Today, I’d like to shed some light on kids who, while they may not fit the stereotypical image of a picky eater, can often still benefit from some attention to feeding. Most of my feeding therapy clients fall into the range of toddler to young elementary school age. This tends to be the time that feeding issues often become more challenging or apparent.
A couple examples of this include:
When a child ages out of the picky toddler phase, but their food variety does not improve.
2.) When a child enters school and the parent has less opportunities to provide the child with their necessary intake throughout the day.
However, as knowledge about feeding therapy becomes more common, I have begun hearing from more and more parents of preteens who are concerned about their child’s rigidity with food or refusal to expand their diets. As a result, I am now seeing more older children who have maintained limited diets for many years. While the feeding issues may present themselves similarly to those of younger children, there are a couple of significant differences that often make the course of treatment different than the approach for younger kids.
One difference that I see appears to be related to the child’s background. With younger children, the goal is often to help them to catch up to the feeding milestones of an average peer. The food refusal is often related to texture sensitivity, the appearance of the food, or possibly a previous medical issue which has been resolved. Therapy with a younger child can focus on exposure in small doses, paired with a lot of positive feedback and fun extras (like games or videos) to help keep things positive.
For older kids, there is often a great deal of anxiety present when new foods are offered, or even discussed. These kids have a long history of food refusal that has often become something much greater than the food itself. It’s not just about what the food looks like anymore, it’s the idea of what the food *might* be like. The last time that the child successfully tried a new food may be so far in the past (years, sometimes!), that they have no frame of reference for what will result from trying a new food. Plus, sometimes picky eating seems to have become part of the child’s identity, in a way. They feel comfortable with having separate food from the rest of their family, and they are used to immediately rejecting offers to try something different.
While a younger child may be open to tasting new foods if they are able to relax with a favorite show or earn a special treat or activity afterward, older kids are not as impressed by these offerings. For all children, the end goal is always that the food variety will end up being rewarding in and of itself, but in the meantime, we sweeten the deal as much as possible. A preteen is going to be more difficult to motivate, as they often have greater access to their most preferred activities, and are often less interested in pleasing their caregivers: An, “Awesome job!” and a high five just don’t cut it the way they used to!
With this in mind, there are some great ways to determine whether your preteen or teenager may be ready to make some progress with food.
They ask you about it. Ok, clearly this is a great sign. Even if your child may not currently be ready to start trying new foods, they may start expressing frustration or discontent related to their limited diet. They may ask questions about particular foods, say “I think I might like that,” etc.
2. They have health concerns or unmet dietary needs. Unlike the little ones, older kids are much more able to understand the more abstract concerns related to a limited diet. If they are experiencing tangible consequences of a limited diet (weight loss or gain, constipation, nutrient deficiencies, etc), this can be a good starting point for discussing changes to their diet.
3. They have feeding related goals. The social element of eating becomes much more important as children become older. Not only do their peers often begin to notice and comment on their limited diet, children often become self-conscious about not being able to partake in mealtime-centered events (pizza parties, post-game socials, holidays, etc.). I often hear preteens talk about feeling nervous about ending up in a mealtime situation where they are not prepared or able to take part. When you have been with your friends for hours, using the explanation, “I already ate,” doesn’t
work very well.
In a nutshell, in order to have positive outcomes for an older child with feeding issues, there has to be some degree of “buy-in” from the child. As with any aspect of raising a child, as they get older, you start to allow them more independence and control over their lives. Mealtimes are no exception. When the parent can take on a supporting role, facilitating their preteen’s course of treatment but not dictating it, that is where the best results are seen.