How can therapy help with my child's feeding skills?

Occupational therapists are trained to assist children whom struggle with self-feeding and/or children whom have a sensory aversion to food (such as those whom are very picky eaters). Speech-language pathologists are trained to assist children whom struggle with the physical act of eating (such as difficulty chewing, difficulty swallowing, choking, coughing, etc.).

What is the progression for "self-feeding?"

  • Drinking from Bottle/Cup
    Age Milestone
    2-4 months Moves hand/hands up to bottle/breast
    6-9 months Holds a bottle with both hands
    Uses a cup with help
    12-15 months Hold a cup with both hands
    Takes a few sips without help
    15-18 months Uses a straw
    2-3 years Drinks from a cup (no lid) without spilling
  • Self-Feeding
    Age Milestone
    6-9 months Wants to help with feeding
    Starts holding and mouthing large crackers/cookies
    Plays with spoon; grabs/bangs spoon
    9-13 months Finger feeds soft foods and foods that melt quickly
    Enjoys finger feeding
    12-14 months Digs spoon in food
    Moves spoon to mouth but is messy and spills
    15-18 months Scoops food with a spoon and feeds self
    18-24 months Wants to feed himself/herself
    2-3 years Stabs food with fork
    Uses spoon without spilling
    3-5 years Eats by himself/herself

What are some "red flags" that my child's feeding difficulty may require immediate medical attention?

  • Ongoing poor weight gain, weight loss
  • Ongoing choking, gagging, coughing during meals
  • Ongoing problems with vomiting
  • More than one incident of gastro-nasal reflux
  • History of a traumatic choking incident
  • History of eating and breaking problems, ongoing respiratory issues
  • Inability to transition to baby food purees by 10 months
  • Inability to accept any table food solids by 12 months
  • Inability to transition to a cup by 16 months
  • Has not weaned off most/all baby foods by 16 months
  • Aversion/avoidance of all foods in specific texture or food group
  • Food range < 20 foods, especially if foods are being dropped

What are some "red flags" that my child may require treatment from a speech-language pathologist due to structural abnormalities?

  • Coughing
  • Choking
  • Wet Sounding/Gurgly Voice
  • Needing Multiple Swallows
  • Obvious Extra Effort with Swallow
  • Feeling like Something is "Stuck" in Throat
  • Food Remaining in Mouth after Swallow
  • Wet Breathing Quality
  • Pocketing Food in Cheeks
  • Chest Congestion After Eating
  • Weight Loss
  • Foods/Liquids Falling Out of Mouth
  • Watery Eyes
  • Grabbing Neck
  • Getting Tired When Eating
  • Getting Respiratory Illnesses Often

What should I do if I notice that my child is struggling with feeding and/or swallowing?

The first thing you should do is talk to your pediatrician about your specific concerns (unmet milestones or red flags). When talking with your pediatrician, make sure to ask whether a therapeutic evaluation from either an occupational therapist or speech-language pathologist may be appropriate.

What are some resources that may be of benefit to me as a parent?


  • Child of Mine: Feeding with Love and Good Sense, By: Satter
  • Food Chaining: The Proven 6-Step Plan to Stop Picky Eating
  • Solve Feeding Problems, and Expand Your Child's Diet, By: Fraker, Fishbein, Cox & Walbert
  • Finicky Eaters: What to Do When Kids Won't Eat, By: Ernsperger
  • How to Get Your Child to Eat But Not Too Much, By: Satter
  • Just Take a Bite: Easy, Effective Answers to Food Aversions and Eating
  • Challenges, By: Ernsperger, Stegen-Hanson
  • Meals Without Squeals: Childcare Feeding Guide and Cookbook by Berman & Fromer
  • No One Ever Told Me (Or My Mother) That!, By: Diane Bahr