July 13, 2017
Three years old blonde child looking at pizza piece in her dish with expression she does not like it, sitting in dark brown chair, in table with beige tablecloth at home, next to mother

Research shows a child takes eight to 15 exposures to a new food just to enhance acceptance of that food. Yet, most parents offer a new food to a child just three to five times before giving up on presenting it. As a speech-language pathologist who specializes in pediatric feeding, I have created a guideline for parents to give them research-based,  practical strategies for expanding their picky eater’s palette.

The Three E’s: Expose, Explore, Expand, is a systematic method of helping families create consistent exposures to a variety of foods, even when the child is a hesitant eater. Exposure and exploration might include sensory play, gardening, visiting farmers' markets or food pantries, and cooking.

Exposure and exploration also mean putting new foods on the child’s plate. I ask parents to start with one tablespoon of a new food on the child’s plate along with preferred foods, until he can tolerate the presence of these previously unfamiliar foods. You can work with caregivers to complete this chart to track new food exposure opportunities.

First, list all foods your client eats consistently. Second, list the foods they “sometimes” eat. This "sometimes" column usually generates the most stress for parents. “What if he doesn’t eat it this time? Will it eventually fall off his repertoire?”

The child needs more exposure to “sometimes foods” to achieve consistent acceptance. Once the child eats the “sometimes food” easily three times, move it to the first column. I also list foods the child used to eat, but recently stopped eating in the sometimes column.

Use the third—lightly shaded—column for foods you’re working on exploring in treatment. I select foods according to my client’s ability to safely bite, chew and swallow it. And I often begin these new foods as purees or finely chopped textures. Once the child can comfortably eat a food with me three times during sessions and with the parent present, we move the food to the “sometimes” column. Now parents can introduce this particular food at home.

This systematic process outlined on the chart provides a simple way to help generalize skills from sessions to family mealtimes. As we help our clients build familiarity with new foods, SLPs decrease anxiety and create a sense of ease with learning eaters. Yet, eating at home, away from our sessions, can spark those challenges again for many kids. Don’t worry—and tell parents the same—if eating the same foods at home doesn’t happen right away.

Families usually want to focus on the final column: “Foods Family Eats Often.” These foods show up frequently, so they already expose their child to them, if only from afar. If the child’s family eats pizza every Friday night, for example, or shares a certain food culture—vegetarian or ethnic dishes—then I need to know. I want to be respectful and thoughtful when helping a child learn to eat the foods the entire family loves. Those foods are often a part of family traditions, even if it’s pizza every Friday night.

Some family foods might present too many challenges for the learning eater, but feeding treatment includes strategies for helping a child progress slowly. For example, if my client eats grilled cheese consistently, but refuses cheese pizza, then I might list “cheese pizza” in the column of foods to approach during sessions. In addition, I list separate pizza ingredients just below—grated cheese, red sauce and plain pizza crust.

Over time, foods on the right side of the chart move column by column to the far left side of the page.

The key is keeping track of the exposures. Each exposure includes just one tablespoon of the food on the plate, presented at least three times in one week at any meal or snack. Instruct parents not to offer the same food with every meal and snack, because this can overwhelm their child! Make an X in a box to count exposures each week. Parents will quickly see how consistent offerings of food yields enhanced acceptance. Conversely, inconsistent exposures cause accepted foods to fall off a hesitant eater’s food preference list.

Melanie Potock, MA, CCC-SLP, treats children birth to teens who experience difficulty eating. She wrote the upcoming book, “Adventures in Veggieland: Help Your Kids Learn to Love Vegetables with 101 Easy Activities and Recipes.” Potock also co-authored “Raising a Healthy Happy Eater: A Stage-by-Stage Guide to Setting Your Child on the Path to Adventurous Eating (2015), “Baby Self-Feeding: Solid Food Solutions to Create Lifelong Healthy Eating Habits” and “Happy Mealtimes with Happy Kids, and produced the kids’ CD “Dancing in the Kitchen: Songs that Celebrate the Joy of Food!” Potock’s two-day course on pediatric feeding is offered for ASHA CEUs. She is an affiliate of ASHA Special Interest Group 13, Swallowing and Swallowing Disorders (Dysphagia). mymunchbug.com/contact-us/


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