Picky Eaters: Understanding Why Your Child Refuses Certain Foods
It's a familiar scene for many parents: a plate of lovingly prepared food is pushed away, a tight-lipped "no" is offered, and another mealtime struggle begins. If you've been battling a picky eater, you've likely wondered, "Why does my child refuse certain foods?"
It's easy to assume pickiness is just a behavioral issue—a child being difficult. However, for many children, food refusal is often rooted in underlying physical or sensory challenges. A significant, yet often overlooked, link exists between your child's speech/oral-motor skills and their feeding challenges.
The Hidden Connection: Oral-Motor Skills and Eating
Oral-motor skills refer to the use and coordination of the muscles in the mouth, including the jaw, lips, tongue, and cheeks. These are the same muscles your child uses for talking, and they are absolutely crucial for safe and efficient eating. Think about eating a crunchy carrot versus a spoonful of yogurt. The movements and coordination required are vastly different When a child has underdeveloped or weak oral-motor skills, eating certain foods can be genuinely challenging, stressful, or even feel unsafe. What looks like "pickiness" might actually be a child self-selecting foods that are easier to eat.
How Oral-Motor Difficulties Lead to Food Refusal
Eating is complex. It requires the precise coordination of many muscles to successfully move food, chew it, and safely swallow it. Challenges in this area can manifest in several ways:
Difficulty Chewing: Chewy or hard-to-break-down foods—like meat, raw vegetables, or certain fruits—require strong jaw and tongue movements. A child with weak oral-motor skills may struggle with the endurance needed to chew these foods. They might avoid them and prefer soft, meltable, or processed foods that require minimal effort (like crackers, pasta, or chicken nuggets).
Poor Tongue Coordination: A key skill is tongue lateralization—moving food from side to side onto the molars for grinding. Without this skill, food isn't properly chewed. The child may swallow food whole, gag, or pocket food in their cheeks, which can be scary and lead to avoidance.
Sensory and Motor Overlap: Sometimes, a lack of oral-motor skill can be tied to a sensory issue, such as being hypersensitive (over-aware) to textures in the mouth. When a child can't feel or control the food very well, the intense and changing textures feel overwhelming or unpleasant, leading to outright refusal.
Red Flags: When to Look Beyond Just Pickiness
If your child's selective eating is extreme or impacts their growth and family stress, look for these signs that suggest an underlying oral-motor or sensory challenge:
Signs of Weak Jaw or Cheek Muscles
Prefers soft, easy-to-chew foods only.
Takes an unusually long time to finish meals.
Exhibits open-mouth posture or frequent drooling.
Signs of Poor Tongue Coordination
Food pocketing (storing food in the cheeks) instead of chewing.
Stuffing the mouth with excessive amounts of food.
Swallowing food whole, often leading to limited chewing.
Difficulty cleaning food off their lips or face.
Signs of Chewing and Swallowing Issues
Frequent gagging, coughing, or choking during meals.
Refusal of mixed-texture foods (e.g., soup with chunks, pasta with sauce).
Avoidance of chewy or tough textures like meat, raw vegetables, or certain bread crusts.
Signs Related to Speech and Motor Skills
Unclear or mumbled speech that may be linked to poor oral muscle control.
Difficulty coordinating air for motor tasks like blowing out candles or whistling.
The Role of the Specialist and Key Resources
You might be surprised to learn that Speech-Language Pathologists (SLPs) are often the specialists who assess and treat feeding difficulties. This is because the mouth is their area of expertise! They, along with Occupational Therapists, are vital in differentiating a "picky eater" (a typically developing child with a limited diet) from a "problem feeder" (a child who refuses entire food groups and has underlying skill deficits).
Key Feeding Therapy Approaches and Resources
The Sequential Oral Sensory (SOS) Approach to Feeding is a highly recognized, evidence-based, and comprehensive program that addresses the whole child, integrating sensory, oral-motor, learning, medical, and nutritional factors.
Sequential Oral Sensory (SOS) Approach to Feeding
The SOS approach is non-coercive and uses play to help children move up the "Steps to Eating" at their own pace:
Tolerate: Being comfortable with the food nearby.
Interact with: Using utensils to prepare or serve food.
Smell: Progressing from the food odor in the room to smelling the food directly.
Touch: Touching the food with hands, then to the lips and tongue.
Taste: Starting with a lick, then small bites, chewing, and finally swallowing.
Website and Parent Resources: The main SOS website offers a wealth of free resources, including the Picky Eaters vs. Problem Feeders Questionnaire and tips for mealtime myths.
Professional Support and Therapy
Speech-Language Pathologists (SLPs): Specialists in oral-motor development who provide targeted therapy to improve chewing, swallowing, and tongue movement.
Occupational Therapists (OTs): Address the sensory component of feeding (e.g., sensitivity to textures, smells) and motor skills for self-feeding.
Pediatric Dietitians/Nutritionists: Ensure the child is meeting their nutritional needs and address any deficiencies related to limited diets.
Feeding Matters: A key organization dedicated to children with Pediatric Feeding Disorder (PFD), offering parent support and advocacy.
Recommended Readings
Helping Your Child With Extreme Picky Eating by Katja Rowell and Jenny McGlothlin.
Just Take a Bite by Lori Ernsperger and Tania Stegen-Hanson (Great for sensory-based aversions).
Simple Oral-Motor Activities for Home
Consulting with a professional is essential for a tailored plan, but some home activities can support oral-motor skill development:
Straw Activities: Drinking from various straws (thin, thick, flexible) and using straws to blow bubbles in water (safely, with supervision) helps strengthen cheek and lip muscles.
Making Silly Faces: Practicing different facial expressions in a mirror helps with muscle awareness and coordination.
Playful Exploration: Engaging in food play (outside of mealtime) encourages a child to interact with food's textures, colors, and smells without the pressure to eat.
The takeaway for parents: If mealtimes are a constant battle, try to shift your perspective from "my child is being difficult" to "my child is having difficulty." Getting a professional assessment can be the first step toward a less stressful, more nourishing mealtime experience for your whole family.
Are you ready to seek an evaluation, or do you have more questions about in-home strategies?
