Myths and Red Flags of Fussy Eating

“Help! My child does not like to eat his vegetables! I have to hide it or blend it into his food”

“My child only eats white bread, noodles and biscuits. I’m worried that he is NOT getting a balanced diet. What can I do?”

Does any of these sound familiar to you? Do you encounter such difficulties? These are some of the common worries that our parents face at our feeding clinic. But when do you seek professional help? When is it normal?

Eating! It is many people’s favourite past time, though for some of us, we just eat to live. Here are some myths that we would like to debunk, to help us understand eating and the mechanics behind it better.

Myth 1 – Eating is instinctive.
FALSE. From birth to 3 to 4 months, sucking and swallowing are instinctive reflexes for babies. However, after 6 months of age, eating is something we learn over time, through observing the models in our lives.

Myth 2 – Eating is easy.
FALSE. Eating is a very complex task. 26 different muscles and 6 different nerves are required for us to swallow. Eating also requires coordination of 8 sensory systems.

Myth 3 – Eating is a two step process. 1 – sit down, 2 – you eat.
FALSE. There are actually as many as 25 steps to eating for most children, involving all their senses, from their sense of sight, smell, touch, taste and motor skills.

Myth 4 – If a child is hungry enough, he or she will eat and they will not starve themselves.
FALSE. This is true for most children as hunger can be a strong motivating factor. But for children who have underlying feeding problems, they will not eat even if they are hungry because they do not have the skills required to eat that food.

Myth 5 – I can offer the same porridge to my child daily, since he likes it.
FALSE. Eating the same texture and taste of food for every meal may cause food jag. Food jag occurs when the food is no longer accepted by the child, and cannot be reintroduced despite it not offered for an extended period of time.

With some of the myths debunked, hopefully it gives you some basic understanding of eating and feeding so you can help your children eat better.

Some children might have sensory and/or oromotor difficulties impacting on feeding. Some children have more severe levels of fussy eating that would be otherwise known as “problem feeders” or medically “children with feeding difficulties”. As speech therapists who have worked at Feeding clinics in Singapore, here are some RED FLAGS for parents to look out for:

Children who require food to be blended or are unable to take blended food after 12 months of age.
Children who require softly cooked food after 18 months of age and are unable to eat adult textured food.
Children eating less than 20 different types of food.
Children who food jag, meaning they “lose” familiar foods and despite several weeks of break from the food, are unable to re-accept the food
Children who refuse certain textures
Children who are unwilling to try almost any new food despite more than 15 exposures.
Mealtimes are stressful for parents and child
Your child needs to be forced fed.
Mealtimes take longer than 30 min.
Your child requires distractions in order to eat.
Poor weight gain and growth, inappropriate for their age

The table below helps to differentiate a Problem Feeder from a Fussy Eater.

Problem Feeder vs Fussy Eater

Problem Feeder	Fussy Eater
Very limited range and variety of food, usually less than 20 types.	Decreased variety of foods, but usually more than 30 types.
Unable to tolerate new foods.	Able to tolerate new foods on plate, and in most cases are willing to touch or taste the food with some encouragement.
Refuses entire categories of food textures or food groups.	Eats more than one food from all textures or food groups.

Normal developing children may also have feeding difficulties. Feeding difficulties also manifest in children who have medical conditions, for example, children who were born premature, children with cerebral palsy, children on the autism spectrum or children who were previously tube-fed. Children with feeding difficulties may have sensory difficulties making it difficult to process and accept the sensory information from food. For example, they may find it difficulties to tolerate the smell or touch of certain foods. They may also have difficulties moving their jaw, tongue and lips for feeding and hence may only accept softer textured foods. Any negative experiences they have encountered previously including vomiting episodes, gagging or choking during feeding may also contribute to their fussy eating.

Early Intervention is always the key! Seek help early! A speech therapist, occupational therapist, dietitian, gastroenterologist/paediatrican who have experience working with children with feeding difficulties will be able to help. A myriad of approaches may work for your child. This may include oromotor exercises, or systematic desensitization of food in play, depending on your child’s difficulties.

Should you have a problem feeder, you may contact Magic Beans Feeding & Speech Therapy, for assistance.