Management of Problem Eater, Picky Eater and Swallowing Disorders

Feeding disorders  include problems gathering food and getting ready to suck, chew,  or swallow it. For example, a child who cannot pick up food and  get it to her mouth or cannot completely close her lips to keep  food from falling out of her mouth may have a feeding  disorder.

Problem eater: less than 20 foods eaten, foods not regained once burned out, falls apart when presented with new foods, refuses entire category of textures, adds new foods in more than 25 tries.

Picky eater: decreased variety of foods less than 30 foods. Foods lost due to burn out regained after 2 weeks, able to tolerate new foods on plate, touch, and taste. Eats at least 1 food of each texture, adds new foods after 15-25 tries or seeing the food.

Swallowing disorders, also called   dysphagia  (dis-FAY-juh), can occur at different stages in the swallowing  process:

  • Oral phase-sucking, chewing, and moving food or liquid into the    throat
  • Pharyngeal phase-starting the swallow, squeezing food down the throat, and    closing off the airway to prevent food or liquid from entering    the airway (    aspiration) or to prevent choking
  • Esophageal phase-    relaxing and tightening the openings at the top and bottom of    the feeding tube in the throat (esophagus) and squeezing food through the esophagus into the    stomach


  • Physical: pain, discomfort, nausea, stool issues, allergies, sensitivities, intolerance
  • Motor: delayed self feeding, over stuffing, choking, delayed chew, tongue, swallow coordination
  • Sensory: texture hypersensitivity, oral hypersensitivity, oral aversion, sensory processing problems, auditory (hurts to hear the crunching sounds, or the sounds in the meal room), too stimulating
  • Behavioral: hyperactive, low frustration tolerance, highly distractable, need for routine, impaired social interactions. If they can’t sit in a chair any other time, why would they sit there to eat for 15 minutes or longer?
  • Impaired social skills: eating meals is very social, they have to answer questions,

Signs and symptoms

  • arching or stiffening of the body during feeding
  • irritability or lack of alertness during feeding
  • refusing food or liquid
  • failure to accept different textures of food (e.g., only    pureed foods or crunchy cereals)
  • long feeding times (e.g., more than 30 minutes)
  • difficulty chewing
  • difficulty breast feeding
  • coughing or gagging during meals
  • excessive drooling or food/liquid coming out of the mouth    or nose
  • difficulty coordinating breathing with eating and    drinking
  • increased stuffiness during meals
  • gurgly, hoarse, or breathy voice quality
  • frequent spitting up or vomiting
  • recurring pneumonia or respiratory infections
  • less than normal weight gain or growth


  • dehydration or poor nutrition
  • aspiration    (food or liquid entering the airway) or     penetration
  • pneumonia or repeated upper respiratory infections that can    lead to chronic lung disease
  • embarrassment or isolation in social situations involving    eating


  • ask questions about your child’s medical history,    development, and symptoms
  • look at the strength and movement of the muscles involved    in swallowing
  • observe feeding to see your child’ s posture, behavior,    and oral movements during eating and drinking
  • perform special tests, if necessary, to evaluate    swallowing, such as:
    • modified barium swallow      -child eats or drinks food or liquid with barium in it, and      then the swallowing process is viewed on an X-ray.
    • endoscopic assessment      -a lighted scope is inserted through the nose, and the      child’s swallow can be observed on a occupational therapis
    • The child’s posture, self-feeding abilities, medical  status, and nutritional intake will be examined by the team. The  team will then make recommendations on how to improve your  child’s feeding and swallowing.



  • medical intervention (e.g., medicine for reflux)
  • direct feeding therapy designed to meet individual    needs
  • nutritional changes (e.g., different foods, adding calories    to food)
  • increasing acceptance of new foods or textures
  • food temperature and texture changes
  • postural or positioning changes (e.g., different    seating)
  • behavior management techniques
  • referral to other professionals, such as a psychologist or    dentist


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