1. “Picky Eaters” Presented by: Molly Pierce, OTR

2. Sensory Feeding Challenges Food aversion Picky eater Small appetite Oral sensitivity, hypersensitive gag reflex Food Phobia Infancy/Toddler, preschool, school aged children

3. Infant Toddler As infant may present with poorly organized suck, swallow pattern. Reflux, medical complications Poor state regulation Sensory sensitivities to touch, sounds, oral, tactile, movement Early satiety

4. Strategies for the Infant Sensory oral preparation Non nutritive suck Nipple modifications Flow adjustment; thickening vs nipple change Positioning; swaddling, side lying Environmental changes Treatment of Reflux Feeding Schedule

5. Strategies for the Toddler Tactile Oral exploration; finger foods, sensory spoon; oral stimulation Lateral placement of foods Offering variety of textures; puree, fork mashed, building texture Recovery bites of smooth after texture, alternate. Offer flavorful foods

6. Strategies for Toddler (cont) Modeling eating, biting, chewing Drinks offered at end of meal. Shared control; First – Then, All Done Bowl Meal schedules; 3 meal and 3 snack, G-tube feeding after oral feeding. Sensory Behavior strategies; First – Then, Motivation Daily oral hygi ene

7. Strategies for Preschoolers Sensory Behavior Program –Introduce the “My Plate” program; small serving for each food group –1-2 bite rule; All Done bowl – Repeat presentation of foods (up to 10-15 exposures) –Creating consistency, structure and mealtime routines (3 meal, 3 snack) –Tactile exploration of foods –Can use drink to help swallow foods

8. Strategies for School Age and Older Kids often have anxiety, sensitivities to food tastes/textures, and may have history of dysphagia and/or reflux. What works: Scheduled meals and snacks My Plate – tool to expand the diet and teach the importance of eating a balance of foods. Www.myplate.org

9. My Plate My Plate is FDA’s program for balanced nutrition

10. School Age (cont) –Offer 1 small serving of food from every category; 2 Bite rule –“All done" or “Learning” bowl –Food rating chart It can be empowering for kids to rate taste/texture of foods. –Keep track of new tastes/foods on a sheet of paper and monitor changes over time.

11. Food Rating Chart – Tool for Empowerment Foods Tried Date I like it It’s OK I don’t like it

12. School Age (cont) Develop reinforcement options - so many bites of new/non-preferred foods earns a sticker, screen time, etc. The Sneaky Chef: Simple Strategies for Hiding Healthy Foods in Kids' Favorite Meals –It is better to develop a child’s palate for eating the healthy fruits and veggies. Parents decide WHEN, WHAT and WHERE foods –Child decides whether or not to eat, and how much.  Avoid Power Struggles. Treatment for Anxiety – CBT, medication