Identifying a feeding problem is not easy. There is neither an accepted definition nor classification system. What is accepted is the need for early recognition and treatment to prevent simple feeding problems from becoming pervasive or resistant to treatment.
Separating a feeding problem from a “picky eater” starts with talking with your pediatrician about your concerns. It’s understandable that a parent may push their child to eat foods when they refuse. If, on the other hand, your child prefers to drink rather than eat, won’t transition from purees to semi solids, coughs or gags, has difficulty moving food around the mouth, chewing, and/or swallowing, all of these symptoms may be related to an underlying medical condition and prompt an 
evaluation.
A feeding assessment should address the whole child as feeding difficulties usually involve more than one issue. Children with chronic reflux, for example, quickly learn to refuse to eat because it hurts when they burp acid back up into their throat. Children with sensory processing issues, such as apraxia or problems with muscle tone, frequently have feeding problems. In most instances, a thorough evaluation will separate the “picky eater” from a child that has behavioral, physiological, and/or structural issues impacting the child’s ability or willingness to eat appropriately.
Before the evaluation begins, the therapist will review your child’s health and developmental, feeding and growth history. During the evaluation, an oral motor and swallowing assessment will be performed to look for physical problems. Sometimes a swallow study will be required to look for structural and/ or physiological abnormalities. Watching the child eat or be fed is important. Taking an inventory of the foods that the child eats and/or refuses and amount consumed per feeding is taken into account.
If therapy is required, intervention will take time…lots of time. Eating is a developmental process. If your child has issues, it usually means that they are “stuck” in the middle of learning a new skill. The therapist will have to identify the problem (eg. lateralizing food from the center of the tongue to the teeth) and then step by step teach your child the necessary skill(s) to contain, manipulate, and swallow foods to reach the goal of independent, health eating. It takes time as the therapist will have to do a lot of detective work to determine the factors inhibiting your child’s development. In most cases, each element has to be resolved one at a time. Family dynamics are a big part of feeding therapy as it’s an emotional issue. When feeding is challenging, it is stressful and impacts the whole family each and every day.
If you are concerned about a feeding issue, you’re not alone. One in four children have feeding problems. As a parent, you are the most important part of the treatment process as you spend the most time with your child. Don’t hesitate to get help.