Thanks for tuning in to the final part of Blake’s story. If you want to catch up with parts 1 through 3, click here to head to the archives. Today we’re taking a little detour to one area we haven’t discussed much in any of our case studies as of yet: selective, or picky eating.
Here’s what we know about Blake’s journey with food
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He eats fewer than 20 different kinds of foods
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Of his list of foods, 0 of them are fruits or vegetables
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He eats mostly carbs and dairy
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He only gets protein through dairy, and sometimes will eat chicken nuggets; no other forms of protein
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He worked with a hospital-based outpatient feeding therapist, but his parents said it didn’t help
Before we get into the insights and education about this topic, I want to clarify that, like with most childhood neurodivergence, there is a spectrum when it comes to “picky eating.” Whether you’re supporting a child who simply has strong food preferences, or one who has a severe eating disability like ARFID that affects their range of foods, this email will discuss “food pickiness” in general.
What’s the deal with the “fewer than 20 foods” qualification?
I’m trained in a protocol called the Sequential Oral Sensory (SOS) Feeding approach, which is considered the gold standard feeding therapy intervention for selective eaters.
The protocol for the training considers anyone with fewer than 20 foods to be in the “problem feeder” category (their words, not mine!), and the graduation from feeding therapy threshold was to hit 30 foods, spread across the fruits/veggies category, protein and starches/grains. (Here's a picky eater vs problem feeder questionnaire). This number was related to the ability to have multiple combinations of foods that would limit repeated meals/foods served back-to-back, which contributes to “food jag” or food burn out. In other words, having at least 30 foods in your repertoire prevents you from repeating a food too often that you end up burning out or dropping the food and never eating it again (as so many neurodivergent kids do).
My approach to picky eating
My clinical training in this topic is mostly within the lens of the SOS model. I like to take what I learned from that training and balance it with what I know about the neurodivergent community.
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My overall goal is to help your child establish a healthy relationship with food. This means not having a complete stress reaction when a certain food is present or at the same table as them. This means giving your child the tools and language to be able to either politely decline the food or self-regulate.
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Aim for variety first over specific nutritional value. What I mean by this is—instead of starting by trying to get your child to eat steak or a bell pepper, start by seeing if you can get them to eat white cheddar CheezIts instead of just regular cheddar. Look for slight changes in seasonings/flavors, brands or shapes of already-safe foods. This can grow your child’s variety of foods in a small way that can still prevent food burnout.
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There should be no forcing when it comes to food exposures or trying new foods. It should all be offered as an invitation to explore, play, or even just watch you explore and play with the food.
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Food play and food exploring needs to happen at times outside of meals.
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Meals don’t just start when they sit at the table; you should consider the nervous system state while they’re approaching mealtime; a stressed nervous system will not eat well, and will not feel comfortable in the presence of new foods.
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Mealtimes can look different for various cultures and family dynamics. Your family may have screens at the table, or eat on the couch. There’s nothing inherently wrong with these routines, but if it’s contributing to the problem then it’s helpful to explore that.
Want to learn more about underlying causes around picky eating and when to seek professional support? Click here.
When feeding therapy isn’t working
When a parent tells me they don’t feel a certain intervention, therapy or approach “isn’t working” for their child, I always ask them, “what does it look like to you when something works?”
