Picky Eaters vs. Problem Feeders with Dr. Kay Toomey (HPC: E74)

Dr. Kay Toomey, PhD is a Pediatric Psychologist who focuses on picky  eaters and problem feeders. 

Plenty of parents complain about their kids being “so darn picky!” (including me, even though I know I shouldn’t use that word!).

But what IS a picky eater, really?

Did you know:

  • Only about 1/3 of kids are actually picky, although 50% struggle age 2-3.
  • Only about 25% of kids outgrow it.
  • 5-10% are problem feeders and need professional help.

Dr. Kay Toomey, the most fascinating guest on the Healthy Parenting Connector yet, explains how parents can determine if their “severity” meter is accurate when it comes to their kids eating. Do you have a problem feeder who is truly extreme? Or just a picky eater? These questions will help you determine!

And the craziest part — it might not all be in your child’s head, even if they are having trouble accepting a wide variety of foods.

It turns out that what matters is how much it takes to chew, physically, and what food feels/looks/tastes/sounds like etc. to the child. Some picky eaters just never learned to chew properly! 😮 #mindblown

I’m humbled to admit that I’ve had to change my own “Raising Adventurous Eaters” presentation in FOUR different places because of what I learned from this 30-year expert pediatric psychologist.

When someone takes kids who literally won’t eat and consistently has success turning them around, I sit up and listen!

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You won’t be able to turn this one-off — which is good, because part 2 is here! I couldn’t stop the interview at my usual 30-40 minutes!! 😉

No time to watch the whole video? Here are the notes!

Picky Eater Video Time Stamps

  • 0:12: Today I’m here with Dr. Kay Toomey, a 30 year expert with picky eaters. We’re going to talk about the real cause of picky eating and the difference between picky eaters and problem feeders.
  • 1:38: Dr. Toomey has her own clinic teaching practitioners and parents her SOS approach to feeding kids. She actually reached out to me about recommending the Kids Cook Real Food course to her families!
  • 2:36: People tend to think it’s a behavioral problem when kids don’t eat. When a child doesn’t eat, it’s because something in their body isn’t functioning properly. Dr. Toomey shares some fascinating information about child development and eating.

When kids don’t eat well it’s all in their bodies, it’s not all in their heads. -Dr. Kay Toomey

  • 4:35: The research shows that parents cause a child’s picky eating only about 5-10% of the time. It’s much more complicated than many people assume.
  • 5:19: If the issue is in the body, then our solutions for picky eaters will be focused on the body and not behavior.

Developmental Stages and Feeding

  • 5:38: The first developmental stage is only the first 4-6 weeks of life. This stage is the only time that your appetite instinct is the primary driver behind eating. 😮
  • 6:09: After the first developmental transition, reflexes become the primary driver. You’re probably familiar with the rooting reflex and grasping reflex in babies.
  • 6:51: Around 4-6 months of age, you get voluntary control of these reflexes. At this age, eating becomes a learned skill. A child can learn to eat, learn to not eat or learn to kindof sortof eat.
  • 7:18: The first transition from appetite to reflexes is driven by the baby’s body. As long as their reflexes are solid, you don’t need to do anything to facilitate the transition. If your baby was premature their reflexes may not be what they should be and you could have difficulties.

Eating is a learned behavior after 6 months of age, so we need to understand what we’re teaching our children. -Dr. Kay Toomey

  • 8:26: As parents, many of us approach feeding as dieticians. We look at what our kids are eating and count up whether or not they got enough calcium, protein, zinc, etc. We need to approach feeding as teachers.

Parents need to come to the table as teachers, not dieticians. -Dr. Kay Toomey

  • 8:46: While parents don’t often cause a feeding difficulty, they can contribute to making it worse.

Root Causes of Picky Eating

  • 9:22: When a child is experiencing picky eating, they often have specific parameters for how they will eat things. For example, they won’t eat “real” meat but will eat processed meat because it’s easier to chew. Notice how this is a sensory issue or a case where the child may have difficulty chewing. The root of the issue is in their body.
  • 10:26: Any sensory difficulties can lead to eating difficulties. The way things taste, feel in the mouth, smell, even how things look or sound can affect a child’s comfort eating them.
  • 11:03: Many vegetables have a bitter flavor and a stringy or fibrous texture. There are two sensory hits against them. Add a chewing difficulty and no wonder kids shy away from them!

Eating is the hardest thing kids will ever do. -Dr. Kay Toomey

  • 11:52: When a child rejects a food ask, “what is it about the food that’s the problem?” Look at the food before looking at the child as the issue. Listen in to this part to hear more about how to avoid the power struggle and figure out why a food is offensive to your child.

When a child rejects a food ask, "what is it about the food that's the problem?" -Dr Kay Toomey

  • 12:43: The next developmental stage is 12-14 months. At this point, kids become self-aware and realize they can express an opinion.
  • 13:12: The rest of the developmental stages happen around ages 2-3, 5-6 and 9-10.

How Common is Picky Eating?

  • 13:40: Not all kids are picky. Only about 1/3 of children develop picky eating habits. The numbers rise to 50% of kids during the 2-3 year developmental stage.
  • 14:18. About 25% of kids grow out of picky eating. Parents assume their child will naturally outgrow picky eating and without an understanding of what’s driving it (something not functioning correctly in the body), they are unable to help their child move past it.
  • 14:37: 5-10% of kids are problem feeders. These are the kids who have bigger developmental issues. You might consider them extreme picky eaters.

Picky Eaters Versus Problem Feeders

  • 17:15: We get into the specific differences between problem feeders and picky eaters.
  • 17:24: An exercise you might find helpful is to take a piece of paper and make three columns: proteins, starches and fruits/vegetables. Write down every food your child eats regularly on the list. Be very specific.

A chicken nugget and baked chicken are completely different foods to a kid. -Dr. Kay Toomey

  • 17:53: Parents think about foods being the same or different based on the name. Kids consider foods to be the same or different based on the oral motor skills needed to consume it and the sensory aspects of the food. Dr. Toomey gives several examples.
  • 22:33: For a typical picky eater, you’ll have about 30 foods on the list. A problem feeder will have less than 20.
  • 23:17: When a child’s sensory systems aren’t working well they tend to have food jags. That’s when they want to eat the same exact food, the same exact way over and over. These are common during developmental transitions.

How does it look? How does it smell? How does it taste? How does it feel in my mouth? -Dr. Kay Toomey

  • 25:17: Dr. Toomey describes the long-term problems with food jags and how they worsen problem feeding.
  • 27:06: Picky eaters will eat at least one food from every nutrition and texture group. They may only eat one fruit or one starch, but at least they have one. Problem feeders will avoid entire groups.

Most parents think their kids eat less than they actually do. -Dr. Kay Toomey

  • 28:04: A picky eater will fuss about a new food, but they’ll eventually settle down even if they don’t eat it. They may be willing to have it on their plate, or even lick it. A problem feeder will have a huge meltdown when introduced to a new food or food they don’t like.
  • 28:41: Picky eaters are willing to eat with others, but they may want different foods. They’ll eat the same spaghetti but don’t want the sauce everyone else has. Problem feeders have a hard time even eating at the table and don’t like eating with other people.
  • 29:39: Letting kids play on a screen or watch TV while they eat is a short-term fix that creates more of a long-term problem. If your child is already used to this, it will take time to wean them off, don’t just cut them off cold turkey.
  • 31:53: Picky eaters fluctuate from month to month whether they will eat or not and what they eat. Problem feeders have constant struggles that can even get consistently worse over time.
  • 32:38: Learning to eat new foods is much more complicated than many people think. The more difficulty a child has with eating, the harder it will be for them to learn to eat a new food.

There are 32 steps in learning to eat a new food. -Dr. Kay Toomey

  • 33:39: If your child is a problem feeder, they need to be in feeding therapy. We as parents can benefit from the therapy as well as we learn to help our children learn to eat.

Make sure you click over for the rest of this interview

Resources We Mention About Picky Eating

Dr Kay ToomeyDr. Kay A. Toomey is a Pediatric Psychologist who has worked with children who don’t eat for almost 30 years. She has developed the SOS Approach to Feeding as a family-centered program for assessing and treating children with feeding problems. Dr. Toomey speaks nationally and internationally about her approach. She also acts as a consultant to Gerber Products. Dr. Toomey helped to form The Children’s Hospital – Denver’s Pediatric Oral Feeding Clinic, as well as the Rose Medical Center’s Pediatric Feeding Center. Dr. Toomey co-chaired the Pediatric Therapy Services Department at Rose Medical Center prior to entering private practice. Dr. Toomey acted as the Clinical Director for Toomey & Associates, Inc.’s Feeding Clinic for six years and SOS Feeding Solutions at STAR Institute for eight years. Dr. Toomey is currently the President of Toomey & Associates, Inc., and acts as a Clinical Consultant to the Feeding Clinic at STAR Institute.

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