Feeding therapy for fussy eaters: does your child need help
“Is feeding therapy warranted for my child’s fussy eating?” is a question I’m often asked.
Many parents come to me ‘tearing their hair out’ with frustration about their child’s fussy eating.
They’ve scoured the internet, attended courses and workshops led by nutritionists or dietitians, read books and taken advice from friends… And found that none of the strategies work.
And that’s because fussy eating or picky eating as it’s sometimes called is hugely misunderstood. Even by health professionals.
Yes, all toddlers go through a picky phase, it’s part of their brain development and asserting their independence. But some don’t come out the other side and fussy eating can go on and on.
In this blog you’ll learn exactly what fussy eating is, when to seek professional help and what happens during feeding therapy.
And if you are a health professional you’ll learn about how I can support your skills in helping parents too.
Understanding Fussy or ‘Picky’ Eating
Not all picky eating is simple. Some children just don’t eat and often parents are told ‘it’s just a phase’ or it’s a ‘behavioural problem’.
Well, actually that’s not correct…..
What is fussy eating?
Let’s start by outlining that for the majority of children, fussy eating is a normal developmental phase of early childhood.
Babies often refuse foods that they are unfamiliar with. This is why you often hear it can take 10 times (or more) before a food is accepted. It’s why repeated exposure is important.
In the toddler years, cognitive, emotional and social development mean that at around 18 months they enter a ‘neophobic’ phase. This is where they become suspicious of both new food and some familiar foods.
Neophobia causes a ‘fear’ response. So encouraging a toddler to eat something they are truly afraid of can result in meltdowns at mealtimes.
But it is totally normal and an expected part of early childhood.
When fussy eating becomes a problem
What starts as typical toddler food refusal can sometimes end up requiring professional support. Often it’s when parents (out of sheer desperation) have adopted tricks and tactics to get their children to eat.
Children have learned to eat in a certain way e.g. in front of an iPad, and struggle without it. Other times children have learned that mealtimes are NOT for eating. Totally the opposite of what we as parents intended.
This is all to do with the cues they have been taught that they associate with eating.
Often the cues are set up to NOT eat at mealtimes, rather than eat.
In addition, some children have sensory preferences that make eating certain food thoroughly unpleasant. Sometimes it’s the texture or temperature, other times it’s how the food looks or smells.
This is more common in children with neurodivergence such as autism or ADHD.
And of course some children can’t eat.
Perhaps they have a medical condition or haven’t learned the skills required to move food around their mouths and swallow. Often these children are still on baby foods way beyond the expected age.
If you’re unsure whether your child has typical fussy eating or whether it’s something that needs more help, you can take my free quiz to find out and get some first steps you can take to support them.
Is picky eating behavioural?
No. It’s not children being naughty. It’s often simply a response to what they’ve learned, or what’s going on in their bodies.
Eating isn’t a behaviour after all, it’s a biological need. This is why behavioural strategies like reward charts should never be used to try and get a child to eat. Unfortunately this is still what a lot of professionals advise.
In my experience, no two fussy eaters are the same, which is why many of the generic strategies don’t work.
Children’s eating habits are as individual as they are. Often we need to take a deeper look at what’s happening to be able to unpick it and help them.
The importance of addressing fussy eating early on
It’s true that the earlier you help a child with their eating, the quicker it will resolve.
Essentially there’s less ‘un-learning’ for them to do.
Picky eaters often repeat meals, making social situations challenging and nutrient intake the same every day.
The longer this goes on, the greater the concern for negative health consequences as they get older.
And the earlier you get started in helping them, the more you’re reinforcing the foundations for a lifetime of healthy habits.
Signs that your child may need help from a feeding therapist
We Registered Dietitians look for red flags indicating a likely need for pediatric feeding therapy, these include children who:
- have multiple food allergies or intolerances
- omits an entire food group
- eats less than 20 foods (not during weaning)
- has ongoing weight loss or poor weight gain
- has ongoing choking, coughing, gagging or sputtering during meals
- has ongoing problems with vomiting
- has severe reflux or cries or arches their back during all meals
- has a history of eating and breathing difficulties
- has not been able to transition from baby food purees to solid foods
- avoids certain textures of food
- has a parent with a current or previous eating disorder in addition to the child not gaining weight. (This is because you may need additional support around food parenting rather than being the cause of your child’s issues)
- when their aversion to food affects family life or social interactions like parties or school dinners.
We also work with a lot of families who decide feeding therapy is the right move for them when none of these apply to their child, especially if family mealtimes are very stressful or if you’ve been trying to improve their eating habits for some time without any significant progress.
What is Feeding Therapy?
Feeding therapy uses a specialised approach to address picky eating and feeding challenges in a supportive, personalised way.
Qualified professionals will lead you and your child through a tailored programme, starting with understanding why your child isn’t eating and identifying the steps needed to instil the necessary skills and confidence around food.
This isn’t just about trying new foods; it’s about understanding your child’s unique needs, their cognitive abilities, your family circumstances, your food parenting and their (and your) preferences.
In our fussy eater clinic, we have supported babies as young as 18 months right up to 18 year old teens, making sure that the approach meets the needs of the individual child and family.
We take a unique approach at The Children’s Nutritionist where our feeding therapy starts with a 6 week family focussed programme that lays the foundations, afterwards parents can opt to book 10 weeks of 1:1 feeding therapy where their child works directly with the therapist.
Who can be a feeding therapist?
A feeding therapist is usually a qualified health professional who has undertaken additional training to become a feeding therapist.
Feeding therapists can be dietitians, speech & language therapists, psychologists, doctors or occupational therapists.
Bear in mind that each of these professions will come with their own expertise and may not be able to offer you everything your child needs.
For example we at The Children’s Nutritionist are dietitians and so unfortunately we can’t help children who haven’t learned to chew and swallow, we would need to bring in a speech & language therapist for that.
Likewise the other professionals listed can’t help you with food and nutrition, they would need to bring in a paediatric dietitian.
Is feeding therapy available on the NHS?
Some larger cities do have NHS feeding clinics made up of all of the disciplines listed above, they often have strict access criteria and long waiting lists.
They are more likely to be able to help if your child has other associated medical or mental health conditions that affect their eating and have a complex presentation.
Is feeding therapy available with private medical insurance?
Unfortunately not. In the UK picky eating not recognised as a medical condition.
You can book to see a private paediatric dietitian, speech & language therapist, occupational therapist, paediatrician or psychologist. Check to ensure they also have feeding therapy expertise.
Benefits of seeking professional help
Seeking professional help for your fussy eater can be incredibly beneficial for both the child and the parents. Here are some of the key advantages:
Expert Feeding Assessment:
Qualified feeding therapists, skilled in understanding the complexities of picky eating, will conduct a thorough assessment of your child’s unique challenges and needs. They can help differentiate between typical picky eating and underlying issues that may require intervention.
Personalised Strategies:
Feeding therapists create individualised treatment plans tailored to your child’s preferences, sensory sensitivities, and developmental stage. Feeding therapy techniques are designed to empower your child to explore new foods at a comfortable pace.
Building Positive Mealtime Dynamics:
Feeding therapists focus on creating a positive mealtime environment. They can help reduce stress and anxiety surrounding meals for both the child and the parents, turning mealtimes into enjoyable bonding experiences.
Addressing Nutritional Concerns:
Working with a feeding therapist who is also a qualified Registered Dietitian ensures that your child’s nutritional needs are met. The therapist can suggest creative ways to incorporate essential nutrients into their diet, even when they are selective eaters.
Early Intervention:
Addressing fussy eating early on can prevent potential long-term feeding difficulties. Seeking professional help at an early stage can lead to more successful outcomes and reduce the likelihood of persistent picky eating.
Parent Empowerment:
Feeding therapy provides parents with the knowledge and tools to confidently support their child’s eating journey right throughout their childhood and adolescence. They gain a deeper understanding of their child’s challenges and feel empowered to navigate mealtimes correctly with patience and positivity.
Improving Social Interaction:
Overcoming fussy eating can lead to improved social interactions during mealtime, allowing the child to participate more fully in family meals and social gatherings.
Enhancing Overall Well-Being:
As a child’s eating habits improve, their overall well-being can benefit. Improved nutrition and a healthy relationship with food can positively impact their growth, development, and energy levels.
Seeking professional help for your fussy eater offers a holistic approach to address the challenges of picky eating.
Does feeding therapy for picky eaters work and how long will it take?
I’m very proud that every family who has worked with us has seen improvements in their child’s eating and reported mealtimes to be significantly less stressful for all.
Most families tell us that before therapy they’d tried every trick in the book and it hasn’t worked. Often they have worked with other professionals but are still no further forwards.
What makes us different is our unique approach combining nutrition and dietetics, positive food parenting, the psychology of eating, child cognitive development and SOS feeding therapy.
Of course we can’t guarantee the solution much like everything in the medical and health profession, but we never book a child in for individual feeding therapy without our initial assessment and 6 week foundational programme.
The vast majority (95%) of our families find that their child’s eating has improved so much after this 6 week programme that they don’t go on to have 1:1 weekly sessions.
What Is SOS Feeding Therapy?
SOS stands for Sequential Oral Sensory and is an approach to feeding developed by psychologist Dr Kay Toomey in Colorado USA.
This feeding programme, backed by 30 years of scientific research, is designed for children with sensory and/or oral motor eating problems.
SOS is grounded in the stages and skills of typically developing children and therefore uses imagination, exploration and play to increase your child’s comfort and confidence around foods.
There are 32 steps to eating divided into 7 sensory stages and each food must progress through the steps in sequential order before it’s accepted into a child’s diet.
We use this approach as part of our food therapy at The Children’s Nutritionist.
Laying the foundations before individual therapy
Before a child starts to work one on one with us in therapy, we first make sure the foundations are in place.
Typically we encourage families to implement and practice these foundational strategies over 6 weeks and offer daily troubleshooting and advice if needed. The foundations include:
Creating a positive mealtime environment
The mealtime vibe is key and getting this right also involves the conversation that happens.
It’s important not to use meals as an opportunity to teach children about healthy eating or nutrition. That must happen away from the table in order for the programme to succeed.
We help families turn mealtimes into stress free happy occasions where children are excited to come to the table to see what’s on offer.
Our intention is for children to learn that meals are a special time when the family comes together to enjoy food. And also each other’s company.
Over time your children will learn to enjoy and respect this important family occasion.
Encouraging self-feeding and independence
Developmentally, toddlers and young children thrive on independence (it’s part of their cognitive development). Therefore one of the fundamentals we get families to put in place is allowing independent serving and feeding.
It can be a messy business and frustrating when there’s extra mess to clear up. Thats ok, mess and play is how young children learn and overcome fussiness.
Making mealtime fun and interactive
Again, because of their development children are ‘magical thinkers’ and so food needs to be fun to be interesting.
Children decide whether to accept or refuse food by its appearance. Parents should consider the colours and shapes of different foods and how you might put them together in a meal.
You can make use of kitchen gadgets such as spiralizers, cookie cutters or even skewers to add some visual appeal.
Use your imagination to tell a story about the food and turn the ordinary into the extraordinary. Think cauliflower sheep, birds nest spaghetti and mashed potato volcanoes with gravy lava.
Follow a strict appetite schedule
Eating regularly, but not in-between those times is key for teaching your child to understand feelings of hunger and fullness.
A typical appetite schedule might be breakfast, lunch and dinner with a mid-morning, mid-afternoon and sometimes a bedtime snack.
Depending on the age of the child you’ll want to ensure a gap of 2.5 to 4 hours in between eating occasions.
Sometimes it’s hard to say no when you get requests for snacks in-between times, especially if they’ve eaten hardly anything at the meal before – but there is a reason why you must. This is why we offer parents unlimited daily support throughout.
Adjust their seating
It’s really hard to eat when children don’t have good core stability. And that’s because as humans we have a primitive reflex to protect our heads (and brains) at all costs in order to sustain life!
This means that if they don’t have good postural stability from their chair, children have to divert their concentration from eating towards keeping upright so they don’t topple over, which of course means that they lose focus and don’t eat well.
One of the first assessments we do is a seating assessment and we give families instructions on how to adapt or change their child’s chair so that they have the best possible foundation for eating.
Fill any nutritional gaps
Did you know that nutritional imbalances can make children lose their appetite and feelings of hunger?
One of the first things we do is correct nutrition (with food or supplements) and ensure feelings of appetite and a desire to eat are present.
Change up the pre meal cues
Most parents, out of sheer desperation, who come to work with us have adapted various tricks and tactics to get their children to eat, conditioning their children to learn that they do NOT eat during mealtimes at home.
We change up the cues ahead of a meal to break this cycle.
This ‘cue conditioning’ is the reason why many children won’t eat at home but will eat the exact same food at grannies house or nursery.
Finding a Qualified Feeding Therapist
When you’re trying to find help for your fussy eater here are some key points to consider:
Researching and selecting the right feeding therapist
At the Children’s Nutritionist, we offer a free discovery call so that you can learn more about us, our unique programme and to ensure that we’re a good fit for each other.
It’s also helpful for us to learn of your situation and let you know whether it is something we can support you with or whether you’d be better suited to another professional.
It’s important for you to have confidence in the team and so do ask for positive reviews and testimonials. We are always more than happy to share these with you!
How much does feeding therapy cost?
Feeding therapy isn’t cheap, it’s highly personalised where each child needs to be individually assessed and gets a tailor made programme.
It also requires the skill and expertise of a dual qualified healthcare professional.
Expect prices to start at £1500 and go as high as £3500.
Be sceptical of ‘one size fits all’ approaches as in our experience, this is exactly what does not work.
At The Children’s Nutritionist we offer a DIY approach called The Happy Healthy Eaters Club where many of our strategies are pre-recorded and available on demand. This does remove the personalisation but some parents prefer this more affordable approach and to go at their own speed.
What to Expect in Feeding Therapy Sessions
Before you ever commit, we believe it’s important to have a discovery call. Here you will be able to share your concerns about your child’s eating and hopes for the journey ahead. If we are a good fit for each other you will be invited to work with us.
Initial Assessment and Formulation:
During the first session, you’ll meet your dietitian feeding therapist. You will be matched to the appropriate expert based on information gleaned during the discovery call.
Our initial feeding assessments are where we learn all about your child, your family, your food beliefs and your wishes. We carry out a growth assessment, nutrition assessment, sensory screening, mealtime and feeding assessment and screen for ARFID, sometimes known as the picky eating disorder.
We’ll ask you lots of questions to ensure we have as much information as we need to formulate why your child isn’t eating well and what the plan should be.
Individualised Treatment Plans:
Your feeding therapist will craft a personalised plan tailored to your child’s unique needs and family circumstances.
If you work with us, we will meet for a number of education sessions in order to get the information you need to set up successful mealtimes at home. You’ll also get access to our Happy Healthy Eaters Club for the 6 weeks we are together and your therapist may recommend additional masterclasses to support your learning.
Collaborating Together:
As a parent, your role is to implement the strategies you learn. We know that not everything always goes according to plan therefore your therapist is available on a day to day basis to troubleshoot and adapt so that you have maximum opportunity for success.
Throughout our time together we’ll closely track your child’s progress and should the need arise, we’ll tweak our approach to ensure we maintain momentum.
Gaining Confidence and Reducing Mealtime Stress:
Because of the changes you will notice your child becoming more inquisitive about whats on offer. Their confidence around food begins to grow and mealtime stress will gradually dissolve. Mealtimes will become an enjoyable experience for everyone involved.
Review And Reflect:
At week 6 we’ll reflect back upon your child’s progress and decide upon next steps. Around 5% of our clients go on to book 10 weeks of 1:1 feeding therapy for their child but the other 95% are so happy with the progress made that they are confident to continue without support at home.
If after reading this you’d like to consider feeding therapy for your child, you are welcome to book a free 20 minute discovery call with Sarah to learn more and see if we are the right team to help you.
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