By Angela Gartner
Tasting and eating certain dishes can be seen as a joyful experience. However, for people who struggle with textures, smells, how the food looks or feels in their mouths, or those who have trouble swallowing, it can be a stressful event.
Typical picky eating is a normal developmental stage for many children, but food avoidance is different, says Esther Verbovszky, M.A., CCC-SLP, owner of Cleveland Feeding & Swallowing Center, and founder and CEO of Star Center Foundation.
“The individual may eat an extremely limited number of foods, refuse entire food groups, become distressed by certain textures, smells, temperatures or appearances, and the restriction begins to affect nutrition, health, daily life or family life,” says Verbovszky, who has more than 30 years of experience in helping infants, children and adults overcome feeding, swallowing, voice and oral-motor challenges.
She says that food avoidance for people with special needs is much more common than people realize.
“Research tells us that about one in four children experience some type of feeding difficulty during development,” Verbovszky says. “Among children with autism, studies have found feeding challenges in approximately 46% to nearly 90% of children, depending on the population studied. “
She adds that feeding challenges are also common in individuals with Down syndrome, cerebral palsy, developmental delays, genetic conditions, neurological disorders, gastrointestinal disorders, and adults recovering from stroke, head and neck cancer, Parkinson’s disease and other medical conditions.
Verbovszky says the important thing to remember is that these challenges don’t magically disappear when someone turns 18. Many adults continue struggling with sensory issues around food throughout their lifetimes.
Verbovszky provides us with some answers to common questions about how to help individuals and their caregivers when dealing with food avoidances.
What are the most common causes of food avoidance in individuals with special needs?
Verbovszky: There usually isn’t just one reason. I often tell families that food avoidance is like peeling an onion. As you uncover one layer, you often discover another.
Sometimes it’s sensory processing. Sometimes it’s reflux, constipation, allergies, oral pain or swallowing difficulties. Other times it’s oral-motor weakness, anxiety after choking, difficulty chewing, developmental delays, or simply years of stressful mealtimes.
That’s why I never assume someone is “just refusing.” I assume there’s a reason, and my job is to find it.
What role do sensory processing differences play in food avoidance?
Eating is one of the most sensory experiences we have. Before food ever reaches our stomach, we’ve already looked at it, smelled it, touched it, heard it crunch, felt its texture in our mouth, and tasted it.
For someone with sensory processing differences, those experiences can be completely overwhelming. What looks like refusal to us may actually be their nervous system saying, “This doesn’t feel safe.”
Some individuals are sensitive to textures, others to temperature, smell, color, sound or even how food is presented on the plate. Something as simple as changing brands can completely change how that food feels to them.
Instead of asking why they’re refusing, I encourage families to ask, “What about this food is difficult?” That one question changes everything.
How do you determine whether food avoidance is sensory-based, behavioral, medical or a combination?
I spend far more time asking questions than giving answers in the beginning. When did this start? Has the child ever choked? Do they have reflux or constipation? What foods do they accept? What textures are difficult? Do they cough? Gag? Get congested? Does it happen at every meal or only with certain foods? Can they chew? Can they move food around in their mouth? What changed?
Every behavior has a reason. What many people call “behavior” is often the result of an underlying medical issue, sensory difference, or feeding-skill challenge. Sometimes a child begins avoiding food because eating hurts. The medical issue improves, but the fear remains.
If meals are stressful every day, if your child is eating fewer and fewer foods, if they gag, choke, cough, vomit, cry around meals, eliminate entire food groups, or you’re making multiple separate meals every day just to get through dinner, it’s worth having an evaluation.
Nutrition isn’t the only concern. Feeding affects development, social participation, school, family relationships and quality of life.
The earlier we identify the problem, the easier it is to help.
As a practical guideline, I become especially concerned when someone consistently eats around 12 foods or fewer, particularly if they continue losing foods instead of gaining them. That tells me we need to look much deeper at what is driving the avoidance.I tell families not to wait until their child loses weight.
How can families help ensure nutritional needs are met while respecting sensory sensitivities?
The goal isn’t to remove every preferred food. The goal is to build from what feels safe.
Families should continue offering accepted foods while gradually introducing similar foods, work closely with their medical team and dietitian when nutrition is a concern, and remember that progress happens one step at a time.
Respecting sensory differences doesn’t mean giving up. It means creating a bridge instead of forcing someone to jump across the gap.
What are the biggest misconceptions about food avoidance and sensory issues?
One of the biggest misconceptions is that people will eat if they get hungry enough. Many won’t. Their fear, pain, sensory discomfort or swallowing difficulty can become stronger than hunger itself.
Another misconception is that food avoidance is caused by poor parenting. Families are usually doing the very best they can with the information they have. I believe parents deserve support, not blame.
How do you help someone gradually expand the variety of foods they eat?
I believe in creating curiosity, not compliance.
We might start by looking at a food, touching it, smelling it, playing with it, kissing it, licking it, or exploring it with our hands before anyone ever asks for a bite.
Food doesn’t have to be scary.
In my therapy sessions we paint with pudding, dig through brown sugar for hidden treasures, build with vegetables, make silly faces with fruit, and celebrate every tiny success.
Learning should be enjoyable. When people feel safe, they’re much more willing to try something new.
How can families make mealtimes less stressful?
Pressure almost always creates more pressure. Force-feeding, bribing, threatening, insisting on a clean plate, hiding foods without someone’s knowledge, or turning every meal into a battle usually increases anxiety rather than improving eating.
Instead, I encourage families to become food detectives, not food judges.
Be curious. Keep meals predictable. Offer at least one safe food. Celebrate exploration, not just eating. When the pressure comes down, curiosity often goes up.
What are realistic expectations
for progress?
Progress isn’t measured only by bites swallowed. Sometimes progress is sitting at the table without crying. Sometimes it’s touching a strawberry for the first time. Sometimes it’s smelling a food they’ve avoided for years — those are victories.
The goal isn’t perfection. The goal is helping someone become healthier, safer, more confident and more comfortable around food.