Feeding Difficulties in a Food Lover’s Paradise

San Francisco is a foodie haven. Even children of San Francisco love food and eating all the exciting dishes this city has to offer. Of course not all children are adventurous eaters and some children are just downright “picky” eaters. But, more than picky, our city (and beyond) has many children who are “problem” eaters. One of our favorite approaches to working with children is the The SOS (Sequential Oral Sensory) Approach. More information about our feeding and oral motor services can be found here.

We love this approach because it focuses on increasing a child’s comfort level by exploring and learning about the different properties of food and allows a child to interact with food in a playful, non-stressful way, beginning with the ability to tolerate the food in the room and in front of him/her; then moving on to touching, kissing, and eventually tasting and eating foods.

Dr. Kay Toomey, creator of the SOS Approach provides an excellent description of the difference between “picky” eaters and “problem” eaters.

Picky Eaters

  • Decreased range or variety of foods that will eat = 30 foods or more
  • Foods lost due to “burn out” because of a food jag are usually re-gained after a 2 week break
  • Able to tolerate new foods on plate and usually can touch or taste a new food (even if reluctantly)
  • Eats at least one food from most all food texture groups
  • Frequently eats a different set of foods than the rest of the family, but usually eats with the family
  • Will add new foods to repertoire in 15-25 steps on Steps to Eating Hierarchy
  • Sometimes reported by parent as a “picky eater” at well-child check-ups

Problem Feeders

    • Restricted range or variety of foods, usually less than 20 different foods
    • Foods lost due to food jags are NOT re-acquired
    • Cries and “falls apart” when presented with new foods
    • Refuses entire categories of food textures
    • Almost always eats different foods than the family
    • Adds new foods in more than 25 steps
    • Persistently reported by parent as a “picky eater” across multiple well-child check-ups

What causes feeding and swallowing disorders?

The following may be causes of feeding and swallowing disorders in children:

  • nervous system disorders (e.g., cerebral palsy, meningitis, encephalopathy)
  • gastrointestinal conditions (e.g., reflux, “short gut” syndrome)
  • prematurity and/or low birth weight
  • heart disease
  • cleft lip and/or palate
  • conditions affecting the airway
  • autism spectrum disordres
  • head and neck abnormalities
  • muscle weakness in the face and neck
  • multiple medical problems
  • respiratory difficulties
  • medications that may cause lethargy or decreased appetite
  • problems with parent-child interactions at meal times



Copyright 2000 / 2010 Dr. Kay A. Toomey