Feeding Issues:

Treating Severe Food Aversion and Extreme Food Selectivity

Approximately 25% of average children will have mild feeding problems. However, between 40% and 70% of infants born prematurely or having chronic medical conditions will have feeding problems.

Signs and symptoms of severe food aversion or extreme food selectivity

The following are signs and symptoms of severe food aversion or extreme food selectivity:

  • Only accepting a narrow range of food choices
  • Extreme preference for certain brands of food
  • Anxiety when faced with a new food item
  • Inability to eat any foods, including foods regularly chosen within the home, when not at home
  • Preference toward avoiding food, often for an entire day, instead of trying something new
  • Failure to thrive
  • Difficulty chewing or swallowing
  • Recurrent pneumonia or chronic lung disease
  • Frequent emesis
  • Frequent gagging when served certain foods
  • Prolonged mealtimes

The following recommendations may help in treating children with severe food aversions or extreme food selectivity.

Family involvement

Treatment should involve the entire family.

Evaluation

Ideally, the child should receive an evaluation from a speech pathologist, an occupational therapist, a psychologist, a dietitian, a gastroenterologist, and an otolaryngologist. A radiologist, social worker, neurologist, and/or a pulmonary therapist also may participate in the evaluation process.

Prechaining and food chaining

Prechaining and food chaining therapies are used to treat children who have either feeding aversion or severe food selectivity.

Prechaining is meant to keep the child on target with feeding developmental skills.For example, you might expose a child to minute amounts of food on a daily basis. You might introduce texture by dipping utensils into flavored purees. The goal during the first year of life is to maintain the tolerance of food taste and aroma until swallowing skills improve enough for the child’s diet to progress. Prechaining should take place during the child’s first year of life, and should begin as soon as the child displays signs of a feeding problem or the potential to develop one becomes clear.

Food chaining begins with a therapist analyzing the child’s current feeding habits to determine which tastes, textures, and temperatures are most acceptable to him or her. Those foods that the child currently tolerates remain the base of the diet, while gradually offering other foods that are identified aspossibly acceptable. Any food that is moderately approved becomes part of the foods that are regularly offered. The child is not overwhelmed with change, as this is a very gradual process, with the introduction of only one or two foods at a time.

Videotaping feedings

Many therapists are asking parents to videotape feedings, so that they can closely analyze familial interaction, the pacing of the meal, the feeding environment, and the level of independence demonstrated by the child.

New foods

Experts recommend combining new foods with preferred foods.

Positive reinforcement

Some studies have shown that positive reinforcement of food progression, including rocking the child or allowing the child to play with a favorite toy, is effective.

Dysphagia

If the problem is related to dysphagia, a change in positioning, textural desensitization, modification of food consistency, and/or use of special feeding devices sometimes is necessary.

Mealtime

Initiation of a regular mealtime schedule and avoidance of force feeding is crucial.It is recommended that the entire family eat a varied and balanced diet, including many different types of food, and that meals are eaten together as a family, within the home as often as possible.

Texture sensitivity

For children with texture sensitivity, “playing with” their food sometimes is helpful.Occupational therapists may recommend other exercises, such as rubbing the child’s gums, providing oral stimulation with a toothbrush or washcloth, etc.

Distractions

Some children eat better when they are distracted, such as when caregivers recite stories or sing familiar songs.

References and suggested readings

CambridgeCenter for Behavioral Studies. Severe food selectivity treated. Available at: Accessed November 6, 2008.

Clawson B, Purcell D, Elliott C. Picky eaters and how to help them. Available at: Accessed November 6, 2008.

Fishbein M, Cox S, Walbert L, Fraker C. Comprehensive treatment of feeding aversion in children. Available at: Accessed November 6, 2008.

Shore BA, Babbitt RL, Williams KE, Coe DA, Snyder A. Use of texture fading in the treatment of food selectivity. J Appl Behav Anal [serial online]. 1998;31:621-633. Available at: Accessed November 6, 2008.

Review Date 12/08

K-0605