their own eating, they will miss out on enjoying one of life’s greatest pleasures: eating. Depending on external cues to self-regulate the intake of food also delays a child’s emotional development. Furthermore, research indicates that bribing smaller children to eat is not an effective means for helping children to grow better.

What can I do to ensure a successful feeding experience for my child?

 Provide regular, consistent meal and snack times. No grazing between meals or snacks.

 Provide variety of healthy and nutritious foods that look and taste good.

 Have family meals. Meals should be laid back and relaxed. Remember you are a model for eating behaviors.

 Provide foods that your child is able to manipulate safely and without sensory aversion.

 Do not force, bribe, trick, or entice your child to eat any food.

 If he or she chooses not to eat, then do not allow snacks or high-calorie drinks before the next meal or snack time. Make sure that your child understands what to expect if he or she chooses not to eat.

 Do not become a short order cook. Offer the refused food during several other mealtimes. If placed on the plate and not forced to eat, he or she will most likely become curious and try the food. Your therapist will design a home program to ensure increased success with new foods.

 Pair new or strange foods with a liked “comfortable,” food.

 Offer favorite foods sometimes, but not all the time.

 Do not make your child clean his or her plate.

 Turn off the TV or other distractions.

 Require that your child sit in his or her own chair during feeding. Do not allow eating travelers.

 And most importantly, support your child’s feeding experience; do not try to control it.

If mealtime is stressful or you feel that your child’s eating skills are challenging, please ask your pediatrician for a referral to evaluate your child’s feeding skills and behaviors.

Please refer to our other FAQ’s related to Challenging Feeding Behaviors including: Extreme Picky Eaters, The Effects of Forcing, Bribing and Sneaking Food, Feeding Complications of Reflux, Establishing Healthy Eating Habits, Swallowing Food Whole, Is My Child Chewing?, Exploring Food, Meal Time Fun Ideas, Nutritional Issues and more.