Food Chaining
A solution to picky and problem eating.
by Cheri Fraker, CCC/SLP

PARENTGUIDE News June 2008

Good nutrition helps keep a child healthy and strong. But, many children go through a period of picky eating. With some children, it is a short phase that passes. In other children, picky eating becomes a significant challenge and may impact the family at all meals.

Parents often need guidance to determine what is typical and what is a developing problem. Statistically, 25 to 35 percent of children in the United States have feeding problems, and up to 40 to 70 percent of children with chronic medical problems have feeding disorders. Feeding problems can lead to malnutrition, congestion, frequent illness and chronic illness, as well as negatively impact sleep and behavior.

A feeding problem affecting your child nutritionally leads to slow weight gain or weight loss, limits the child socially and results in health problems often requiring treatment. Your child needs good bottle, breast, spoon and finger feeding skills. If your child struggles in chewing and swallowing food, or in controlling liquid in his mouth, he needs an evaluation by a feeding specialist.

Other children have good chewing, biting and drinking skills, but struggle to accept a variety of foods. The picky eater may be selective about what foods he will eat. He may accept 30 foods or more and want to eat a certain food for many days at a time. Though the picky eater may tire of a certain food, after a break from eating it, he generally accepts it again.

The problem eater accepts only a few foods, usually less than 20. He often has a strong fearful reaction to new food and may even be unable to touch a new food item. The problem eater may also reject entire food groups, such as refusing all fruits or all vegetables in the diet. If the problem eater grows tired of a food, he often does not accept it back into his diet after a break. Some problem eaters have only three or four foods they eat well.

If you think your child needs help with feeding or nutrition, realize that there are many approaches to feeding therapy. The best forms of intervention come from pediatric multidisciplinary feeding teams. Feeding disorders are complex and there may be valid reasons why a child refuses to eat. Pediatric multidisciplinary feeding teams can evaluate the child for digestive tract disorders or food allergies, determine if there are any swallowing problems and evaluate the child’s sensory skills, behavior and learning style.

There are specific reasons why a child eats only certain foods. Our feeding team has developed a unique treatment approach to feeding therapy that we’ve dubbed Food Chaining.

Food Chaining is a child-friendly treatment approach that builds on the child’s successful eating experiences. Foods a child accepts are studied for patterns in taste, texture and temperature. New foods similar to the ones the child eats well are used to create the food chains, or links, formed between the foods a child accepts and the new, targeted foods we wish for him to eat. The child is presented with new foods he is likely to eat as they are similar to the ones he already enjoys eating.

Food Chaining uses a variety of techniques to make food more palatable. Flavor mapping refers to the analysis of your child’s flavor preferences. It allows the feeding team to determine how to expose your child to a balance of different flavors and choose foods for your child’s food chain that he is most apt to accept. Flavor masking is the term for when a condiment or sauce is used to mask the taste of new foods for your child. Flavor masking coaxes the child to gradually experience more of the flavor of the targeted food and increases the chances he will accept it.

Transitional foods are old favorites used to encourage a child to eat a familiar food followed by a bite of a new food, before having a bite of the familiar food again. Transitional foods and drinks help to cleanse your child’s palate and reduce the aftertaste effect.

Food Chaining programs also teach a child about nourishment to take the mystery and fear out of new food items. The child’s reactions to foods are rated on a scale of one to ten, and ratings are monitored to evaluate changes in taste, texture and temperature preferences over time. New foods are targeted based on the child’s ratings of foods successfully added to the diet. Food Chaining progressively desensitizes the child to the tastes and textures of foods from all food groups and works to improve nutritional status by slowly incorporating a wider range of fruits, meats and vegetables.

Cheri Fraker, CCC/SLP, is a pediatric speech pathologist and oral feeding specialist. She is employed at Koke Mill Medical Center in Springfield, Illinois, where she sees infants and children at The Center for Selective Eating and Pediatric Feeding Disorders. Fraker is the author of Evaluation and Treatment of Pediatric Feeding Disorders from NICU to Childhood (Speech Dynamics Inc) and Food Chaining: The Proven 6-Step Plan to Stop Picky Eating, Solve Feeding Problems and Expand Your Child’s Diet (Da Capo Press). Fraker has published and presented on feeding disorders internationally.