From Fear to Fun: OT for Picky Eaters

As a Pediatric Occupational Therapist, I have seen my fair share of referrals for OT for picky eaters. Picky eating is a common concern that many parents struggle with, and it can be frustrating for both the parents and the child. However, I’ve found that there are effective strategies for OT to support picky eaters and expand a child’s food choices. In this blog post, I want to share with you my experience working with picky eaters as a preschool-based OT and one strategy that we put in place that had surprising results. 

OT goals for Picky Eaters 

A few years ago I was working in a special-education preschool, specifically for autistic kids. Six out of the eight preschoolers that I was working with had goals around food and picky eating in their Individualized Educational Programs (IEPs). 

Each child had unique goals: 

1. One was an extremely picky eater, relying on formula at ages four and five. In this case, we as the educational team were in the process of referring to a feeding clinic. (Is my child a picky eater? Quiz)
2. A few children managed to eat enough to meet most of their nutritional demands, but they really struggled with a variety of food. 
3. A few of the goals were in relation to oral-motor skills which were impacting not only eating and the types of food that they were eating but then also speech. 
4. One child had a complex sensory profile and many fears and anxiety around food
5. And another child that really the motor coordination of eating was one of their goals. 

Occupational Therapy for Picky Eating in a Preschool Setting 

As a preschool-based OT there were many ways that I, the educator and the educational team worked towards those picky eating IEP goals. 

1. During meal time: Meals in this preschool were sent from home. This meant that the meals comprised of all “safe foods” that the parents felt confident the child would eat. We used the opportunity of mealtime to provide sensory preparation for eating, oral motor preparation, and feedback to support motor coordination and self-awareness around hygiene.
2. Individual therapy time: In our traditional “pull-out” therapy time there were many ways that we used therapeutic activities to take a bottom-up approach to many of those picky eating IEP goals. 
3. Therapy time with the parent: In this preschool, I had bi-monthly therapy time with the children and their parents. This was a critical piece of the therapy strategy. Not only did I provide parent coaching but we also cooked with the kids and ate together. (link parent article)

However, considering that increasing the variety of foods eaten was a common goal for the majority of the kids we as a multidisciplinary team wanted to do more. 

If you’re interested in learning more about picky eating and how to support children who struggle with it, I recommend attending this workshop. Alisha Grogan, an occupational therapist, is hosting a free workshop about picky eating. The workshop covers topics such as the types of picky eating, the causes of picky eating, and evidence-based interventions for picky eating. Disclaimer: I am an affiliate for this course but my opinions are my own.

The Food Fun Group 

In order to expand the preschooler’s food choices and overcome their fear of trying new foods, we, the multidisciplinary team came up with a program called the Food Fun Group.  

The Food Fun Group was run once a week for 30 to 40 minutes, and the goal was to play with food and prepare dishes. 

We focused on providing food with more variety of textures. This was mainly fruits and vegetables 

One of the key strategies of the Food Fun Group was encouraging participation, not necessarily making the children eat. 

Our group emphasized the preparation of the food, such as: 

1.  Making pictures with food (like a bear face on toast, a caterpillar made from grapes, hedgehogs from oranges). 
2. Preparing 1 or 2-step food (like squeezing orange juice, Buttering bread, grating carrots)

OT for picky eaters should always include Food Preparation 

OT for picky eating should always include food preparation because it gives children a low-pressure environment to begin the steps of exposure to new foods. 

We often forget that even with our other OT tools like sensory preparation, and social stories, kids still need the opportunity to overcome various hurdles of exposure to foods before they actually eat them. 

These exposures may include seeing, touching, smelling, or licking. 

When we set a precedent that (outside of mealtime), in this specific group time we will never pressure you to eat these new foods- kids are remarkably more open to taking the first steps of exposure. 

How to Run a Picky Eating Group for Preschoolers

The group was based on 3 simple rules 

1. The foods that we used were fruit and vegetables (not baking cookies) 
2. It was run as a group (Kids are often far more willing to participate in a group) 
3. Everyone is offered a turn in the preparation process, no one has to take their turn if they don’t want to and no one has to eat the “product” that was made afterward (unless they want to).n 

The group was run once a week with myself, the Occupational Therapist, and the educator. 

Does “Playing with your food” work as an OT picky eating strategy? 

Yes! A big yes! Through this Food Fun Group we not only watched the children exploring, laughing and interacting with food but also- eating fruits and vegetables. 

Within the first three weeks of running the group more than half of the children had, of their own will (remember this group needs a no-pressure environment) tasted something that they had never eaten before. 

At the end of the year as we evaluated the IEP goals we saw that many of these foods that were first tasted at the Food Fun Group had been added to our children’s regular menu of “safe foods”. 

There were also two interesting spin-offs that I didn’t expect 

1. The no-pressure around food motto seemed to catch on. Both with the staff inside the preschool as well as with parents. “No-pressure” mealtimes can be a hard-to-sell strategy for most parents. However, seeing it in action seemed to have a much deeper impact than all that parent coaching. 
2. A picture is worth a thousand words. At the end of our group, we messaged each parent with the product that we had made in the group whether it was a bear face or a caterpillar made from grapes. The fun of the idea seemed t also spark a level of enthusiasm in our wonderful group of parents. Constantly cooking meals that don’t get eaten can be disheartening. Especially when it’s year after year. The new way of playing with food seemed to re-ignite the problem-solving and determination in some of our families. 

Conclusion

The Food Fun group is a concept that can be adopted by Occupational Therapists working with picky eaters, preschool and kindergarten teams, educators as well as parents. 

This weekly group with 8 preschoolers was seen to contribute towards goals positively met on each child’s IEP. It was also an effective strategy in the overall work of OT for picky eaters. 

Why don’t you try it out? And Let me know how it goes.