Why " They'll eat when they're hungry" Doesn't Work With Every Child.

Child crying and refusing food offered them

We all have those people in our lives, although well meaning, they give advice based on their experience and genuinely believe it applies to your situation. They'll say things like " just put the food in front of them, and if they refuse. Too bad. No snacks until the next meal." You may have also heard " You've spoiled them. If they are hungry they will eat." Specifically regarding the topic of food refusal, or picky eating. There are of course, instances when a child refuses to eat what is offered because they have learned that when they cry and throw a tantrum they will eventually get their way.

This is not true for all children who exhibit food refusal, picky eating, or who demonstrate behaviors such as crying, avoiding meals, and trying to escape from their high chairs, for example. This is especially not true for those children who are diagnosed on the spectrum. Individuals diagnosed on the spectrum can present with difficulty perceiving internal cues, known as interoception, such as hunger and satiety among other sensations. You can see how "They'll eat when they are hungry" can be problematic if they don't sense hunger. They are more likely to present with food avoidance or selectivity because of sensory aversions and possibly other underlying medical conditions such as GERD ( gastro-esophageal reflux disease). While it is possible that a child avoids certain textures because let's say their sensory receptors haven't been desensitized to lumps in purees or they are hypersensitive to biting down on crunchy textures, and yes, sensory based feeding therapy will help them overcome these challenges overtime. It should also be noted that GI issues, even dental issues can be a reason for food avoidance.

It's not just kids who are on the spectrum either. Children with food allergies, and food intolerances that result in discomfort somewhere along the digestive tract such as inflammation in the esophagus or who experience gastrointestinal distress or discomfort after eating certain foods, can develop food avoidance or a negative association with mealtime. They don't know yet how to explain what they are feeling, so outside of the obvious symptoms- vomiting, diarrhea, skin rashes, throat closure- you have no way of knowing what is happening and therefore can't tease out the foods triggering their symptoms. So what do you think their natural response to mealtime is going to be? Step into their shoes for a moment. Sometimes, when you sit down in that high chair to eat, within a few minutes, your stomach cramps, you become so gassy its painful, or you feel as if food is stuck in your throat. Do you think you're going to look forward to mealtime? Or, since you can't fully express yourself verbally yet, are you going to do everything in your power to avoid sitting in that high chair, and push the bowl of food away from you while you wiggle your way out?

This information isn't meant to scare you. It's meant to provide you with information to make the best decisions for your kiddo or loved one. From the questions to ask your doctor or therapist, which referrals to seek out, and even possibly provide the labels for what you are seeing or experiencing.

So, now what? You've noticed changes in behavior around mealtime.

Get a notebook. Any notebook. If mealtimes are challenging, or you notice changes in behavior prior to, or post mealtime. You notice they are experiencing symptoms of indigestion, changes in stool, vomiting, etc. Don't panic, don't go down the internet m.d. rabbit hole. You need data. You need to organize your observations so you can clearly and concisely describe what is happening to your child's doctor to get the right referrals and evaluations. You need to record the date, time of day, what they ate and drank, try your best to record how much they ate and drank, and how they behaved before the meal and after. All of this information will help you see patterns overtime and make it easier to figure out what is going. It's going to look something this:

NOTE: This is not a recommended diet. This is a fictional entry based on a combination of several past clients entries.

1/1/25- morning woke up happy

6am- 3-4oz milk from bottle after waking up

7am- 1/4cup oatmeal, 5 banana slices, approx 2 tbsp of scrambled eggs, some sips of water

8:30-seemed cranky tummy looked bloated

10am gassy, cranky

11:00 refused snack, refused to sit in high chair

fell asleep at 11:15

afternoon 12:30 requested bottle drank 2-3oz

soft bm ( bowel movement)

1:30 ate from my plate- 6 pieces of roti dipped and soaked in dal

some water

3pm 1/2 strawberry yogurt

4:45pm drank 1/2 water 1/2 apple juice approx 4oz

happy, playing, showed no signs of discomfort

6pm 1/4 cup rice and dal, 2 tbsp plain yogurt, few sips of water

Is the above extra work? Yes, but overtime you might be able to notice this child prefers soft foods and after every entry when they had oatmeal, bananas and eggs, they experienced discomfort related to excess gas and halfway through their day when you changed them, they had soft stool. Is it the combination of oatmeal, bananas and eggs? Is it just eggs, or do any products made with eggs make them flatulent? You'll only know if you write it down. Recording meals, time of day and behaviors exhibited, can help you answer that question. Then you can take that notebook and talk to your doctor. Can they provide a referral for a feeding therapy evaluation and then a script for feeding therapy? Do they avoid harder solids, and crunchy foods because of sensory aversions, or is it due to a weak chew? An OT or SLP who is a feeding therapist can help you answer that question.

You can also decide whether you need a referral to an appropriate specialist- pediatric gastroenterologist, or allergist- to find out if this is a food intolerance, an actual allergy to a specific food or if there is the possibility of a medical condition. Does your child needs to avoid eggs, and products with eggs in them. Are they itchy, do they experience swelling around their lips and eyes, or is flatulence the only only symptom? If it's just a matter of avoiding the banana, oatmeal and egg combination, you'll see it as plain as day. The day you give eggs and a soft bun with hummus for breakfast, they are perfectly fine. Then you tried oatmeal, bananas, and scrambled eggs and they were gassy again. Or you notice whenever they have eggs and anything made with eggs ( pancakes, muffins, etc) they experience discomfort and you get the sense there is a real problem with digesting eggs in any amount or product.

Bottom line, with a notebook full of pertinent information, the data will be there for you and your doctor to easily reference and make informed decisions. After that, it's up to you to decided if and how to respond to a dismissive "They'll eat when they are hungry", statement.

Note: As of 10/31/25

If you're a therapist and you need continuing education credits, I highly recommend a course titled "Feeding Interventions with Allergy Considerations" by Kristen Thompson OTR/L available on SpeechPathology.Com. Within the course she provides two food lists that are incredibly useful while working with clients who have food allergies. This is not a paid advertisement. It is a short but informative course that I found useful and since it is relevant to this post I have included the citation and link in the references section.

References:

Adams, K. L., Murphy, J., Catmur, C., & Bird, G. (2022). The role of interoception in the overlap between eating disorders and autism: Methodological considerations. European eating disorders review : the journal of the Eating Disorders Association, 30(5), 501–509. https://doi.org/10.1002/erv.2905

Cermak, S. A., Curtin, C., & Bandini, L. G. (2010). Food selectivity and sensory sensitivity in children with autism spectrum disorders. Journal of the American Dietetic Association, 110(2), 238–246. https://doi.org/10.1016/j.jada.2009.10.032

Haas A. M. (2010). Feeding disorders in food allergic children. Current allergy and asthma reports, 10(4), 258–264. https://doi.org/10.1007/s11882-010-0111-5

Keles, M. N., Ertoy Karagol, H. I., Yildiz, R., Egritas Gurkan, O., Sari, S., Elbasan, B., Dalgic, B., Bakirtas, A., & Gazi University Pediatric Eosinophilic Gastrointestinal Diseases Working Group (2025). Sensory Processing Difficulties in Children With Eosinophilic Esophagitis. Brain and behavior, 15(6), e70642. https://doi.org/10.1002/brb3.70642

Loureiro, F., Ringold, S. M., & Aziz-Zadeh, L. (2024). Interoception in Autism: A Narrative Review of Behavioral and Neurobiological Data. Psychology research and behavior management, 17, 1841–1853. https://doi.org/10.2147/PRBM.S410605

Sdravou, K., Emmanouilidou-Fotoulaki, E., Mitakidou, M. R., Printza, A., Evangeliou, A., & Fotoulaki, M. (2019). Children with diseases of the upper gastrointestinal tract are more likely to develop feeding problems. Annals of gastroenterology, 32(3), 217–233. https://doi.org/10.20524/aog.2019.0348

Tompkins, K. (2025). Feeding Interventions with Allergy Considerations. [Video]. SpeechPathology.Com.

https://www.speechpathology.com/slp-ceus/course/feeding-interventions-with-allergy-considerations-11347