Help for families coping with feeding struggles

For parents, it’s hard to know when a toddler is going through a phase of picky eating or when it is a sign of greater problems surrounding food.

Luca Gannucci, 6, wears his cracker like an eye patch with occupational therapist Lisa Houska. Photo by Mandy Moran Froemming
Luca Gannucci, 6, wears his cracker like an eye patch with occupational therapist Lisa Houska. Photo by Mandy Moran Froemming

Meal times were extremely stressful for Luca Gannucci’s Andover family.

The list of foods he would eat were shrinking. Chicken nuggets from McDonald’s were OK, but if his mom Jesse tried to make a homemade version he would shun them.

He would eat turkey pepperoni, but no other similar meats. Food had to be cut and presented specific ways. If something he didn’t like was on his plate, it could induce a meltdown.

“I think the most important thing is for parents to know this isn’t your fault,” said Sara Biers, an occupational therapist with Family Speech and Therapy Services in Andover. “It’s not because of something you did, or didn’t do.”

While some people subscribe to the adage that if kids get hungry enough they will eat, according to Biers that strategy is not the best approach for children with feeding struggles.

“It’s not going to work for these kids,” she said. “They will leave the table without eating. Not because they aren’t hungry, but because they would rather go to bed hungry and protect themselves.”

Feeding struggles affect up to 45 percent of typically developing children and 80 percent of developmentally disabled children, according to research shared by Feeding Matters, a non-profit that provides support and resources on the topic.

The pickiness started when Luca was 2 1/2 years old – a pretty common age for that kind of behavior. Jesse chalked it up to family transitions. Her daughter had been born and Luca was adjusting to becoming a big brother.

But by the time he was four she knew it wasn’t just a phase.

“He was only eating about 10-15 foods, only a couple of fruits and no vegetables,” Jesse said. “It was a lot of stress on our family.

She was worried about Luca’s health and what would happen when he went off to school and she needed to pack him a lunch. Mealtimes would drag on for more than an hour.

Luca’s feeding struggles were affecting him socially, too. Birthday parties and family gatherings would cause anxiety about the food choices and he often just wouldn’t eat at all.

But for the last year and a half Luca, 6,  has been receiving feeding therapy from occupational therapists at Family Speech and Therapy Services’ Andover clinic.

He started with twice-weekly sessions, but has since moved to once a week.

“It was tough at first, but we were able to push through,” Jesse said. “He has made so much progress. Meal times are not stressful anymore.”

The sessions start in the gym, where Luca gets a chance to warm up his body. Then specific exercises are done to improve strength and movement in his mouth and jaw.

Then it’s time to test the waters.

At a recent session, he breezed through eating a cracker, some dehydrated apple and an almond.

But when it came time to eat a slice of kiwi, it got tough.

He and therapist Lisa Houska touched it, stuck to their hand. They smelled it.

Luca didn’t eat it. But there’s no pressure. Maybe next time.

Houska encourages the kids to have fun with their food. During the session, she and Luca pretend to wear their crackers like eye patches.

Food can be scary, she said, and having fun helps take the stress out of the situation.

Some signs of feeding problems that parents are encouraged to discuss with their child’s doctor include: limited food range; avoidance of certain food textures or food groups; difficulty transitioning from pureed to table foods; prolonged and stressful mealtimes; tantrums or other problem mealtime behaviors; delayed self-feeding skills; difficulty drinking from an open cup after the age of 2 1/2 years old; ongoing concerns with weight gain; difficulty sucking, swallowing or chewing; gagging, choking or coughing during mealtimes.

Biers said they like to see kids be willing to eat at least 10 foods in each food group. Although the same foods with different textures – like apples and apple sauce – would count as two.

To help your child at home, therapists advise offering a variety of foods at meals, both preferred and not. During family-style meals, kids should be encouraged to take a serving of all foods.

Parents are also encouraged to change the presentation of foods in small ways – cutting foods into different sizes or shapes.

Celebrating small wins are also important, even if a child just touches a green bean to their lips.

The therapists at the Andover clinic are passionate about sharing resources with families, and letting them know they are not alone.

“The thing I most often hear from parents is that they wish they had known about their options sooner, so they didn’t have to suffer for so long,” Biers said.

More resources can be found at including a list of practitioners in your area. To schedule a feeding assessment with Family Speech and Therapy Services call 763-755-4275 or visit

Mandy Moran Froemming is at [email protected]