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What are the Key Indicators That a Client’s Picky Eating Might Be Rooted in Food Allergies?

Kristen Tompkins, OTR/L

March 1, 2026

Question

What are the key indicators that a client’s picky eating might be rooted in food allergies?

Answer

Before attributing feeding challenges to behavior or sensory processing, therapists must screen for underlying medical allergy issues through family interviews and symptom monitoring. Vital indicators include physical signs such as rashes, eczema, runny noses, and watery eyes, as well as gastrointestinal symptoms such as stomach aches, vomiting, or diarrhea. Even subtle symptoms, such as a "headband headache" occurring shortly after consumption, can signal a problematic reaction. If traditional sensory interventions are ineffective or these physical signs are present, therapists should assist families in using food diaries to identify triggers and facilitate a medical referral to a pediatrician.

 

This Ask the Expert is an edited excerpt from the course, Feeding Interventions With Allergy Considerations, presented by Kristen Tompkins, OTR/L.


kristen tompkins

Kristen Tompkins, OTR/L

With over 25 years of experience as a school-based occupational therapist in Las Vegas, NV, Kristen has developed a high skill level to navigate this unique and often challenging practice setting. She graduated with her bachelor’s degree in occupational therapy in 1996 from Loma Linda University and worked as a traveling therapist in adult settings for the first 2 ½ years of her career. Ultimately, she settled on school-based practice in Nevada. Throughout her career, she has regularly provided in-service training on various topics that impact therapy outcomes in the school setting. Based on her extensive experience with handwriting development issues, she is the author of the Construct>>Draw>>Write program, and she has also created TALL HOUSE/short mouse Adapted Writing Paper with a supporting flashcard activity to aid students in developing letter sizing and placement skills. 


Related Courses

Feeding Interventions With Allergy Considerations
Presented by Kristen Tompkins, OTR/L
Video

Presenter

Kristen Tompkins, OTR/L
Course: #6935Level: Introductory1 Hour
  'This was very informative!'   Read Reviews
This course provides a unique look at the treatment area of feeding disorders, with a particular focus on consideration of allergies and their impact on children who may be labeled "picky eaters" or as having "sensory defensiveness."

Visual Perceptual Motor Supports For Handwriting Development
Presented by Kristen Tompkins, OTR/L
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Course: #6919Level: Introductory2 Hours
  'Great course, even for seasoned therapists'   Read Reviews
This course/lecture will examine underlying visual perceptual motor issues that impact student acquisition of efficient, effective, and legible handwriting skills. Treatment strategies will be provided for therapist use, whether in direct therapy sessions or in consultation with parents and teachers.

Motor Supports For Handwriting Development
Presented by Kristen Tompkins, OTR/L
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Kristen Tompkins, OTR/L
Course: #6654Level: Introductory1 Hour
  'Very easy to understand'   Read Reviews
Underlying motor issues that impact fine motor development are needed for the acquisition of efficient and effective handwriting skills will be examined in this course. Treatment strategies will be provided for therapist use, whether in direct therapy sessions or in consultation with parents and teachers.

Foundations of Feeding Therapy for OTs: Anatomy, Physiology, Terms, and Tools
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Course: #5382Level: Introductory1 Hour
  'This presenter is extremely knowledgeable on the topic of feeding therapy! The course went really fast, squeezing in a lot of info'   Read Reviews
This course provides a foundational overview of the anatomy and physiology of the orofacial complex related to feeding therapy. The course also teaches commonly used terminology in this field of practice and provides an overview of therapeutic tools and their uses specifically for pediatric feeding therapy.

Using Adult Learning Theory To Enhance Coaching In Pediatric Feeding And Swallowing Intervention
Presented by Pam Smithy, MS, OTR/L, Rhonda Mattingly, Ed.D, CCC-SLP
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Pam Smithy, MS, OTR/LRhonda Mattingly, Ed.D, CCC-SLP
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  'The intervention strategies, collaborative plans, and techniques with family/caregivers were well explained and very useful to implement'   Read Reviews
This course describes the application of adult learning theory to coaching within pediatric feeding and swallowing interventions. Grounded in adult learning principles, participants will gain tools to effectively collaborate with caregivers to share knowledge, utilize evidence-based strategies, and foster confidence to encourage positive feeding and swallowing outcomes.