Why is my child having feeding difficulties?
Our previous posts have discussed feeding milestones and how to best help your little ones advance through the feeding skills and food repertoire necessary for them to eat a healthy, age appropriate balanced diet. However, despite following all the right steps and introducing developmentally appropriate foods at the right time, your little one may still struggle to meet these essential milestones.
Assuming underlying medical issues have been ruled out, feeding difficulties in the pediatric population primarily fall into two categories: Oral-Motor and Oral Sensory.
Oral-motor refers to the aspect of chewing and swallowing that involves how the muscles of the mouth function: how strong the muscles are, the coordination of the muscle movements, how well the lips, jaw and tongue work together as they manipulate food in the mouth. The oral-sensory aspect of eating involves how the mouth tissues perceive sensory information such as the taste, temperature and texture of food. Feeding disorders can be oral motor based, oral sensory based, or often times a combination of deficits in both skill areas.
An oral motor skill deficit may look like:
- Delayed advance of textures because the child can’t physically or safely manage chewing solid foods
- Slow or inefficient chewing
- Food left in the mouth
- Food falling from the mouth
- Coughing or choking
- Low intake of food (the child may not consume enough calories because it takes so long or is tiring to eat)
- Delayed advance of other feeding milestones (such as transitioning to a regular open cup from a sippy cup)
For these types of cases your SLP will analyze and determine oral motor goals to help your child develop the muscle movements to safely and effectively chew and swallow. Some of these goals may include teaching your child to keep foods in their mouths, lateralize foods using their tongue to get food to the molars for effective chewing, safely controlling the chewed food and forming it into a bolus, and getting the food to the back of the mouth for successful swallowing. Your child may also need to work on strengthening and range of movement of the lips, jaw and tongue through exercises meant to target and support their feeding skills.
An oral sensory skill deficit may look like:
- Refusal to eat
- Extreme pickiness
- Crying during meal times
- Delayed eating milestones (the child may be able to tolerate liquids and purees but have trouble with chewable foods, or vice versa)
- Unusual taste preferences (such as salsa on eggs)
- Spitting out foods
For these types of cases, which are often referred to as feeding aversions or texture aversions, therapy will focus on normalizing sensation and sensory processing skills. Sensory processing and by extension sensory based feeding disorders are very complex, but typically fall into the categories of hypersensitivity, hyposensitivity, or mixed sensitivity (a combo of both). Depending on the severity of the sensory processing deficit, a consultation with OT (Occupational Therapy) may be needed in order to comprehensively address your child’s needs. Feeding therapy to address sensory based feeding disorders will include desensitizing the child to the sensory properties of the foods (how they look, smell, feel especially). Before working on eating the foods, your SLP will work with your child to help them becomes comfortable with foods, which is a gradual process what may include play, manipulation (making faces out of it, smashing it, rolling, drawing, stacking, etc.) and eventually smelling, licking/tasting and eventually biting, chewing and swallowing the foods.
We hope our posts are helpful in helping you understand more about feeding disorders, so that you can better understand the experiences of your little ones. Please keep in mind the information above is meant to be informative and not diagnostic. If you have concerns that your little one may be experiencing feeding difficulties, a speech language pathologist (SLP) who is trained in pediatric feeding can evaluate your child in person to evaluate for whether a feeding disorder exists, determine the nature and type of feeding deficit, and formulate and target appropriate goals to get your little one on track to a healthy balanced diet.
Do you have additional questions or topics you would like more information about? Leave us a comment below, we’d love to hear from you!