The Picky Eater
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Presentation and Article by Kelly Dorfman, M.S.

Developmental delays and picky eating frequently occur together. Generally, neither clever recipes nor attempts to hide healthy foods in "accepted" ones will correct poor intake. Better to determine the cause and correct the problem from the inside out.

Problem 1: Sensory Misreading in the Mouth or Poor Oral-Motor Skills. A child with tactile defensiveness often exhibits hypersensitivity in the mouth and/or craves oral stimulation, such as chewing on his clothes. Low muscle tone in both mouth and face often coexists with deeper oral-motor issues. Poor sucking, chewing and swallowing skills can cause gagging or terror by merely being near food. Passing a medical swallow study does not guarantee that a child can chew and swallow consistently and has the stamina to consume an entire meal.

Possible Solutions for Problems in the Mouth. A speech or occupational therapist with oral-motor training can help. Teaching the child to use an electric toothbrush to massage (desensitize) the mouth or to drink from a straw can strengthen oral-motor skills and greatly reduce eating anxiety. Helpful books are Progress with Puppets and Out of the Mouths of Babes.

Problem 2: Nutritional Deficiency. Poor eating creates nutritional imbalances, which further reduce appetite or increase carbohydrates cravings. Deficiencies in zinc and vitamin B-1 contribute to anorexia, but a specific nutrient deficiency need not be present. General malnutrition can contribute to disinterest in food, leading to further mal-nutrition, reducing appetite increasingly over time.

Possible Solutions for Nutritional Deficiencies. Children cannot be forced to eat the necessary diet to correct mal-nutrition. Once they become malnourished, diet alone may not correct the deficiencies, particularly if children have poor absorption or delivery of nutrients. Best to use nutrient supplements with moderate levels of a broad range of vitamins (C, E, and B-6) and minerals (magnesium, molybdenum, chromium and selenium) that are most deficient in an overly processed diet. Liquid nutrients are available for children who refuse chewables. Pills ground up in a mortar and pastel can be mixed with frozen grape juice concentrate, applesauce, strained pears, or, in desperate cases, chocolate syrup.

Problem 3: Weak Digestive Function. Children with a history of reflux, colic, frequent antibiotic use, allergies, diarrhea, constipation, and low tone, often have a digestive system that is immature, inflamed or inefficient. Most cases are subtle, with a heavy or sinking feeling accompanying eating. These youngsters are uncomfortable and tend to avoid eating, becoming high risk for malnutrition. They do not know how a happy tummy feels, from lack of comparison.

Possible Solutions for Weak Digestive Functions. The Comprehensive Digestive Stool Analysis by Great Smoky Labs is one of the several tests that evaluate subtle digestive issues. A physician must order these tests.

Another solution may be digestive tonics. A traditional remedy for weak digestion and internal inflammation is ginger tea, made by boiling peeled root slices, then cooled and served a few teaspoons at a time (possibly with honey for children older than one), several times per day.

Digestive enzymes in small amounts may increase appetite, but, if used in excess, can loosen stools or cause intestinal cramping. Digestive capacity diminishes as the day progresses, so, if trying enzymes, always start at the most problematic meal for poor digesters.

Problem 4: Drug Side Effects. Stimulants such as Ritalin and Dexedrine decrease appetite. Antibiotics can also reduce appetite by increasing yeast overgrowth and damaging the intestine's lining. Yeast overgrowth can turn the intestines into a fermentation machine. When yeast digest sugars, the intestines bloat, sending either a "full" signal or a call for more carbohydrates.

Possible Solutions for Drug Side Effects. If stimulants severely affect the appetite, re-evaluate the side-effect/benefit ratio. Stimulants are controlled substances, and their use in a young child should yield huge benefits to justify the long-term costs (both known and unknown). If stimulants are deemed absolutely necessary, feed the child dinner foods for breakfast, because he will eat little while the drug is in the system. After school, when the medicine is breaking down, feed a second dinner, rather than snacks. Then at 7:00 p.m., bring out the low-sugar cereal, toast and snacks.

Although picky eating can be interpreted as a behavioral issue and treated with behavioral modification, it frequently has nutritional causes. By playing detective, parents can determine which solution is right for an individual.

Reprinted with permission from New Developments: New angles on developmental delays, a quarterly newsletter published by Developmental Delay Resources, 4401 E. West Highway, Suite 207, Bethesda, MD 20814; phone: 301-652-2263; web site: www.devdelay.org