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Kids needing feeding clinic intervention are the pickiest of the picky. Their super picky appetites have frustrated their parents to no end. They tend to have more dental problems, get sick more often, and can have more developmental delays or behavior problems. They don’t eat well, have a very short list of acceptable foods, and don’t grow well as a result.

Why are they doing this? The feeding clinic approach doesn’t ask why, but operates from a cognitive approach – that is, it’s assumed kids are doing this by some choice on their part. Feeding clinics are part behavioral intervention, part social group (peer pressure is leveraged to help kids try more foods), and part occupational therapy. They try strategies to get little ones eating more, by pressuring them to push through texture aversions, gagging, squirreling food in their cheeks, spitting food out, or rigid beliefs about foods.

I’ve met a lot of feeding clinic flunkies – kids who stumped teams of psychologists, speech and language pathologists, GI doctors, and occupational therapists. What went wrong?

In some cases a swallowing issue is found, and an occupational therapist as well as a speech and language pathologist can help this. Otherwise, it’s often assumed that there is no physical rationale for the child’s eating pattern, that it is purely psychological.

But that’s rarely the whole story, in all the kids I’ve met with feeding problems this deep. I often end up finding a physiological backstory. And when that is defined, it can be fixed; when that is fixed, appetites can improve. Eating becomes a non-issue, stress for the entire household drops several notches, and the child can begin eating and growing normally again.

What physiological gaffes can create a picky eater monster? Here are the usual suspects:

1 – Reflux medication. These lower appetite over time, and make everything harder to absorb from the gut. My opinion? These medications are rightfully earning a bad reputation. They are over-prescribed for infants and children. They are associated with lesser bone density (and fractures in older adults), and lower digestive capacity in general. They make it harder for many nutrients to be absorbed, notably, minerals like calcium and iron, and vitamin B12. Reflux medicines also let fungal infections (Candida or yeast) flourish at the expense of healthy gut microflora. I have seen at least one case of stunting due to long term use of reflux medicine. Leaving a baby on this medication during crucial developmental years means optimal levels of nutrients will not reach brain, bones, and body tissues.

Reflux medications leave food sitting longer in the stomach, because they reduce digestion. Food will remain poorly digested. The result can be constipation or loose stools, bloating, gas, more reflux, and – never feeling very hungry. Strategies to wean off reflux medicines – and how to avoid them in the first place – are discussed in detail in Special Needs Kids Go Pharm-Free. Be sure to tell your doctor if you would like to wean this out of your child’s regimen.

2 – Intestinal candidiasis. This is a Candida (yeast) infection in the intestine or GI tract. While Candida microbes are a usual resident of a human gut, they can take over and grow too much. This makes kids more picky for sugary, starchy, smooth foods. A yeast-heavy GI tract also tends to have a pH that weakens digestion. The result is a little like too much reflux medication: Bloating, gas, constipation or loose stool, and picky appetite. Treating the yeast infection with the right medication, diet, herbal tools, or probiotics can move your child to eating healthfully and heartily. In my practice, I use stool and urine tests to detect how much yeast is growing in the gut, and to see what might herbs or medicines might best clear it out.

3 – Food sensitivities. Food allergy is not so hard to see: Usually there are hives, rashes, eczema, stomach pain, tingling at lips, tongue or throat, or vomiting. But food sensitivities can have few obvious symptoms, other than weak picky appetite. I test for these in my practice with a blood test called ELISA IgG to specific foods. We find problem foods, and figure out how to rotate them. This can help your child feel less discomfort when eating, and can help reduce the texture aversion part of the story.

4 – Mineral deficiencies. Picky eaters usually have poor mineral status in their blood and tissues. Iron, zinc, and other minerals all influence appetite. These can be checked with blood tests, but there are also easy to check clinical signs for mineral deficiency states too. See Special Needs Kids Eat Right for a table on detecting mineral imbalances without drawing blood. Restoring good minerals can lift a picky appetite.

If you have an epically picky eater, take heart – there are many nutrition strategies that may crack this nut for you. See either of my books for details.

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