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?
- 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