Our friend and colleague, Lisa Aquilino Haley, Occupational Therapist, is at it again. Giving you the inside knowledge to help those trickiest of eaters.
Lisa Aquilino Haley has 15 years of pediatric occupational therapy experience. Her expertise shines through in feeding issues. She conducts videofluoroscopic swallowing studies and is a facilitator of an out-patient feeding program, supporting picky eaters and challenging feeders in an interdisciplinary setting. She has a special interest in transitioning children from tube feeds to oral feeds. You can access more great content on her website: https://www.lisamarietheot.com/
She is also one of our guest speakers in our flagship course Infant Nutrition Essentials and because we love her so much, she is a guest speaker in our 2022 spring Picky Eating Series: Looking for New Techniques? Experts Share Their Approach.
You’ve heard the recommendation before: “Continue to expose your picky eater to new foods”.
But how do you do that, when each time broccoli is on their plate, they have a full-on meltdown about the sight/smell/feel of it? It’s completely understandable why parents just don’t have the energy to implement this strategy of “repeated exposures” when mealtime just leads to more and more battles.
Unfortunately, no kid in the history of kids has ever opened up the fridge and said “I think I’ll try broccoli today”. So we KNOW, intuitively, that broccoli needs to somehow materialize occasionally in front of them so that they get used to it.
What does the research say about food exposure?
Research shows that generally, parents offer a new food 3-5 times before they assume it is not something their child will take. In fact, when food exposures increase (8-15 exposures), acceptance of new foods increases. For extreme picky eaters, or kids with sensory sensitivities, I generally advise parents even to go up as much as 20-30 exposures.
What does that exposure look like for these sensory sensitive kids?
We need to respect and consider their sensitivities to ALL the senses; sight, smell, sound, touch and taste. In general, I advise people to “start with LOOKING at the new food”. Can they tolerate SEEING broccoli? (And I’m sorry if you like broccoli, but clearly I am using it in this example because I really don’t!) Have that food on the table, on a side plate, next to their plate, in the grocery cart, or on the counter. Basically, start incorporating visual encounters with the new foods. For really young kiddos, it can even be picture books about food.
For some kids the smell is extremely offensive. Problem-solve tolerance building activities. Can they sit “this far” from the food? Can they sit for 30 seconds in front of it, or can they sit with essential oils by their side? Heck, I’ve even heard of a kid who came to the table with swim nose plugs. Kids come up with great ideas, if you problem solve together. And with that as a start, you can slowly fade these crutches over time.
Mesophonia is a legitimate issue for some. This is being triggered by the sounds someone makes when eating, chewing, or breathing. I’ve had kids suggest listening to music to drown out the sound. Consider earbuds or even noise-cancelling headphones during mealtimes.
Once they can be AROUND the food, it’s time to build tolerance to the tactile input the food provides. One of my hallmark mantras is “kids will not put in their mouth what they don’t understand with their hands”. So, be cool with your picky eater requesting that their less preferred food be banished from their sight, but have THEM touch and remove it and calmly put it in a tupperware. Have them clear the plates and put things in the food waste bin. There are also lots of opportunities to touch/tolerate new foods as part of meal prep, grocery shopping or baking. Consider those opportunities as part of your 30+ exposures! There are some fun studies out there that looked at when kids picked up food items to use as tokens when playing bingo, their acceptance to new foods increased.
Finally, the big one is having kids actually taste the foods. Help them to be curious about the food “is it cold? Is it slimy? I wonder if it will stick to our lips? I wonder what happens if we put it on like lipstick? How long do you think you can hold it between your teeth?”
Most importantly, understand that building tolerance to the sensory components of food takes time. Be gentle with yourself as clinicians or parents, without putting pressure to make a child a “good eater” overnight. Respect that just as a child might be the kind that takes more time to warm up to new people or environments, they may also be the kind of kid that takes more time to get used to a new smell or taste. Continued exposures, in a stress-free and calm environment will get them closer to that love of eating.
References to check out:
Carruth, B. et al. (2004) Prevalence of Picky Eaters Among Infants and Toddlers and Their Caregivers’ Decisions About Offering New Foods. Journal of the Academy of Nutrition and Dietetics. Vol (104): p 57-64.
Thank you once again Lisa for taking the time to write these wonderful tidbits for us.
We hope you enjoyed them.
Charlene and Julie
P.S. Love what Lisa has to say?! Join our wait list for our next round of our flagship course Infant Nutrition Essentials where she delivers a full module on Feeding Readiness, Safety and Function – An Occupational Therapist’s Perspective.
P.P.S. Make sure you check out the details on our new Picky Eating Series: Looking for New Techniques? Experts Share Their Approach.