Understanding and Addressing Fussy Eating in Children

Picky eating or food selectivity isn't a modern trend. People have always experienced highly selective eating, but what was often missing were the proper assessment protocols to diagnose and treat it.

Today, we have more trained professionals equipped to identify and intervene effectively in cases of feeding difficulties.

When addressing feeding difficulties, there are several key areas we must look at, which we can call the pillars of feeding skills:

• Cognitive Skills

• Motor Skills

• Sensory Skills

The Three Pillars of Feeding Skills

1. Cognitive Skills: The Mind-Food Connection

This pillar refers to a person's prior experiences with food, the feelings and emotions food awakens, and even their fond memories related to specific foods and meals.

It's vital to remember that eating should be a pleasurable experience that releases "feel-good" hormones—not a stressful chore or a moment defined by tension and conflict.

Understanding the emotional and psychological aspects is the first step toward a healthier relationship with food.

2. Motor Skills: Beyond the Mouth

When we assess motor skills, we look at the patient's entire body, not just their mouth. Posture, foot support, and even the pincer grip of the hands are just as important as the muscle tone in the face.

In addition, assessing and stimulating the mobility of the tongue and the strength of oral structures like the lips and cheeks are crucial. These factors actively optimise the core motor functions of eating: chewing and swallowing.

3. Sensory Skills: How We Process Food

The sensory pillar highlights how each person's nervous system perceives, registers, and processes the information we receive through our senses. The sensory "entryways" for food are varied and numerous (up to 12!), including:

• Auditory (Vestibular): The sound food makes (e.g., crunching, squelching).

• Visual: The colour of the food, the plate, and the lighting in the dining environment.

• Olfactory: The smell of the food.

  
  

We must understand each patient’s sensory profile because the same stimulus can generate vastly different responses. What one person finds comforting, another might find completely aversive.

Treating Fussy Eating:

The Four Cs Framework

During the treatment of food selectivity, our focus should always be on establishing and reinforcing four key elements: Comfort, Connection, Competence, and Confidence.

1. Comfort

This includes both physical and emotional comfort.

• Physical: Investigate the digestive system to rule out underlying pathologies that could be causing discomfort, such as Gastroesophageal Reflux Disease (GERD), food allergies, or oesophagitis.

• Emotional: Assess the mealtime environment. Is it tense and full of conflict, or is it a pleasant and harmonious moment? Family coaching and guidance are often essential to ensure emotional comfort.

2. Connection

Connection is built within the therapeutic setting as the patient is introduced to new experiences that slowly and respectfully bring them closer to new foods, all while maintaining their autonomy. It’s important to remember that the use of tablets, phones, or TV during meals hinders the ability to create a meaningful connection with food.

3. Competence

This is where we must assess and intervene in the areas of motor and sensory skills and how any issues in these areas may be disrupting successful eating. Professionals like Speech and Language Therapists (SLTs), Occupational Therapists (OTs), and Physiotherapists are most often involved in addressing these specific needs.

4. Confidence

Confidence relates directly to the child's autonomy during mealtimes. They should eat because they want to and enjoy it. They should know what they are eating and do so pleasurably. A major obstacle to building this confidence is when families habitually hide food or lie about what is being served without the child’s full understanding. This breaks trust and undermines the whole process.

Wrapping Up: The Journey to Happy Eating

This comprehensive approach—addressing the pillars of Cognitive, Motor, and Sensory skills and working within the framework of Comfort, Connection, Competence, and Confidence—is the roadmap to successfully navigating feeding difficulties.

Remember, every child's journey to enjoying food is unique and deserves a supportive, informed, and respectful approach. The goal isn't just to get them to eat, but to help them discover the joy of eating.

Meet the Expert: Beatriz Gomes

Hi! I'm Beatriz Gomes, a Speech and Language Therapist (SLT), and my passion is helping children and families find peace and pleasure at mealtimes.

I graduated from the State University of São Paulo (UNESP) in 2021 and hold a specialisation in SLT intervention for Food Selectivity. I'm also trained in the Padovan Neurofunctional Reorganisation method. To keep my knowledge updated, I recently travelled to Spain for an International Immersion Program focusing on food selectivity.

I work with a range of needs, including neurological challenges, neurodevelopmental variations, and, of course, feeding difficulties—all to make eating a positive experience.

I see clients in person in São Paulo, but I also love guiding and supporting families, patients, and fellow professionals online, all around the world!

You can follow my work and tips on Instagram at www.instagram.com/fonotriz.