Understanding Selective and Picky Eating in Children: Causes and Therapy Solutions
Is your child a picky eater who refuses certain foods or struggles to eat a balanced diet? At TheraPlay LA, we know how stressful mealtimes can become when children eat only a few select foods or resist trying new ones.
But picky eating isn’t always just “behavioral.” There are many underlying causes—from sensory sensitivities to oral motor skill challenges, tongue ties, chronic tonsillitis, and even dental or orthodontic issues.
Let’s explore why children become selective eaters—and how feeding therapy, orofacial myofunctional therapy, and collaborative care can help.
What Is Selective or Picky Eating?
Selective eating (or picky eating) means a child consistently refuses certain foods, food groups, or textures.
Common signs include:
Eating only a few preferred foods
Refusing entire food groups (like vegetables or meats)
Meltdowns at mealtimes
Gagging on or spitting out certain textures
Avoiding foods with mixed textures (like casseroles or sandwiches)
Pocketing food in their cheeks instead of swallowing
“Picking” things out of food
While some food refusal is typical in toddlerhood as toddlers begin to exercise their ability to say “no,” persistent or extreme selectivity can signal underlying issues that require professional support.
Causes of Selective and Picky Eating in Children
1️⃣ Sensory Processing Challenges
Many picky eaters are sensory-sensitive.
They may:
Dislike certain textures (mushy, crunchy, slimy)
Be sensitive to strong flavors or smells
React negatively to mixed foods or unexpected flavors or textures in food
React strongly to certain temperatures
For these children, eating unfamiliar or challenging foods can feel overwhelming and result in frequent gagging or refusal to interact with the food.
How Feeding Therapy Helps:
Gradual exposure to new textures and tastes
Sensory play with food to reduce anxiety
Strategies to make mealtimes less stressful and more positive
2️⃣ Oral Motor Skill Difficulties
Eating isn’t just about taste—it’s a complex motor skill!
Some children have difficulty with:
Chewing effectively
Moving food side-to-side in the mouth (lateralization)
Forming and managing a bolus (the mushy ball of chewed up food you created before swallowing)
Coordinating chewing and swallowing safely
Signs of oral motor difficulties include:
✅ Gagging on certain textures
✅ Taking very small bites
✅ Holding food in cheeks
✅ Taking a long time to chew
How Feeding Therapy Helps:
Exercises to strengthen jaw and tongue muscles
Practicing chewing with safe, manageable foods
Building confidence with new textures
3️⃣ Restricted Oral Tissues (Tongue Tie)
A tongue tie (ankyloglossia) or other oral tethered tissues can limit tongue movement.
This can make eating and swallowing harder:
Difficulty moving food around the mouth
Trouble clearing food from teeth and cheeks
Challenges forming a bolus for safe swallowing
Preference for soft, easy-to-swallow foods
How Orofacial Myofunctional Therapy Helps:
Identifies restrictions in tongue or lip movement
Works with specialists (like dentists or ENTs) for release if needed
Strengthens and retrains tongue movements post-release
Supports better chewing, swallowing, and speech
4️⃣ Chronic Tonsillitis or Enlarged Tonsils/Adenoids
Children with chronic tonsillitis or enlarged tonsils/adenoids may experience:
Pain when swallowing
Frequent infections making eating unpleasant
Sensation of food “getting stuck”
Preference for softer foods (i.e. buttered noodles, ice cream, cream cheese, yogurt, soft breads, etc.)
How Therapy Helps:
Coordinating with medical providers for assessment and possible surgical recommendations
Helping children relearn safe, confident swallowing after tonsil or adenoid removal
Supporting feeding skill development in recovery
5️⃣ Dental and Orthodontic Concerns
Jaw alignment and dental health also impact feeding.
Issues that can contribute to picky or selective eating include:
✅ Jaw misalignment (overbite, underbite, crossbite) making chewing difficult or uncomfortable due to the teeth not aligning properly
✅ Enamel wear from grinding (bruxism) causing sensitivity or pain when biting certain foods
✅ TMJ (temporomandibular joint) issues leading to jaw pain, clicking, or limited range of motion
These concerns can make children avoid certain textures or limit their willingness to chew tough foods (especially protein like chicken, steak, etc.) or crunchy foods.
How Therapy Helps:
Assessing chewing patterns and jaw function
Collaborating with pediatric dentists and orthodontists for evaluation and treatment
Providing exercises and strategies to reduce grinding, clenching, and TMJ discomfort
Supporting better jaw stability and efficient, pain-free chewing
6️⃣ Behavioral and Emotional Factors
For some children, picky eating is reinforced by behavioral patterns:
Power struggles at meals
Anxiety about new foods
Negative past experiences (gagging, choking)
How Feeding Therapy Helps:
Parent coaching to reduce pressure at meals
Positive experiences with food exploration
Creating a calm, safe eating environment
How TheraPlay LA Helps: Feeding, Orofacial Myofunctional, and Collaborative Care
At TheraPlay LA, we take an integrated approach to feeding challenges.
Assess sensory, oral motor, and behavioral factors
Create personalized treatment plans
Support families with strategies to make mealtimes positive
Desensitize sensory aversions
Orofacial Myofunctional Therapy:
Evaluate tongue posture, strength, and movement
Address tongue ties and restricted oral tissues
Improve chewing, swallowing, and oral resting posture
Dental and Orthodontic Collaboration:
Work with dentists, orthodontists, and ENTs to address structural issues
Coordinate care plans to optimize oral health and feeding success
Comprehensive, Child-Centered Care:
Build trust and reduce anxiety about eating
Help children develop skills for safe, confident, and varied eating
When to Seek Help
Consider an evaluation if your child:
Avoids entire food groups (e.g. vegetables, fruits, proteins)
Has feeding-related meltdowns
Has trouble chewing or swallowing
Gags or chokes on certain textures
Shows signs of teeth crowding, jaw misalignment, or teeth grinding
Eats fewer than 20 foods
Refuses to touch or interact with various foods
Has known tongue tie or airway concerns
Early intervention can make a big difference in reducing stress and building healthy eating habits.
Ready to Get Support?
At TheraPlay LA, we believe every child deserves to enjoy food, grow well, and feel safe and confident at mealtimes.
Contact us today to schedule a feeding therapy evaluation and learn how we can help your family thrive!
