Food Chaining for Picky Eaters – How to go from selective to successful eater

Guest Blogger: Heather Reymunde Wittmer, MS RDN LDN

Food chaining can help parents of picky eaters to increase the variety of their child’s limited diet from the comfort of their own home.

What is food chaining?

Food chaining is a child-centered, individualized feeding technique used to increase the variety of foods your child eats. It is done by making gradual, small changes to characteristics of foods that your child currently eats and accepts. This method is based on the principle that a child will eat what they like (1). This process is used as a part of feeding therapy, and is especially helpful and effective when working with children who have sensory or texture aversions or extreme picky eating. It helps children transition from an accepted food to a new food through a series of gradual changes to sensory qualities like texture, color, taste, temperature, or smell.

Research on Food Chaining

Food chaining appears to have recently gained momentum in practice. While the practice has been around for over 20 years, it has little published research. A small study published in 2006 assessed the efficacy of food chaining in treating children with severe selective eating. The study found that all the participants were able to increase their number of accepted foods over a 3 month period while using this method. The median number of accepted foods at the beginning of the study was 5 (with a range of 1–10). At the end of 3 months the median number of new/target foods was 20.5 (with a range 8 –129). To find a full copy of the study check out the link below. (2)

Who is involved?

Parents play a key role when it comes to food chaining. Before getting started, parents should seek advice from their pediatrician or family doctor to discuss current nutritional status or other nutrition concerns. The next step would be to schedule an appointment with a Pediatric Registered Dietitian Nutritionist (RDN) to assess current nutritional intake, growth, and nutrient needs. A dietitian will help the family and the patient set attainable goals and will guide the family in the food chaining process. Other practitioners that may be involved throughout the process are Speech Language Pathologists (SLP) to assess chewing/swallowing issues and Occupational therapists (OT) to assess feeding skills.

When and where can food chaining be done?

Some traditional feeding therapies such as outpatient weekly feeding therapy, or an 8-week, inpatient program with healthcare professionals can feel quite invasive. However, food chaining can be done from your own home, with you, (the parent) as the facilitator. By utilizing this method at home, along with the guidance of your feeding care team, you will have support from your health care practitioners while your child learns to eat a variety of foods in a more comforting environment. The process can begin as soon as your child’s food preferences are determined, as discussed in the following steps.

How does it work?

Food chaining is completely individualized based on the current intake of your child. The process starts off with a food that is currently accepted by your child and each food introduced has some similarities to the accepted food. Some children may only require 4 steps/links in their food chain, while others may require 5-6 or more links. Before beginning food chaining, there are steps that should be taken to determine your child’s preferences.

How to make a food chain:

• Step 1: Make a list of all of the foods your child currently accepts, previously accepted and always rejects
• Step 2: Assess the textures, colors, flavors, smells and temperatures of the currently accepted foods.
• Step 3: Group foods together by their similarities. At this step you will observe your child’s preferences and have a good idea of the best starting places for your child. Example: my child likes foods that are crunchy and salty.
• Step 4: Slowly add foods with similar characteristics until each new food is accepted
• Step 5: Continue through your chain until you reach your target food.

Example of a food chain:

1. BRAND Chicken Nuggets
2. NEW BRAND chicken nugget
3. Baked Fish stick
4. Baked fish with breading
5. Baked Fish!

Tips:

• Brand new foods can be added throughout the process as your child begins to accept more and more foods.
• 2. A rating scale is also a helpful tool to assess how each item has been received.
• 3. Do not be afraid to try new foods with dips and sauces at first and slowly reducing those as acceptability has increased.
• 4. If you need some food chaining examples, you can my previous article with a ton of examples and more guidance on food chaining here.

To find out if food chaining is right for your family, talk with your pediatrician, pediatric dietitian or speech therapist and check out other resources from Littles Nutrition

References/Tools:

1. Food Chaining, The Proven 6-Step Plan to stop picky eating, solve feeding problems and expand your child’s diet. Cheri Fraker CCC-SLP, CLC, Mark Fishbein, MS, Sibyl Cox, RD, LD, CLC, and Laura Walkber, CCC-SLP, CLC.
2. Food Chaining: A Systematic Approach for the Treatment of Children
   With Feeding Aversion https://www.researchgate.net/publication/7222254_Food_Chaining_A_Systematic_Approach_for_the_Treatment_of_Children_With_Feeding_Aversion