Feeding Therapy

What is feeding therapy?

Feeding therapy is provided by either a licensed Speech Language Pathologist or an Occupational Therapist who has experience with feeding disorders. When a child is not eating, it is because there is a structural, functional, or sensory-based issue that needs to be addressed (often, it’s a combination of multiple factors). When a child is struggling to maintain weight, explore new textures, or engage in the mealtime experience, a feeding therapist can evaluate the child to discover the underlying cause of that difficulty. That provider can also make home programming recommendations for a family to carry over to improve the quality of their mealtime experiences at home.

What is the difference between picky eating and a feeding disorder?

Picky Eater

  • Usually eats over 30 different foods

  • May experience “food jags” where the child refuses a favorite food and needs a break from that food for a few weeks before eating it again

  • Can usually eat the same meal as the rest of the family

  • Can usually eat bites of non-preferred food

  • Eats a variety of textures (wet, dry, soft, hard, crunchy, and mixed-textured)

  • Eats food from a variety of food groups (fruit, veggies, starches, and proteins)

  • Prefers specific plates and cups and will only eat with those at home but can eat use other cups/plates/silverware at restaurants

Feeding Disorder

  • Usually eats fewer than 20 foods

  • Experiences food jags, but is unable to return to a previously jagged food after a few weeks, resulting in a smaller inventory of accepted foods

  • Often needs a meal that is different from the rest of the family

  • Is unable to take bites of non-preferred food without a negative response

  • Refuses specific textures of food regardless of flavor

  • Often refuses an entire food group

  • Unable to eat/drink without a specific cup, plate, or utensil, resulting in the family’s needing to bring those when eating out or on vacation

  • May also have delayed oral motor skills

How do I know if my child needs a feeding therapy evaluation?

You should seek a feeding therapy evaluation if you have concerns in the following areas:

  • Food range of fever than 20 foods

  • Picky eating/limited diet

  • Avoidance of a particular texture or food group

  • Gagging, coughing or choking during mealtimes

  • Stressful mealtimes

  • Oral motor concerns

  • Swallowing and chewing difficulties

  • Difficulty drinking from an open cup or straw cup

  • Meals exceed 30 minutes

  • Your child often becomes upset during meals

  • Your child often pushes away food

Feeding Milestones

Birth - 6m

  • 1m: Rooting reflex will become more controlled over the course of the first month. You can facilitate this by touching your baby’s cheeks or lips a finger or nipple, and watch them turn their mouth towards it. 

  • 1.5 -2m: Baby’s suck-swallow-breath-coordination improves at 6-8 weeks. If your baby is having a difficult time maintaining a latch, consider asking your PCP for a referral to a Certified Lactation Consultant. Tongue and lip ties have become more common and can also be a contributing factor to a baby’s inability to latch to a bottle or breast. 

  • 2-3m: Suckling reflex will begin to become more controlled. You can initiate this reflex by placing your finger or nipple in your baby’s mouth, which will alert touch receptors in baby’s lips. 

  • 2-3m: Baby mouth may begin to change shape

  • 2-3m: Baby will begin to bring their hands together and may begin to put their hands on the bottle or your breast

  • 3-6m: Baby will be able to sequence 20+ sucks without pausing and will also recognize the bottle or breast when it’s in sight

  • 4-6m: You will notice your baby’s gag reflex become more active

  • 5-9m: If you press on baby’s gums, they will begin to open and close their jaw

6-8m

  • 4-6m Baby’s digestive system is getting ready for pureed food and cereals, many professionals recommend waiting until 6m.

  • 6-8m baby begins to control tongue lateralization and will move their tongue sideways towards food.

  • 6-9m Gag reflex should move back to back 1/3 of their tongue.

  • What can I feed my baby at 6m?

    • Breast milk or formula via breast, bottle, or open cup (a small cup without a straw)

    • Stage 1 baby food puree via spoon or open cup

    • Homemade pureed food via spoon or open cup

    • You can add infant oat cereal for texture

  • How do I know when my baby is ready for solids? 

    • My baby is 6m (adjusted age, not chronological age) 

    • My baby can sit upright unassisted

    • My baby can hold their head up

    • My baby is no longer pushing everything out of their mouth (that’s the extrusion reflex/tongue thrust which helps keep baby safe from choking)

  • Utensils: At 6m you can introduce baby to a small open cup, so baby can practice lip closure and tongue elevation.  You can put in breast milk, formula, or purees/smoothies. It’s best to fill the cup to the brim because then the baby will get immediate gratification and is less likely to have the negative sensory experience of spilling all over themselves. 

  • You can also introduce small spoons pre-loaded with puree so baby can practice the motor skill of self-feeding.

    8-12m

  • What new things can I feed my baby at 8-9m?

    • Mashable table food and soft cubed food (e.g., bananas, avocado, overcooked potato etc.)

    • You can check to see if food is soft enough by squeezing it in between two fingers, if it doesn't smush, it is not cooked enough.

    • Hard munchables like celery, a carrot, or dried mango (in a stick shape) for baby to teethe on and practice chewing on. 

  • 10m: Baby should be using their pincer grasp to pick up food. A plate or bowl that they can use as they scrap food up the side will support this milestone. 

  • What new food can I feed my baby at 11m?

    • Soft foods like rolled or cubed deli meats, bread, and pasta. You can dip bread into sauces to make it easier for the baby to eat.

  • 12m: Your child should now be able to hold their open cup independently and drink from it with minimal spillage. 

  • 12m: you can begin to introduce dairy. Allergic reactions should occur between 2 minutes and 2 hours of consumption. Talk to your PCP if you notice any allergic reactions. 

  • What new food can I feed my baby at 12-13m? 

      • Mixed-texture food like french fries, mac ‘n’ cheese, or chicken nuggets.

      • You can also serve fruits and veggies that have been boiled so that the texture is softer, like pasta.

      • If serving meats, make sure that they are soaked in a broth to keep them moist and toprevent choking.

15-8m

What new food can I feed my baby at 15m-18m? 

  • Hard foods like crackers, cereals, raw fruits and veggies, pretty much everything you eat!

  • You can also demonstrate chewing by showing your child your exaggerated chew. 

  • Any time you introduce a new food, think about how you can make it seem familiar. That’s why all those Instagram videos of shaped food are so popular. Presenting a new food in a familiar shape makes it more inviting!

    • Eyes may open wider than usual

    • Rooting reflex is stimulated when you touch baby’s mouth

    • Baby is sucking on their hands

    • Baby is fussing

    • Baby lets go of the nipple (unless they have trouble latching)

    • Baby turns their face away

    • Baby begins to arch

  • In 94-96% of the population that us correct however children with feeding disorders are often unable to maintain adequate nutrition.

    When children are being forced to eat a non preferred food during a meal it can make them upset. When we are upset our hunger cues are shut off, making it even more difficult to continue to eat.

  • Consistency is safe. A tomato, for example may be sweet, sour, soft, hard, and may burst in your mouth when you eat it.

    A Cheez-it will always be square, cooked to perfection, and seasoned the same.

    This is why so many children have favorite foods that are more processed.

  • No more than 30 minutes. If your meals last 45 minutes to an hour, you should definitely consult with a feeding therapist.