Why won’t my child eat? A parents guide to feeding therapy

Feeding is the most complex thing that we as humans do. It involves almost all of the organs in the body, almost all of the muscles and all the sensory systems. If one of those systems is not working 100% properly this can impact on feeding. But Cubs Paediatric Dietetics can provide direction on how to best improve selective eating and better yet, delve deeper into the reasons why.

This page applies to all children. You might be a mother with a fussy eater wanting help with increasing oral intake or figure out why they won't eat. You could be a mother of a child with Autism Spectrum Disorder who thinks their child's feeding issues goes beyond the diagnosis of ASD. You could also be a mother of a tubie who wants to start increasing oral intake. All these rules apply to all these kiddos.

Of course a tailored approach is always needed for each child but these are the beginner steps that everyone can benefit from.

What could be the reason my child won’t eat?

Children won’t eat food for a number of reasons and we support families to figure out why. It is a myth that we simply sit down and eat. Those of us who did learn to eat well learnt well because there was nothing impacting on any of our body systems. Think about eating like a sport. We do not learn without training. If there was an issue when we started on solids as a baby this will have impacted our training.

In addition to this if there is an ongoing underlying medical issue (which I will discuss in depth soon!), then this can also be the root cause of why your child 'still' isn't eating as we might expect. So let's now delve into breaking down how the body works and how it affects feeding.

How breathing affects eating

Eating is not the body’s number 1 priority, it is the third. Breathing is the number 1 priority. If we have any breathing problems throughout our lives this will certainly impact feeding. Because it is very difficult to breathe and eat at the same time when we have an airway issue. Some of the medical issues we might encounter include, asthma, allergic rhinitis, reflux, high arch palate, allergies, swollen tonsils or adenoids or even a cardiac issue. At cubs we support families with figuring out these issues firstly before even working on variety.

I will assess if your child has any red flags for each of these issues and address these in our first consultation. If it is not in my scope I will refer you onwards depending on the issues. Whether this is to an airway focused dentist or ENT, speech pathology or immunology.

If the breathing improves the feeding improves! My assessment will be aimed at figuring out if your child has any of these issues.

How posture affects eating

The body’s second priority is postural stability. If we can’t keep our head balanced we run the risk of injury. If our body has to focus on posture it cannot focus on mealtimes as the body is now working hard on focusing on posture. Children with low tone or developmental delays or disability are at increased risk of selective eating because they do not always have the co ordination to manage sitting, chewing and swallowing required for mealtimes.

So I will review the chair! I will check posture and how your child is sitting to work out what adjustments we can make. Once the postured is better supported in the right chair your child can focus on feeding. The example I like to give parents is this: imagine when you are at a bar but in a high stool. Do you ever notice before you can focus on your friends/ drink or meal you have to find a way to wrap your legs around the chair in order to stabilise yourself before you can focus. This is exactly what your child is doing. Foot rests keep your child supported, high chairs often lead to their butts slipping down and sitting at an awkward angle.

Again Cubs Paediatric Dietetics reviews all of these issues and directs care to address these individual needs in consult or by referring to a feeding team for Speech Pathology and Occupational Therapy input.

A part of my assessment includes reviewing these aspects to feeding to make sure we aren't missing out on the root reason as to why a child is not feeding.

The other medical issues that affect feeding

We have covered now some of the medical issues that affect feeding from a posture standpoint and an airway viewpoint. Now I will highlight some of the other issues that I assess that could affect feeding:

Oral Motor: reviewing your child's texture and history with solids will identify delays in oral motor skills
Allergy: reviewing your child's early feeding history and look for allergy red flags, as if your child's gut is always uncomfortable with an underlying allergy they will not be enjoying their foods which leads to refusal
Bowels: This can relate to diarrhoea or constipation, understanding the reason behind a child's bowel habits can vastly improve their enjoyment with foods. Constipation means a reluctance to want to eat and diarrhoea means discomfort when eating day to day.
Sleep: Assessing sleep is a good way to identify an airway issue, if your child does not sleep well this can add to fatigue and result in poor mood and therefore willingness to try new things
Nutrition: particularly Iron, if a child is deficient in iron this will impact their focus, fatigue, mood and again willingness to try new things

How mealtime routines affect feeding

So now we have tackled a majority of all the things that can affect feeding from a medical perspective. It's complicated isn't it? Just remember feeding is actually one of the most complex things our body does. It is a huge myth that children just sit down and eat. Our bodies need to have almost all of our muscles and organ systems in perfect order in order for us to be successful eaters. If one component is out of balance it disrupts the whole experience.

In a consultation with me I always tackle the medical issues first before delving into mealtimes behaviours in the home. Because as you can now imagine if the underlying issue is unresolved the fussy behaviours will continue. Let's now delve into the factors at home that can have an impact on feeding. What I am about to discuss is called the division of responsibility.

Ultimately what this means is that when we are talking about feeding we like to divide the roles that parents and children have during mealtimes and feeding. If parents stick to their roles and children stick to their roles we will eventually create a peaceful mealtime. What I do in consult is work out your family dynamic, what is said, what is implied, how we look at each other, how the food is offered and so forth. Each appointment we work out your families mealtimes and make suggestions to figure out how we divide the roles. Now you might be thinking what the heck are these roles. Stand by, I am about to tell you.

Parent's Roles: Parent's are in charge of 'what' their children eat and 'when' their children eat. Let's break this down.

How to choose when your child eats

It is important to feed your child every 2-3 hours, ideally 3 meals and 3 snacks. It is important you provide your child with a meal or snack of your choosing at regular set intervals throughout the day. When you do this you create trust from your child that they will be fed and you create appetite. This is your best weapon against a fussy eater. Think about it, if you are hangry you will just about eat anything and your child will too.

If your child is a grazer this will disrupt your child's appetite and often backfires. We sometimes think that giving children food all the time will make them gain more weight but often it does the opposite. When we provide our children with space around meal times we create appetite. If your child is choosing when they eat they will likely ruin their appetite and then loose interest in the meal you actually want them to eat.

What we work on here is giving the parent the full responsibility of choosing when their child gets to eat. What you will find is a child who is hungry and more interested and engaged in the next meal you provide for them.

How to choose what your child eats

What I will do is train you to feel empowered in choosing what you want your child to eat. What we want your child to eventually learn is that there is no wriggle room on what is offered at mealtimes. They will trust that you will provide them with a meal and give them the space and independence to let them choose if they want to eat it without pressure.

So how do we achieve this mythical place that contains no psychological warfare? Let's start with my top strategies:

(There is a lot here so my advice is just start doing one thing at a time then incorporate the next once you feel confident)

Start with no longer asking before a meal what your child wants to eat, you get to now make this decision now
Stop asking questions - do you want to try this?, do you want chicken?, do you like this food? Can you try for me?, Can you have one bite? (remember you children are children and their answer will be 'No!')
- Let's break this down further. If you ask a question like this and they say 'no' this reaffirms for them that 'I am a person that does not want chicken or a person that does not try new things.
Put the food down on the table - when you have done this your job is now done. There is nothing you can do after this point that will get your child to eat. They have to want to do that for themselves. So sit back have a wine and enjoy the meal.
Let your child serve themselves - this will increase their independence and sense of choice at mealtimes and will reduce anxiety and pressure
Do picnic style meals - this means all the foods you are preparing - place them on seperate plates or bowels on the table (e.g. plate for steak, plate for mash and plate for peas)
- Think about how well taco night usually goes?? It is because they get to make the decisions and build their own meal.
Get your child a second plate - I like to call this the 'i'm not so sure about this' plate
- Does your child ever come to the table, look at their meal at the table and go -'yuck i'm not eating that', your mood crumbles, stress rises and then you are left battling them back to the table
- They do this because children believe that whatever is on the plate = I am expected to eat all of this, an empty plate reduces this anxiety and gives them the power of choice which leads to satisfaction and reduced anxiety
- The second plate also teaches your child that they can actually say yes and no to foods and it is ok
- Encourage parents and siblings to get a second plate - it is important here to role model that it is ok to not eat everything that is offered on the table
Make it a family rule that everyone has to pick up something from all components of the meal
- But say that if they do not want to eat it, they do not have to, and they can place it on their second plate
- Exposure leads to increased variety - now we have them actively exposed regularly to family meals
Place one preferred food on the table that you know your child will eat
- This is your ticket to getting them to come to the table and keep stress levels low
- However I want all family members to be able to eat this and have access to it
- Do you see what we have done here????

We just transformed your meal into a FAMILY MEAL! To your child, you have blended together what they eat and what the family eats. You have given them the freedom to serve themselves. They get to choose what they want, if they want it and how much they get to eat! So now this leads us perfectly towards understanding the child's roles.

How do I get my child to want to eat new foods?

So we just covered all the parents jobs on what you can do to ensure success with your child. Now we are covering what the children's roles are. Ultimately what we cover here is giving your child more independence with their food choices.

Children's Roles: 'if they want to eat at' all and 'how much'

If they want to eat at all:

To all the parents out there! This is the hardest lesson for you to learn. This is where you let go. Where you realise you have no control over if your child wants to eat. Learning this lesson will ultimately be the thing that reduces your stress at mealtimes. If you can accept that it is 100% up to your child on whether they want to participate in dinner or whether they want to eat only pasta and no meat, then you will will have an enjoyable mealtime.

Ultimately the strategies I have been providing you with are all about creating a new environment. Psychologically speaking you are creating an environment where it is easier for your child to make the right decision. Without telling your child what the right decision is. In the strategies above we have stopped asking our child what they want and we started providing for them what we want them to eat. We are keeping in mind that our child has preferences by offering the 1 preferred food at mealtimes. What we have created here is the impression of independence. When a child feels like they are making their own decision about their food they are more likely to eat it.

To give an example of this in another scenario let's talk about the little mermaid movie. Fast forward to the scene for 'kiss the girl'. Now in this scenario Sebastian couldn't just go up to Ariel and the Prince and say, 'come on guys, Kiss!'. That would backfire into the two of them standing their awkwardly wishing it was never brought up. What he had to do was make it seem like it was their own idea.

Sebastian created some mood music with the trees, he started singing in the princes ear and chose a spot where the mood was romantic. Overall Sebastian was trying to create the right environment that made the prince feel like it was his own idea to kiss Ariel. Otherwise it wouldn't work.

Now let's apply this lesson in psychology to our children! We cannot simply ask our children to do the things we want them to do. Otherwise they are less likely to do it. We need to make it seem like it was their idea in the first place. The decision for your child to eat needs to be theirs alone. Because if they are in full control of 'if they want to eat at all' they are more likely to try it and also try it again.

How do I know how much to feed my child?

Now we are covering the second job we are giving to your child. Which is letting them decide how much they want to eat. There is no answer to how much is enough. My answer is this, 'When they stop eating'. Now there are those children that will refuse to eat in order get out of a mealtime. My strategies thus far are targeted at those kids to get them feeling more involved. So this next part is reviewing how you accidentally take away your child's decision on 'how much' they want to eat.

'How much' they want to eat:

A lot of this section related to reflecting on how you as a parent may or may not be inadvertently coercing your child into eating. Remember we have now learnt that we have officially lost control, as parents, over if your child wants to eat at all and how much they want to eat. So now is the time to reflect on the ways you might be influencing your child. Here are some examples:

'Just one more bite'
'You haven't even tried the broccoli'
'But you always eat that'
(Silently staring at your child's plate hoping they will eat it)
'You cannot leave the table until you have finished what's on your plate'
'If you eat dinner I will let you have dessert'
Keeping your child at the table longer than it has taken for the family to at the meal

These phrases are little forms of pressure that a child may encounter at mealtimes. They come from a loving place however the root of the problem is that it takes away the child's decision. If we allow them to make their own decision on their own appetite we are creating competent feeders in the long run.

The things you do have control over as parents is this. You chose the meal, you choose when the food will be served, you choose how the meal is served, how long the meal goes for, what you talk about at the meal or how you talk about the food.

I like to say to families that your job really is done once the food is on the table. Once everyone is there kick back and just be a family and talk about your day. The more positive the mealtime and relaxing the more enjoyable it will be. If you stop worrying about how much your child is eating your child will too.

Just ask yourself this - would I be doing/ saying this if I was not worried about their weight/ what they are eating? If you answer is 'no' then don't do it. This is a good strategy to practice stopping yourself before doing or saying these things. So remember, your child gets to pick how much they want to eat. If you feel like they did not eat enough at dinner, relax, throw in a dessert like toast, yoghurt, cheese and crackers.

How to talk to your child at the table about their food

Ok, so now you might be wondering...'well what can I do or say that will help'. In terms of how you communicate with your child at mealtimes I like to use the 'Food Scientist' approach. This approach is intended for families to talk about the properties of the food without talking about eating the food. When I say properties I mean - talk about the colour, the smell, the texture, the crunch.

Let's run through an example of communication styles when being faced with a carrot. You could say the following:

What colour is the carrot?
This carrot feels soft and squishy, how does it feel to you?
I think this carrot smells sweet, how does it smell to you?
When I bite my carrot it feels really crunchy, does your carrot crunch too?

I have this great placemat, from the SOS feeding therapy course, that can give you a guide on talking about new foods.

What else can I do at home to make my child eat?

At home there are many things you can do to make your child eat. Think of it like densitizing your child from a phobia. You wouldn't just throw your child into a room with a snake. You might start with showing them a picture, letting them see it in a cage, see it on the zookeeper, have the zookeeper come closer all the while gradually doing these things and making sure you child feels relaxed.

So think of this graded approach when thinking about getting a child to eat. We start from the bottom and work our way up. This might be a good time to add there are in fact 32 steps to eating...wow I know. Eating is a learned behaviour not an automatic one. Huge myth that eating is simple. Think of eating like a sport - you either learn to do it well or you don't.

When a child is refusing a food I like to think about it this way. They are refusing what you are asking them to do with the food not refusing the food. So we need to look at what we are asking them to do with the food then work back from there. So let's take a look at these steps.

So at home how you need to do activities that include allowing your child to tolerate the food, then interact with the food and smell, before you touch the food before you chew and swallow the food. A lot of the issues I see is that because families are so set on achieving step 32 they miss all the other parts that their child is progressing through. The next part is some activities you can do to get them moving through the steps.

How can I make my child tolerate new foods?

Let your child watch you make dinner
Describe properties of the food in front of you
Pass food to other people near your child
Place not tolerated food on a second plate nearby

How can I make my child interact with new foods?

Takes new foods out of their wrapper (fruit bags, muesli bars, biscuits)
Your child helps with food preparation (spiralizing, cookie cutters, mixing, pouring etc)
Ask your child to pass food to you or another person at the table/ kitchen
Ask your child to serve another person food, at the table, using a utensil
Food play ideas - pushing food with another to make a train, make faces with food (like fruit faces), candles into birthday cakes, blowing food with a straw)

How can I make my child smell new foods?

Parents cook food in the room they are in
Get you child to help with food preparation
Help with peeling, cutting, stirring with utensils
Waving food in their face
Bringing food to the nose (to make a mustache, whiskers, beards, lipsticks, clown noses)

How can I make my child touch new foods?

Serve yourself with your fingertips
Throwing away food on the table with fingertips
Food play ideas: painting with foods, building trains, steps, bridges with food, smashing, crunching, breaking, ripping, tug of war with foods
Food 'dancing' on their body
Putting food on your head as a hat then sneezing it off
(Prepare for some messy play - do this on weekends or after dinner)

How can I make my child taste new foods?

Kiss the food good bye as you throw it in the bin after dinner
Pretend you are a puppy with a bone
Play tug of war with food in mouth
Blowing food out of mouth (i.e. launching a cherry tomato or aiming for a bowl)
lick food off the table
Pretend to bite of parts of animals (i.e. cookies in shape of animal)

So obviously it seems like you may need to get your hands dirty. Simple stuff I like to start with is going shopping together, picking out foods, helping out the in the kitchen, serving other family members foods, cleaning up after themselves. Regarding food play I suggest things like making foods and using cookie cutters or do some make believe play and pretend foods are animals. You could incorporate this at the end of afternoon tea or after dinner.

So these are some of my strategies. If you want help putting it all together for your child follow the steps below to get the ball rolling for your family.

Book an appointment: in-person or online video call

I’ll meet with you and your child via telehealth or face to face. We’ll discuss your child’s full history from birth until today and answer all your questions.

Get a customised nutrition plan

You’ll receive a nutrition plan that meets your child’s specific needs.

See your child thrive and their confidence grow

As your child’s digestion improves happiness will return to your mealtimes.

Book an appointment

FAQ's: Your questions answered.

Who else might be involved in supporting my child to eat?

Well depending on your child's medical history will be dependent on what extra help your little one might need. For example if your child has an issue with textures then you may need a speech pathologist to perform an oral motor assessment. This will provide guidance on what exactly is going on in your child's mouth and will determine what skills they need to work on in their mouth.

If your child has sensory issues or emotional regulations problems you might need an occupational therapist to support you with helping your child with their individual needs. Whether this is for toileting, routines, calming strategies or proprioceptive/ vestibular support.

Depending on the assessment you may also get a referral to an immunologist or ENT.

What to do when my child only drinks milk?

I often find when children resort to drinking milk there is often an oral motor or air way issue affecting your child's feeding. Of course there are other things that could be going on but this is a good starting place. When children have a preference for milk often it means they are struggling with other textures. Struggling with textures calls for a meeting with a Speech Pathologist to review their oral motor skills.

On the other hand an air way issue might be making it difficult for your child to breathe and/ or swallow certain textures. For examples if adenoids or tonsils are swollen this can make feeding difficult. In consult I will be able to identify these issues and make appropriate referrals to get your child on the right pathway.

Why do children with sensory issues have trouble eating?

This is related to a child having a response to the taste, texture, temperature or the smell of food. It is an over reaction to the sensory element they are struggling with. This is important to identify which sensory component they are responding to in order to direct therapy. Often the solution to these issues is exposure. Exposing children in a graded response at their own comfort level to allow them to feel calm to these sensory properties.

I would like to also point out that I feel people or clinicians can often 'over explain' a child's feeding behaviours on solely their sensory profile. In my experience it is more imperative to work out a child's medical issues first before delving into their sensory profiles.

How do I support my child with disabilities to improve their eating?

In my experience the process for doing feeding therapy is exactly the same as every child has their own unique history. I start with establishing a safe swallow and oral motor assessment, via a Speech Pathologist, to determine what food and fluid is appropriate to recommend. Then we go through their medical history to work out other contributing problems. Then all of the things are addressed that has been discussed above.

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