Last updated on Feb 2nd, 2021 at 09:23 am

Feeding your family is complicated enough. Add a fussy eater to the mix and the dining room table quickly becomes a war zone.

“There is more to fussy eating than just being a picky eater,” says occupational therapist Tamryn Paulsen of Innova OT at A Really Good Therapist Centre in Johannesburg. “In today’s society, children are raised to be independent and make their own decisions. A common dilemma parents face is where to draw the line if their child shows a preference for specific food items – is the child simply exercising her autonomy or is she a fussy eater?
“It is perfectly normal for children of all ages to show a preference for certain food flavours, textures and even smells. In young children, oral exploration and gradual broadening of food variety is expected. Fussy eating, as defined in occupational therapy, is usually a result of underlying sensory processing difficulties. This results in hypersensitivity to food textures, smells and tastes, and can create significant problems around mealtimes.

ALSO SEE: 5 common types of picky eaters  and strategies to help you deal with them

Should I be concerned if my child is a fussy eater?

“Fussy eating is only considered to be an issue when it “negatively affects a child’s activities or daily life,” explains Tamryn. For example, a child may be unable to participate in a stress-free meal at home or school without anxiety, discomfort or emotional unease.

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Speech therapist and audiologist Ashira Segal, of Happy Kids in Johannesburg, says that fussy eating signs include:

  • Children who do not eat the same food as their families.
  • Gagging, choking or vomiting up food.
  • Food jagging (eating a certain food all day, every day).

“Fussy eating is quite common and is often misinterpreted as a child being naughty, or a parent being lazy when, in fact, the parent is fighting a daily battle to just get their child to eat,” explains Ashira.

Reasons for picky eating

Parents may not realise how many factors affect the relatively normal process of eating a meal. Some of these include:


Babies who are born early may struggle to feed, grow and gain weight. An orogastric tube (OG) or nasogastric tube (NGT) may be fitted. These are life-saving, but can cause hypersensitivity and muscle weakness later on.

ALSO SEE: 10 things you didn’t know about your premature baby

Spit up

Common in babies, it becomes a problem if gastroesophageal reflux disease (GERD) is present. This is painful, and the child then associates eating with pain.


This may be a sign that your child is having difficulty chewing or manipulating food. The vomiting is a biological coping mechanism.

Solid food struggles

New textures and flavours are exciting for many children, but others battle to transition to solids.


A child may consistently gag if she is having difficulty swallowing or coping with certain solids or textures. This can lead to an oral aversion to food.

Failure to thrive or being underweight

This may be a sign of fussy eating or an eating difficulty. Reasons include malabsorption, or not eating enough food.

Oral motor difficulties

These include an inability to chew, muscle weakness, hyper- or hypo- oral sensitivity, which makes certain tastes or textures unbearable.

Learning by example

Children can learn bad habits from parents, siblings and peers.

Oral sensitivity

This goes hand in hand with other sensory difficulties and can be addressed through occupational therapy.

Other underlying causes include:

  • Unstable core postural muscles that are necessary to sustain a good posture while eating.
  • Insufficient bilateral integration, midline crossing and hand-eye coordination, which are necessary for manoeuvring food from plate to mouth without spilling.
  • Inadequate fine-motor control and age-appropriate emotional processing, which facilitates a healthy relationship with food from a young age.