Feeding Aversion Part 2: Feeding Strategies for Children with Oral Sensory Issues

feeding strategies, chocolate sandwich

Jalapeño Pringles, chocolate chips, and Pediasure. This was my son’s breakfast, lunch and dinner for weeks at a time. Every couple weeks it might change to one specific type of dry cereal and chocolate or saltine crackers. And that was it. Nothing else. As I detailed in my previous post, My son had a complicated medical history that led up to severe oral aversion and oral sensory difficulties. But we have seen significant progress since his first solid feeding attempts.

This post contains a variety of different feeding strategies that might help children with oral sensory issues. I am not a doctor or therapist, and this shouldn’t replace medical advice. I am writing based on anecdotal experiences I’ve had from the past nine years of working with my son and my own personal research. Some of these topics are specific feeding strategies for different ways to help your child interact with food. Other suggestions illustrate how to communicate a positive attitude during meals. I hope some of this information will help you to safely encourage your picky eater to gain more confidence in eating skills.

Feeding Strategies for the Picky Eater

Food Chaining

Food chaining is the practice of gradually exposing someone to new foods with incremental texture or flavor changes. This process is detailed in the book Food Chaining, which is an excellent resource for parents trying to understand the underlying cause of their child’s selective eating and how to safely introduce new foods. For example:

  • For a child who only eats chicken nuggets from one type of fast food restaurant, you may want to try working on offering chicken nuggets from a variety of different restaurants, then making them at home, then offering breaded chicken patties or even pork.
  • For someone who only eats dry, crunchy textures, you can introduce different flavors of his favorite cereals, crackers or chips. You can then eventually chain to dehydrated fruits and vegetables.
  • Children who drink juice may accept a very diluted smoothie that they help make. You can gradually increase thickness or vary flavors. After enough exposure to juicing, they may be willing to lick an actual fruit, then nibble, and then eat it successfully.

Food Chaining has several more detailed food chain examples. These small, gradual changes allow your child to experiment with food in nonthreatening ways. I’ve found food chaining to be successful with my son, and it’s given me a manageable approach for my feeding toolkit.

Offering Choices

For our family, a critical feeding strategy was making our son feel like he has some control of what he eats. After all, you can’t force feed your children (nor should you want to), so it’s best to let them understand that they are in control so mealtimes feel safer. This doesn’t necessarily mean your child should be allowed to eat junk food whenever he wants. You are in control of the types of choices you give him; make sure to offer preferred choices and non-preferred choices. You can even give him choices about the type of plate or cup to use or where the food is placed on his plate. The more choices he has at each mealtime will help him feel safer returning to the table and eventually trying new things.

Food Academics

If your child is interested in reading or learning about food, you can heighten interest in eating by exposing him to all sorts of information about a food before encouraging him to eat it. For example, you might read a book about apples one day, then watch a video or read about how apple trees grow, plot apple-growing states on a map, go apple picking in an orchard, make an apple craft, go bobbing for apples, make an apple pie, cut an apple into fun shapes, etc. Because your child will have had so much exposure to this food, it will be a less threatening presence on his plate. He may not want to try it right away, but all of these safe experiences will help you establish a familiarity with food that may not come naturally to him.

Don’t Say “Just Try It” or “Take a Bite.”

This request comes so naturally to most people. The assumption is that you don’t know whether or not you’ll like something unless you’ve tried it, so you assume that your child needs to take a bite before he decides to turn it down for good (or maybe he’ll even like it!). The problem with this request is that we are assuming our children have the same eating skills and confidence that we have. We can look at a new food and predict how its texture will feel in our mouths and anticipate most of its taste based on our past experiences with a variety of foods. Your child won’t have the skills to do this; therefore, eating “just one bite” can be very scary. Additionally, for many children with eating issues, the problem isn’t that they have never tried a particular food, it’s that the texture may be frightening, or they had a hard time swallowing something similar in the past, or the smell makes them nauseous, for example. These issues all take time to overcome, and pushing your child to “take a bite” may cause additional eating stress rather than improve any long-term eating skills. Instead, constantly give your child choices so he feels in control. Some examples include “Would you like to try this?” or “Do you want me to cut that up for you?”

Play with Your Food

Most children are naturally motivated to participate in mealtimes–they get the satisfaction of a full belly. For children with eating problems, this natural motivation to sit down and eat may not be there, and families have to create this to begin associating positive attitudes towards eating and mealtime routines. If your child is particularly sensitive to eating different textures, encouraging him to touch and manipulate the food is a great introduction. For example, my son was more willing to lick or nibble food after making numbers or letters out of it or pretending the numbers could talk and tell each other “number jokes” (He got a real kick out of “Why was 6 afraid of 7? Because 7 ate 9,” and he would often take a bite of 9 like he was #7.). Other ways you can play with your food include:

  • Cutting food into fun shapes.
  • Combining foods to make people, animals, etc.
  • Food painting
  • Having your child participate in the cooking process.
  • Tell food stories while you eat (We like to talk about carrot families going down the throat slide to go swimming together in the belly pool.).
  • Food Bingo
  • Cereal necklaces
  • Food car races
  • Any other pretend play

Use All 5 Senses

Choose one food for your child to explore and encourage her to touch, smell, examine, listen to, and taste/lick/kiss the food. Facilitate a conversation with your child that safely exposes her to experiencing the food with all of her senses. Some prompts you might use could be:

  • Sight: What does it look like? What color is it? What shape is it?
  • Touch: What does it feel like? Is it smooth or bumpy? Soft or rough? Do you like the way it feels?
  • Smell: What does it smell like? Are there any other foods that smell this way? Do you like the way it smells?
  • Hearing: Does the food make any sounds? What does it sound like when I take a bite? What if we squish it?
  • Taste: What does it taste like? Is it sweet, salty, or sour? Is it juicy? Would you like to taste this? Would you like to lick this? Would you like to give it a kiss?

If you don’t push your child to eat, she may view this activity as a game and begin to explore new foods at her own pace.

Discard Bowl

Even if your child currently never eats anything remotely healthy, working towards constant visual and tactile exposure is still important. Try putting both preferred and non-preferred foods on your child’s plate. If your child doesn’t like the mere presence of the non-preferred food, try telling him he can put it in a “discard bowl” or a “No, thank you bowl” that you place next to his plate. This encourages him to at least touch and move the food even if he never eats it. It also helps him practice being in the proximity of foods he doesn’t like, since this is likely to happen in a variety of different environments.

Create Novel Eating Experiences

Some children enjoy novelty and are actually more stimulated by busier or less ritualistic eating. They may be more willing to try something new when you aren’t sitting at the dining room table. Here are some examples of ways to create a novel eating environment:

  • Take your child to a restaurant and let him order off a menu.
  • Eat a picnic in a park.
  • Take him to a friend’s house and ask the parent to offer him a snack.
  • Let your child buy lunch at school instead of packing.
  • Sit in different seats around the table.
  • Sit under the table.
  • Eat in a different room of the house.
  • Dress up in costumes for dinner.
  • Speak in accents during dinner.
  • Invite friends or relatives over for a meal.
  • Give your child a grocery list to help pick out dinner, then eat dinner at a grocery store if there are tables or at a park or in your backyard.

Be Careful with Rewards

There is a lot of debate about the effectiveness of bribing children with preferred foods. My son used this approach with different therapists, and I understand both sides of the argument. I allowed his therapist to work on feeding skills with him assuming she followed my lengthy list of eating guidelines. When he was first introduced to the “bite for bite” approach at age three (he takes a bite of a non-preferred food and then gets a bite of a preferred food), he didn’t like it. He would take small bites of the non-preferred food in order to please the therapist and never acquired any skills that transferred to a natural interest in any new foods. He was merely performing a “trick.” We stopped the approach because I was worried he wasn’t enjoying the sessions and I wasn’t getting any closer to discovering his likes and dislikes.

However, three years later, we began a similar reward-based approach with a different therapist who came to our home that ended more successfully. Again, I gave the therapist my list of guidelines and said that if she could help him safely discover new likes and dislikes and keep eating fun, then she could reward positive, exploratory behavior. He was older now (seven) and more aware of his health. He was capable of reading and understanding the importance of healthy eating habits. His therapist appealed to his interests, constantly offered him choices, and then rewarded positive eating behavior. Below are some examples of their exchanges and how we interact with our son during mealtimes:

  • What types of foods should we put on our plates for snack time?
  • What food should we eat first? What food should we eat last?
  • Do you want to take a bite of your apple or lick it?
  • Do you want to take a bite of a cracker first or second?
  • How many ccs of fruit smoothie can we drink in one gulp?
  • Do you want to try and make apple juice in your mouth?
  • Do you want to chart your bites?
  • Let’s rate the foods on our plates.
  • I noticed you ate several new foods. How does your body feel after you eat healthy foods?
  • It looks like you’ve eaten enough healthy food to earn a treat. Would you like to have a piece of chocolate now or would you like to save it for later?

While he still doesn’t sit down and eat an entire serving of fruits and vegetables, he will eat small amounts when I ask him (no preferred food bribe necessary), and we are figuring out more of his likes because he is more willing to explore.

Food bribes can be dangerous if they are too contrived. However, I think anyone who follows these guidelines may also be able to safely use food rewards to further encourage success.

In Conclusion

No matter what combination of feeding strategies you employ, remember: 

Keep Eating Fun!

If your child always associates fear, anxiety and frustration with eating, then she will be very unlikely to try new things or even progress to a healthy diet. Keep eating fun, stay positive, and gradually encourage small changes. You cannot force your child to eat, so engaging in a power struggle at the dinner table is not likely to end well. If your child is already highly anxious at mealtimes, consider adapting your strategies or changing your expectations. Success doesn’t always have to mean that food is consumed.

It Takes Time

In my experience with my son, it takes time to see results with any of these feeding strategies. Not days. Not weeks. Not months. YEARS. But I am confident that always maintaining a positive eating environment and letting my son stay in control of his eating has helped him begin to become more curious about exploring new foods.

It took me a while to really understood how much time it would take to see lasting results. I would try each of these feeding strategies and think they weren’t working because he still wasn’t eating anything or that I would never have the time to implement them with the regularity they required to be effective. What I needed to learn was that success didn’t depend much on frequency of specific games as it did on adopting a long-term feeding philosophy of: My son will enjoy mealtime and feel like he has control over what he eats.

Adhering to this philosophy resulted in many Pringles and Pediasure breakfasts and only saltines and chocolate chips for days on end, but he finally learned to eat enough to sustain his body weight and enjoy eating. He’s seven now and will eat very small amounts of fruit and vegetables, fruit smoothies, and peanut butter (along with a variety of dry, crunchy foods, which have always been his favorites). I see him willing to try more and take control of his health. Most people would still be horrified by his diet, but I know how far he has come and how much more room he has to grow. I’m confident that the positive feeding environment we have established will help him continue learning how to enjoy food and making ever so small steps in a healthy direction.

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  1. Reply

    Hey. I have an infant with oral aversion that is currently not taking anything through her mouth and is getting fed by gtube. After long medical history she was not able to take the bottle and continued to be fed by gtube. Do you have any suggestions how to even start introducing her to foods to make it a pleasant experience? I work with speech therapist but not sure of any plan moving forward to help her achieve any success unfortunately. Not sure if it’s too early but she’s seven months and I would love for her to be able to start tasting foods. I’m afraid to make aversion worse. Any suggestions greatly appreciated!

    • Jenna


      Hi! I’m certainly not an expert in this area, but I do have some anecdotal personal experience since my son DID have a g-tube, complicated medical history, and was unable to take a bottle as an infant. We had a wonderful speech therapist at the time who started us with a variety of different strategies to encourage interest in oral feedings. We made sure not to do continuous feeding through the g-tube and only feed him during specific times during the day that aligned with meal/snack times. Whenever he was fed through the g-tube, we also put some formula or baby food on a pacifier or chew toy and gave it to him during the feeding so he would associate his belly being full with tasting food. My son also had a trach, so we had more success with high flavor foods (baby foods are sometimes bland). So he was more interested in trying foods by spoon (or eventually by hand) that had strong or intense flavors (salsa, ice cream, jalepeno chips, etc.). The biggest principle we followed (that I think has helped throughout his life so far) is that we tried to keep eating fun. It shouldn’t be work. So it might take a while, but we found that helping him grow with the g-tube allowed him to develop the strength to enjoy eating more and try more foods by mouth without it being so scary. And we let him eat/try whatever he wanted (it didn’t matter if it wasn’t your typical healthy baby/toddler food).

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