Ask: Is a grandson's grazing cause for worry?

Joan Dietrich Comrie of Carolina Pediatric Dysphagia has dedicated her entire career to studying, teaching and practicing in the area of dysphagia, specifically pediatric dysphagia.Â
Joan Dietrich Comrie of Carolina Pediatric Dysphagia has dedicated her entire career to studying, teaching and practicing in the area of dysphagia, specifically pediatric dysphagia.Â

Q. My grandson is nearly four but only weighs about 30 pounds. He basically refuses to eat full meals. Instead, he grazes: very small amounts 4-5 times a day, and mostly carbs. He does not eat meat or vegetables. His older brother, who's 6, will try almost anything. My daughter and son-in-law have family meals every day. No one leaves the table until everyone is done, and the little one does not get dessert if he doesn't eat at least half of what's on his plate. Needless to say, he rarely gets dessert. And, he doesn't care.

He was not a good eater from the day he was born. I'm pretty worried about him. He will eat cereal, french toast, pancakes, sometimes bacon and, of course, cookies, cake, candy if he's given them. but not much that has any nutritional value. Even when he is given sweets, he'll take one or two bites and then he's done. Should I be worried about his eating habits? Is there anything we can do to make him a better eater? -- Grandma Barbara

A. Grandma Barbara, you have good reason to be concerned. Be assured that you are not alone. We see many children like your grandson every day. There are many things that can be done to help your grandson make healthy food choices.

First of all, you daughter and son-in-law are doing the right thing by having family meals. They need to continue to have stress-free meals. Increased stress only decreases appetite.

When we see children who present with behaviors like your grandson's, we want to address all of the systems that could interfere with a child’s ability or motivation to make healthy food choices.

Given his behaviors, I would wonder if he had or still has reflux. Some children that have or had reflux as an infant spit up all the time and are irritable. But not all children with reflux spit up. The children with non-regurgitive, or silent, reflux are the tricky ones because they don’t give obvious signs of reflux. We know that kids with reflux link the pain of reflux with eating and are often very poor eaters.

If he fed better when distracted or when sleep- or dream-fed, he may not have the body cues of satiation and hunger. That may be why he doesn’t care if he doesn’t get dessert. He may just really not like to eat.

One needs to make sure that his gut is healthy. Infrequent bowel movements, constipation, thrush or diaper rash as an infant all could indicate problems. Food in the bowel movement is a sure indicator a child is not chewing his food well enough to be processed by the body. That can cause or contribute to difficulty gaining weight and can cause stomachaches.

The largest system that we as speech pathologists that specialize in pediatric feeding disorders/dysphagia can impact is feeding behaviors and the oral (mouth) sensory and oral motor system. Children with oral sensory and oral motor feeding problems prefer carbs because carbs are relatively easy to eat. They provide loud sensory input (crunch) that allows a child to know where the food is in the mouth, and with saliva, it quickly turns into mush so that even the poorest chewer is able to swallow the food without much difficulty. A piece of broccoli or chicken, for example, will stay in its original form for a very long time (days even) if not chewed. It is a lot harder to swallow a chunk of food than it is to swallow mush. I would guess that your grandson does not have adequate chewing skills to feel comfortable eating and swallowing vegetables or meats. And given the fact that he limits his volumes, he may have something going on in his gut that makes him feel uncomfortable when he eats.

Unfortunately, these feeding difficulties most often do not go away by without intervention. If he has not developed these skills by now, it is highly likely that he will not develop them without help. I would suggest that you encourage your daughter to have your grandson complete a feeding evaluation by a practice like Carolina Pediatric Dysphagia that specializes in pediatric feeding and swallowing disorders. We will establish a feeding treatment plan based on the results of your grandson’s evaluation. Length of treatment depends on a variety of factors including: severity of the problems and interfering problems, ease of working with the child and the caregiver’s ability to attend therapy sessions, follow the feeding plan and complete home program activities. If you have any additional questions, my contact information is on our website:

If you have a question about your child's health or happiness, ask Joan or any of our experts by sending email to

Joan Dietrich Comrie of Carolina Pediatric Dysphagia has dedicated her entire career to studying, teaching and practicing in the area of dysphagia, specifically pediatric dysphagia.  She received her bachelor of science degree and then her master of science degree in the area of speech pathology at the University of Wisconsin-Madison in 1986.  Before starting Carolina Pediatric Dysphagia in 1996, she worked at several hospitals (Cardinal Hill Rehabilitation Hospital, Lexington, Ky., Vanderbilt Medical Center, Nashville, Tenn., and WakeMed, Raleigh) where she developed or reorganized the hospital's pediatric dysphagia program. Joan has spoken on the topic of pediatric dysphagia nationally and internationally.  She has published in a professional journal.  She co-taught the first dysphagia course offered at UNC and continues to guest lecture to several university graduate level speech pathology programs and to the UNC Medical Students who complete their rotation at WakeMed. She has served as chairwoman and member of a subcommittee of the Special Interest Division #13 of the American Speech Language Hearing Association (ASHA). She has received her certificate of clinical competence (CCC) through ASHA and is licensed in the state of North Carolina.