Feeding Challenges & Early Intervention

early intervention and feeding challengesDoes your child appear to struggle with feeding?

Eating is a complex activity that requires coordination of both cognitive and motor skills. These same skills are also important in creating the foundation for language development.

At teli our Pediatric Occupational Therapists and Speech Language Pathologists have extensive experience with feeding concerns and are excellent resources to help.  Parents are worried and want answers.  To support these families, our staff has identified some of the most common feeding questions that parents ask and provides answers.  Parents should always consult their pediatrician for to discuss their concerns with feeding struggles.

Q: Should I be concerned that my child gags and chokes on food often?

A: The keys words in this question are “chokes” and “often”.  It is not uncommon for a child to gag and spit out newly introduced food due to taste or texture. Transitions from purees to solids or jar foods to table foods can initially be challenging for your child.

Typically, the more exposure and practice eating various foods he or she tries, the more your child will adapt and accept the food.

There may be a variety of reasons why choking or gagging is occurring. At teli we value parent’s gut instincts. If you feel something isn’t right with how your child eats or doesn’t eat then consider discussing your concern with your pediatrician. A feeding evaluation provided by teli’s experienced Early Intervention therapists will work closely with you and child to achieve the best outcome. An teli Early Intervention feeding therapist’s assessment may include:

  • Observing your child at a typical meal
  • Interviewing you about what a typical meal looks like at your home such as:
    • Where does she eat?
    • How does she behave during a meal?
    • What kinds of foods does she eat?
    • How long is a meal?
  • Understanding if your child has explored with their mouth, such as putting toys in their mouth, during infancy through toddlerhood.
  • Understanding if there are any specific behaviors you may have noticed such as sensory sensitivity to food textures, tastes or temperatures.

From this assessment, the therapist will help to determine if your child is having difficulty manipulating food with his/her lips, jaw, tongue and mouth muscles to break down food and accomplish a coordinated swallow.  They will also want you to share any important health history that could be contributing to the choking and gagging.

If, however, gagging and choking happen at many or most meal and snack times it would be beneficial to explore the cause so meals can be an enjoyable and safe experience for you and your child.

Resource: Kim Morrow, Developmental Specialist

Q: How can I get my child to try new foods rather than eat just a few items?

A: If you feel you have a “picky eater” know you are not alone.  Many young children have food and taste preferences and will happily eat some foods and toss others on the floor. Here are a few creative ideas to try at home that may help broaden the variety of foods your child eats.

  • Provide opportunities for your little one to help in the kitchen. Let them help you wash lettuce, shell beans, roll out and knead dough or make a smoothie.
  • Bring your child along on a short grocery shopping trip and ask them to help you find different colored and shaped foods.
  • Let your child play with their food during a meal and even better outside of mealtimes. Try painting or stamping with cucumbers or carrots or hid toys dry beans or pasta.
  • Explore activities that give children a chance to look at, touch, smell and explore new or non-preferred foods without the expectation of eating it such as finger paint with yogurt, hummus, and foods of similar texture.
  • Give foods fun and catchy names like “Eat your X-ray Carrots” or “Try this Absolutely Awesome Avocados” or “Zany zucchini”
  • Read stories about foods and then let them see smell and touch the foods in the story. Some book options could include:
  • I Will Never Eat Tomatoes by Lauren Child
  • Peas by Andrew Cullen
  • Lulu’s Lunch by Camilla Reid
  • Play musical pass the food with friends or family.
  • Have a family adventure picnic on the floor of the family room or in a blanket tent.
  • Remember to limit mealtime to 20 minutes in length and make sure there is 2-3 hours between meals and snacks so children have a sense of hunger and food grazing is reduced or eliminated.

Resource: Kim Morrow, Developmental  Specialist

Q: How do I make mealtime less of a struggle?

A: It is important to remember that your job as a parent is to buy the food and make the meals and snacks. It’s your child’s responsibility to eat (or not eat) and decide how much to eat. It’s also important, as a parent, to have realistic mealtime expectations, which include:

  • Allow your child to determine the size of their bite/taste even if it is as small as a ½ teaspoon
  • Allow your child to have the option to spit out their taste of a new food by providing a “spit bowl” or napkin if they choose not to swallow
  • Present only 1 new food at a meal and always pair it with a familiar food
  • Never force a child to try a food or eat a food. The Mealtime Goal is to be a pleasurable experience not a battle of wills or  the creation a frightening daily routine.
  • Remember many children, according to research, may need to be offered a food 10-15 times before they accept it.
  • Limit a meal/snack to 20-30 minutes maximum and when the meal is over, state “we are all done eating” and promptly pick up the food from their tray or table ending the meal WITHOUT any negative comments or negative facial or body language.
  • Finally, be patient, relax and focus on praising positive eating skills and behaviors.  Avoid commenting on his or her food or what has been consumed.

Resource: Kim Morrow, Developmental Specialist

Q: Why does my child refuse foods with certain textures?

A: Dependent on the child, there are a couple of reasons why textures may be challenging for your child. First, the ability of a child to chew and manipulate foods is linked to their oral motor skill development.  Moving from pureed foods to mashed, minced and eventually finger foods is a learned behavior and for some children with developmental delays, the progression may be challenging.  If moving their tongue to chew is difficult for a child, foods with texture may be that much more challenging for a child.

A second reason that a child may have difficulty with textures is sensory processing disorder.  An extreme sensitivity or under-sensitivity may cause a child to refuse to try foods of a certain texture.

In both cases, discussing your concerns with your pediatrician and identifying the cause is essential. Based on the unique challenges of your child, getting Early Intervention support can help you and your child identify the specific concern and address the issue through appropriate therapy.

Resource: Jennifer Schreiner, Occupational Therapist

Q: My infant seems to have a problem sucking from a bottle. What can I do to help?

A: Not all babies take to a bottle immediately, it may take some time to get them, and you, comfortable.  Creating a calm atmosphere for both you and your child can be helpful as a child can be very sensitive and pick up stress in their parents. Creating a relaxing space with a comfortable chair and dim lights may help.  Additionally, a baby must be alert and hungry enough to be interested in eating, but not starving so that they become frustrated and fussy.

In addition to creating a calming environment there are some other suggestions regarding the bottle and your position to feed that may be helpful.

  • Explore a variety of bottle nipples that may assist your infant in improving their ability to ”latch on” by size or type of nipple; for example a wider based nipple may assist with latch.
  • Consider adjusting nipple flow to either slow down flow or increase flow to meet your infant’s needs. Position changes to either their body or the bottle can help. For example, placing the bottle in a horizontal position to assist with pacing and flow.
  • Your infant may benefit from external supports, such as chin or cheek support to assist with maintaining latch during bottle feeding.
  • It is also important to rule out anatomical barriers, such as a lip tie, tongue tie, or submucous cleft palate, etc.

Finally, you should discuss your feeding concerns with your pediatrician. An Early Intervention  therapist  can help to tailor feeding strategies that are most appropriate for your child.

Resource: Jennifer Schreiner, Occupational Therapist

If you are seeing some of the above noted signals in your child’s behavior, you should talk to your health care provider.  Importantly Early Intervention Services are available at no cost to you!   Call us today 412-922-8322!

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teli provides therapeutic Early Intervention for children birth to 3. We're here to help every child reach their potential! Early Intervention