Supporting a Child with Picky Eating

Noah is a 5-year-old child who was referred to occupational therapy due to concerns regarding picky eating and a highly restricted diet. His parents reported that he ate fewer than 15 foods consistently and became distressed when presented with unfamiliar foods. Mealtimes were often stressful, with frequent refusals, anxiety around new foods, and family concerns about nutrition.

Service

Occupational Therapy

Setting

Clinic

Approach

Sensory-based Feeding

Background

Noah is a 5-year-old child who was referred to occupational therapy due to concerns regarding picky eating and a highly restricted diet. His parents reported that he ate fewer than 15 foods consistently and became distressed when presented with unfamiliar foods. Mealtimes were often stressful, with frequent refusals, anxiety around new foods, and family concerns about nutrition.

Noah preferred foods with specific textures, colours, and brands, and would often gag or refuse foods that looked, smelled, or felt different from what he was accustomed to eating. His parents wanted support to expand his food repertoire and make mealtimes more positive for the whole family.

Assessment

An occupational therapist completed a comprehensive feeding assessment to better understand the factors contributing to Noah’s picky eating. This included:

What the assessment included

Parent interviews regarding feeding history, mealtime routines, and food preferences
Assessment of sensory processing and responses to food textures, smells, temperatures, and appearances
Observation of eating behaviours and interactions with food
Identification of strengths, challenges, and family goals

What We learned

The assessment identified sensory sensitivities related to food textures and smells, anxiety around unfamiliar foods, and limited confidence when trying new foods. Mealtime stress and pressure to eat were also contributing to food refusals.

Intervention Plan

A personalized occupational therapy plan was developed to support Noah in building positive experiences with food and increasing flexibility around eating.
Sensory-Based Feeding Support
  • Exploring foods through play and sensory activities without pressure to eat
  • Gradually increasing tolerance to different textures, smells, and appearances
  • Supporting comfort and confidence during food exploration
Food Chaining Strategies
  • Introducing new foods that were similar to accepted foods in taste, texture, or appearance
  • Building on existing preferences to expand food variety gradually
  • Encouraging small, achievable steps toward trying new foods
Mealtime Routine Development
  • Establishing predictable and positive mealtime routines
  • Reducing pressure and power struggles around eating
  • Supporting family strategies that encouraged exploration rather than forcing consumption
Oral Motor and Feeding Skill Development
  • Assessing and supporting chewing, biting, and oral motor skills where appropriate
  • Introducing activities to improve comfort with a wider range of food textures
Parent Education and Coaching
  • Providing strategies to support progress at home
  • Teaching responsive feeding approaches
  • Helping caregivers understand the relationship between sensory processing and eating behaviours

We offer flexible support options to meet you and your family's individual needs

Results

Following occupational therapy intervention:
Noah became more comfortable interacting with and exploring unfamiliar foods. Helped his mother prepare foods for dinner, touching and smelling the different ingredients
The number of accepted foods increased significantly. Tried pepperoni pizza for the first time as well as sweet potato fries
Regulation tools and strategies were trialed and anxiety and distress during mealtimes decreased
Family meals became more positive and less stressful
Noah demonstrated increased willingness to taste and try new foods
Parents reported greater confidence in supporting feeding at home and exploration of new foods.
While Noah continued to have food preferences, he developed greater flexibility and was able to participate more successfully in family meals and social situations involving food.

Conclusion

Picky eating can be influenced by a variety of factors, including sensory processing differences, oral motor skills, anxiety, and past feeding experiences. Occupational therapy can help children develop a positive relationship with food while supporting the skills needed to expand food variety and participate more comfortably in mealtimes.

 

Through individualized intervention and family collaboration, children can build confidence around eating and develop healthier, more enjoyable mealtime experiences.

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