Imagine sitting your infant down in the highchair for the first time to try solids. As you film the moment, your baby puckers his lips, spits out the puree and turns his head. Mealtime doesn’t improve with time. Instead, food refusal becomes more intense with every meal.

While your friends’ children are happily gumming puffed kale at the park, you can’t imagine offering food in public. You feel exhausted and isolated.

If your family has experienced difficult mealtimes, you’re not alone. I have been honored to support hundreds of families on their PFD journey as an occupational therapist and feeding specialist. Yes, for some children food refusal is a naturally occurring developmental stage, but for others it’s a sign of pediatric feeding disorder (PFD).

Mealtime Behavior Is Communication

All behavior is communication. Children’s communication skills develop over time, and many children are not fully equipped to manage intense emotions mealtimes can evoke. A child may use actions such as leaving the table or display strong emotions such as crying and screaming when their first attempts at communication aren’t heard.

Miscommunication and misinterpretation of communication behaviors can be exhausting for both the parent and the child. Mealtime stress signs may look like:

• Pursed lips
• Head turning
• Throwing food
• Leaving the table
• Gagging
• Retching
• Vomiting
• Screaming
• Tantruming
• Hitting

Causes of stressful behaviors at mealtime

While mealtime behaviors may look similar to families who are struggling to nourish their child, the reasoning behind the communication can vary. Children don’t want to eat and are afraid to eat for many reasons. Some conditions that can cause mealtime stress include the following:

• Food allergies
• Constipation
• Sensory sensitivities
• A structural or anatomical issue in the gastrointestinal tract or esophagus
• Alternate interpretations of food and food properties
• Medical complications in the lungs, heart or brain
• Pediatric feeding disorder (PFD)

Siblings of children with mealtime stress also may be impacted. Research shows that families with one child who struggles during meals are more likely to have multiple children who do.

How to improve your child’s behavior during meals

The underlying reason for your child’s stress behaviors during meals will help you determine your next steps. For example, if your child has a developmental delay or is neurodivergent, they may have more difficulty communicating their needs. They may need support to communicate without extreme stress.

Children who have a physical condition impeding their ability to eat may need support addressing the physical issue before they feel confident eating new or more complex foods.

Whatever the etiology (cause), it’s important to first ask, “What is my child communicating?” Acknowledge their feelings. Never force your child to eat. Seek support. Speak with your child’s pediatrician and share your concerns. Children who are struggling to eat can and do make progress with proper support.

Get help for stressful mealtimes and behavior concerns

Children learn to eat over time. As they grow and develop, their bodies support new feeding and eating skills. By the time a child is five, they will have mastered most oral-motor skills needed to eat a varied and textured diet. But the adventure of learning to eat new foods never ends.

Negative mealtime behaviors during these developmental years can be devastating to any family. Mealtimes should be positive, safe and enjoyable. If you dread mealtimes, this compounding stress can impact other areas of your parent-child relationship. In extreme cases, it can impact every interaction.

It doesn’t have to be this way.

Talk to your doctor if you’re feeling stressed about feeding or are concerned your child is not getting good nutrition.

Prepare for this conversation by taking Feeding Matter’s Infant and Child Feeding Questionnaire© (ICFQ) and print out or email the results to your pediatrician. This educational tool highlights red flags and builds a more concrete picture of your child’s feeding behaviors.

You may also find it helpful to bring a mealtime record of what, when and how your child eats. A short mealtime video also can be useful to share with your pediatrician.

Your doctor can help rule out medical complications and connect you with other professionals, such as occupational therapists and speech language pathologists with specialized training in feeding. These professionals will help you develop and embed new strategies and behaviors into your family’s daily routines.

The skills needed for safe and pleasurable mealtimes take time to develop. Your therapist should partner with you to identify strategies that will be safe and successful for your child.

Click here to take Feeding Matter’s ICFQ. Find a feeding specialist in your area by visiting Feeding Matters’ Provider Directory. Cuyler Romeo is Director of Strategic Initiatives at Feeding Matters and a clinician at Banner-University Medical Center’s NICU.