Strategies to Improve Feeding

Perspectives on sensory, texture, and environmental control factors: tips for picky eaters, feeding problems, and expanding your child’s diet.

Most children learn that we have five senses:

  • sight
  • sound
  • taste
  • touch
  • smell

However, there are other very important senses not included on this list.

Awareness of our body position or “proprioception” is one of these. Because we do not usually teach children about this sense or think about how much we all use it, most people are not aware of it. This creates an additional challenge when the sense is not working well. If we’re not even aware of it, it’s hard to understand problems related to it. Just as our eyes and ears send information about what we see and hear to the brain, parts of our muscles and joints sense the position of our body and send these messages to the brain as well. We depend on this information to know exactly where our body parts are and to plan our movements. When our proprioceptive sense works well, we make continual, automatic adjustments in our positions. This sense helps us to stay and to move into optimal positions for everyday activities such as sitting in a chair to do paperwork; holding utensils such as a pen or a fork in the right way; judging how to maneuver through an aisle so that we don’t run into or knock down things; knowing how far to stand away from people so we’re not too close or too far; planning how much pressure to exert so we don’t break a pencil lead or a toy; and changing actions that were not successful, such as the throw of a ball that was off target or a dive that turned into a belly flop.

Since proprioception helps us with such basic functions, a problem in this system can cause a great deal of trouble. Often, an individual has to pay attention to things that should happen automatically. He may also have to use vision to compensate and “figure out” how to make adjustments. This can take a lot of energy. A child with these difficulties may feel clumsy, frustrated and even fearful in some situations.

For example, it may be very scary to walk downstairs if you’re not sure where your feet are. The proprioceptive system is activated through push/pull type activities, jumping, and activities that involve weight and deep pressure. This kind of sensation is often calming and may be helpful to a child who becomes easily disorganized.

Help Your Child Be More Aware Of Body Position

The following are some examples of proprioceptive-type activities. They may be useful in helping children be more aware of body position and become more calm and organized:

  • Have children help with “heavy work” activities like carrying in the groceries, carrying the laundry basket, pulling bags of leaves, taking out garbage cans and pulling weeds.
  • Play “backpacking” by placing bags of beans or rice in a child-size backpack. Pretend to be climbing mountains and jumping off rocks at the park or in the backyard.
  • Make a “sandwich” out of your child between the couch cushions. Gently add pressure as you pretend to put on “pickles”, “cheese”, ”lettuce”, etc.
  • Have the child close his eyes and “feel” where his legs, hands, arms, etc. are. Ask if they are up or down. See if the child can get into different positions without looking, such as rolling into a ball, touching his nose, making a circle with his arms, making an “X” with arms and legs, etc.
  • Some children will especially enjoy the sensation of holding onto a bar and feeling the stretch of hanging and swinging their body from it. A pull-up bar installed in a doorway can be a simple way to offer this activity to a child at home.
  • Give the child extra proprioceptive input when he is learning a new skill. For example, wearing a light-weight cuff when a child is trying to throw a ball may give a little extra feedback about the position of his arm. Other examples include practicing letters, shapes or numbers by making them in clay or another firm mixture; placing your hands on his hips or shoulders and providing gentle pressure when the child is learning a new motor skill such as climbing upstairs or skating; and moving the child through an action and providing gentle resistance to his movements so he can “feel” it more easily.
  • Provide gentle but firm massage if your child enjoys this. Try rubbing arms and legs to help wake him up, applying gentle pressure to his shoulders and head to calm him down, or massage his hands before he tries a difficult fine motor task

These are just a few ideas. Use common sense and don’t apply too much pressure or ask a child to push, carry or pull something that’s too heavy. Experiment and find out what seems to help your child the most.

Eating is a developmental process which changes over time as the child becomes more confident with his/her eating skills. Many children between the ages of two and three years old are picky eaters because they are going through a stage of development where they fear new foods. This state may occur at a later stage in children with developmental delays. The fear of new foods generally improves during childhood. These changes in childhood are normal and most children balance their food selections and eat a nutritional diet over a period of time. Children with special needs sometimes are described as “picky eaters”, meaning they may have limited food selection, show anxiety or tantrums when presented with new foods, and/or require one or more foods be prepared in the same manner. Solving the feeding dilemma is not a quick fix.

Feeding Development: Texture Perspective

“Texture” refers to how smooth, lumpy, thick or thin the food is. The following chart describes textures, examples of food, and the age the child generally is expected to handle a given texture:

0 – 13 monthsbreast/bottle 
6 monthsthin pureesstage 1 Baby Food
7 monthsthick pureesstage 2 Baby Food
9 monthsmeltable hard solidsGraham crackers, Fruit Loops (foods which dissolve with spit only)
10 monthssoft cubesGerber Graduates fruits, boiled potatoes, bananas
11 monthssingle textured soft mechanicalmuffins, soft pasta, thin meats in small rectangles
12 monthsmixed texture soft mechanicalmacaroni and cheese, fries, spaghetti
16 monthshard mechanicalpretzel sticks, ritz crackers, chips

When working with your child with chewing and/or swallowing difficulties, there are a few general principles to keep in mind:

  • Often times, a child with swallowing problems is able to handle thicker foods and liquids best (e.g. applesauce in apple juice, yogurt,  etc).
  • Chewable foods that maintain a solid mass are often easier to handle (e.g. banana, pancakes,  etc).
  • Food with more than one consistency is more difficult to handle (e.g. soup with veggies/meat).

Feeding Development: Sensory Perspective

Children developmentally learn to accept new foods through their senses such as smell, touch, and taste. Providing children with experiences to learn each new food from its’ sight, smell, and texture often increases their tolerance and acceptance. Here are some guidelines and ideas to promote your child’s sensory development in feeding:

    • Activities for learning about new foods can be implemented either at the end of the meal or a separate scheduled time dedicated to “learning about new foods”
    • Graded sensory input (such as background visual and auditory stimuli) to fit the child’s level of sensitivity
    • Keep it fun without any coercion to explore new food and maintain a positive and supportive attitude
    • Activities to “touch” new foods
    • Painting with food
    • Stamping with food
    • Stringing the food items onto yarn to make food jewelry
    • Activities to “smell” new foods

Placing a food item in the container and have your child smell it through the hole on the top then guess the item

  • Activities to “taste” new foods
  • Tasting a new food item begins with licking the item, then holding a small bite on the tongue, and finally chewing a small portion
  • Allow your child to spit out a new food item during the beginning of the exploration or have ice or water on hand for your child to use
  • Have your child to make a “teeth mark” on a food item
  • Invite your child to join the cooking process

Environmental Control Perspective for Picky Eaters

Environmental factors play a key role in developing and maintaining food aversions and problem eating. Environmental controls include scheduling meals, selecting an appropriate setting, creating a supportive climate, designing meals and portion-sized, and addressing food jags.

Guidelines for creating the meal/snack schedule to help with consistency and predictable routines:

  • Write a schedule that is understandable and clear to the child
  • Use a timer to indicate when the next meal/snack will begin
  • Use a kitchen timer during the meal to set the pace and length of the meal
  • Make sure the mealtime schedule includes snacks
  • Offer the child at least one preferred food item at every meal and/or snack
  • Provide only water to the child between the scheduled meal/snack time to limit grazing

Mealtime setting should be a comfortable and supportive setting to help your child relax and focus on learning new skills to eat:

  • Eating and drinking should be done at the table for proper stability and posture
  • The child should sit in a chair with feet resting on the floor
  • The number of distractions at mealtimes should be kept to a minimum
  • Parents, siblings, and peers play an important role during the meal for socialization

Guidelines for creating a supportive mealtime environment for a child to feel supported, safe, nurtured, and trusted to explore new foods/skills:

  • Respect the child and do not invade his/her mouth without permission
  • Roleplay and demonstrate eating techniques
  • Never discuss the child’s eating habits or how much he/she eats during the meal
  • Discuss the taste, texture, and smell of new foods

Portion size and food selection should be presented in a manner that allows a child to be successful.

  • Provide your child with an age-appropriate sized plate and utensils
  • It is better to start the meal with smaller portion sizes as it allows the child to see the results when taking a few small bites
  • A good rule of thumb for controlling portion size is to consider one tablespoon of each type of food for each year of the child’s age

Food selection should take into consideration the child’s age and eating habits. Keep in mind that new and exotic foods can be scary for your child.

  • Select only one menu for the entire family and include a variety of foods familiar to the picky eater as well as some new foods
  • Select foods that are child-friendly
  • Consider texture, color, and smell when introducing a new food
  • Include a piece of bread or roll with meals since the child is often successful with this
  • Be flexible since the goal is for long-term changes it is ok to miss one balanced meal or not to always have the family eat the exact same meal

Food Jags refers to the insistence on the same food, serving utensils, or even the same setting over long periods of time. Guidelines for addressing food jags:

  • Create opportunities for structured flexibility and choice-making allowing the child to have some choices (foods, dining ware, etc) while maintaining the structure of the schedule and healthy choices
  • Do not cater to the child’s rigidity in wanting only the same foods. Make slight changes in the presentation such as changing the noodle shape for insistent mac-n-cheese eaters
  • Include the child in food preparation and presentation

Guidelines for implementing appropriate mealtime behaviors:

  • Resistant eaters often exhibit challenging behaviors during mealtimes due to their persistent food aversions. Be patient and take the time to extinguish challenging behaviors and replace with appropriate behaviors
  • Set up a routine for transitioning to the table
  • If the child exhibits noncompliance or tantrums during the meal, calmly remove them to a safe area away from the group
  • If the child throws food or destroys food, he must clean it up
  • Analyze your judgment about the child’s behavior in terms of cultural beliefs, messiness, and expectations