When Dani was a small child, she became afraid of choking on chunky food. Pills were difficult to swallow and often regurgitated. Dani was afraid of feeling hard things in the back of her throat and often complained she felt an uncomfortable lump in her throat.

Dani’s pediatrician and a pediatric gastroenterologist evaluated Dani for the causes of her intolerance to hard food items in her throat. The results suggested it was unlikely that there was an underlying physical cause. At home, the family accommodated Dani’s food preferences so that she could eat and grow.

As the years passed, Dani began to fall off her growth chart as her food avoidance increased. She developed a fear of choking and not being able to breathe when eating lumpy foods, and gradually became intolerant of foods with any texture or chunks. By the time she was 10 years old, the range of foods she found acceptable had narrowed significantly.

Dani’s mother was frustrated that Dani’s physical growth was not on track and knew it was because Dani wasn’t eating the wide variety of foods she needed to be healthy. Meat was impossible—too fibrous. Vegetables had to be boiled until mushy. Some fruit products were acceptable because they were soft and smooth, like applesauce. Puddings, ice cream, and soups were well-tolerated when smooth, creamy, and free of chunks.

Dani’s mother didn’t want to resort to puréeing foods to help her eat well. She was already regularly accommodating Dani’s fears by preparing special meals. Social problems then developed for Dani because she brought unusual lunches to school and couldn’t eat many of the foods her peers ate—chips, pizza, bagels, and........

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