How Can We Tell the Difference Between a Picky Eater and a Problem Feeder?

Question

Answer

Dr. Kay Toomey, from the STAR Institute for Sensory Processing Disorders, has outlined the differences between picky eaters and problem feeders (Toomey, 2000). You can view her work here.  We all have likely had children who are picky eaters. Toomey's guidelines can help us determine when to get additional help for children who need it, in the form of targeted feeding therapy. These guidelines include:

• A picky eater has 30 or more foods in their repertoire. A problem feeder has less than 20 foods in their repertoire.
• Picky eaters and problem feeders will both often experience food jags (when a person will only eat one food item, or a very small group of food items, meal after meal). When someone eats a particular food every day, one day they may decide that they can't eat that food anymore. I have seen this happen a lot in children with autism. Parents will tell me that their child used to eat chicken nuggets every single day, but then one day they didn't want them anymore. With picky eaters, if they take a two-week break from that food, they may gain it back after having that time away from eating it. However, a problem feeder will likely never want to eat that food again.  
• Picky eaters will eat at least one food from most all nutrition or texture groups (e.g., purees, proteins, fruits). Problem feeders refuse entire categories of foods. For example, they might not eat any protein, they might not eat any meats, and they might not eat any fruits or vegetables. If they completely refuse food from one category, that's a problem feeder.
• A picky eater can tolerate new foods on their plates. You're able to fix your family meal, and add a new vegetable to their plate. They may not eat it, but they can at least tolerate it being on the plate. In contrast, a problem feeder might cry, scream, and have a tantrum when any new foods are presented.
• A picky eater might have a different set of food at the meal, but they can sit at the dinner table at the same time with the rest of the family. Problem feeders can't do that. They eat a different set of foods, at different times, and in different locations.
• Picky eaters may sometimes be reported as picky eaters at their well-child visits, whereas problem feeders are persistently reported as picky eaters.
• A picky eater can learn to eat new foods in 20-25 steps. Problem feeders require more than 25 steps to learn to eat new foods. They need a lot more work and more time to add new foods to their repertoire.

Reference

Toomey, K.A., & Ross, E.S. (2011).  SOS approach to feeding. Perspectives on Swallowing Disorders (Dysphagia), 20(3), 82-87.