Anxious Eaters Defined

Marsha Dunn Klein, OTR/L, MEd, FAOTA

December 9, 2019



Who are anxious eaters?


There can be a lot of different terms that are used, but for the purpose of this talk today, we are going to refer to these children as anxious eaters and look at the worry aspect of what is going on with their eating. We are going to talk about children who are worried about a very specific look, a very specific sound, smell, texture, or taste for foods. Changing from any of those sensory variables is very worrisome for this crowd, and we are going to look at the big concepts of worry and change when those are difficult for these kids. Some of these kids have a diagnosis of food neophobia. This is a term that was coined a while back, Leanne Birch popularized it, and they talked about the fear of a new food introduction. I like that term a lot for these kiddos because many of them are actually fearful and overly worried about new food presentations. However, Leanne Birch and others talked about this as being a typical stage in toddler development. However, I think the children that we are talking about today are not typically developing toddlers that get a little bit picky for a while and then outgrow it. These are children where the food worry is really real.


  • Food neophobia

  • Sensory processing disorders

  • Autism

  • Obsessive-compulsive or anxiety disorder

  • ARFID (Avoidant Restrictive Food Intake Disorder)

  • What they ALL have is worry

Some of these children have sensory processing disorders, like diagnoses, but we have many children with sensory processing disorder diagnoses who do not have any eating issues. So, this term does not work that well. Many children with a diagnosis of autism do have picky eating and anxious eating issues; however, again, not all children with feeding challenges have autism. Some of these kiddos have obsessive-compulsive or anxiety disorders that are diagnosed or undiagnosed. It might fit with the Avoidant Restrictive Food Intake Disorder (ARFID) crowd, but there is a lot of controversy and discussion about whether that term fits all of these children, and who should treat them. 

marsha dunn klein

Marsha Dunn Klein, OTR/L, MEd, FAOTA

Marsha Dunn Klein OTR/L, MEd, FAOTA is a pediatric occupational therapist who has spent a career specializing in pediatric feeding challenges. She received her bachelor's degree in occupational therapy from Sargent College of Boston University in 1971. She received a master’s degree in education with an emphasis on special education in 1975 from the University of Arizona. Marsha has co-authored Pre-Feeding Skills editions one and two and Mealtime Participation Guide, Homemade Blended Formula Handbook with Suzanne Evans Morris and Feeding and Nutrition for the Child with Special Needs with Tracy Delaney. She lives in Tucson, Arizona and travels to present locally, nationally and internationally on pediatric feeding issues.

Related Courses

Crumbs as a Tool in Pediatric Feeding Transitions
Presented by Marsha Dunn Klein, OTR/L, MEd, FAOTA


Marsha Dunn Klein, OTR/L, MEd, FAOTA
Course: #3991Level: Intermediate1 Hour
  'Very concrete practical things I can use in practice'   Read Reviews
This practical course will describe the use of crumbs as a bridge to sensory and motor transitions in feeding therapy to support the clinician and family. The goal with crumbs is child success and comfort, worry reduction, and parent success.

Anxious Eaters and Anxious Mealtimes
Presented by Marsha Dunn Klein, OTR/L, MEd, FAOTA


Marsha Dunn Klein, OTR/L, MEd, FAOTA
Course: #4452Level: Intermediate1 Hour
  'Specific examples and intervention ideas'   Read Reviews
This practical webinar will identify who are anxious eaters and outline sensitive and systematic ways to support these worried eaters and their families in mealtime peace and expanding diets. The approach is based on the responsive feeding principles of the Get Permission Approach that begins with child success and tiptoes towards change with small positive and compassionate steps.

Supporting Infants With Visual Impairment With Feeding
Presented by Marsha Dunn Klein, OTR/L, MEd, FAOTA


Marsha Dunn Klein, OTR/L, MEd, FAOTA
Course: #4542Level: Introductory1 Hour
  'Very thorough and informative course'   Read Reviews
We will discuss the developmental characteristics of children with visual impairments and specifically how these children develop trust in the feeding relationship. Strategies for breast and bottle feeding and transitions to solids and utensils will be presented in support of parent success.

Ultrasound as a Therapeutic Intervention
Presented by Andrew Starsky, PhD, PT


Andrew Starsky, PhD, PT
Course: #1410Level: Advanced2 Hours
  'clear explanation of US modality and how it works and how it should be used'   Read Reviews
This course will review the application, physiology, and evidence behind the use of ultrasound as a therapeutic intervention. Indications, contraindications, and precautions will be examined as well as the evidence base that supports the appropriate use of ultrasound.

Please note: This course is also offered in a series of recordings titled "Series on Modalities: Thermal Therapy and Ultrasound", course 1798 which is offered for AOTA/0.4 and NBCOT/5.0.

This course is part of the “Hand and Upper Extremity Review Series.”

Ethics in Rehabilitation: A Clinical Perspective for Occupational Therapists
Presented by Kathleen Weissberg, OTD, OTR/L, CMDCP, CDP


Kathleen Weissberg, OTD, OTR/L, CMDCP, CDP
Course: #1574Level: Introductory1.5 Hour
  'Break down of components of ethics'   Read Reviews
Very simply stated, ethics guide the determination of right and wrong in moral life and also extending into professional life. This seminar will review principles of ethics as they relate to occupational therapy practice, will review common ethical dilemmas including fraud and abuse and give participants 2 frameworks to analyze the ethical issue and contextual considerations.