Feeding therapy

At Children’s, speech-language pathologists and occupational therapists work together to provide the best feeding services for your child. When you to call to schedule an evaluation, our intake coordinator will ask a series of questions to determine if your child should be seen by a speech-language pathologist or an occupational therapist. These therapists work closely with Children’s Feeding Clinic and if your child would benefit from a comprehensive, interdisciplinary evaluation, we will provide you with referral information.

In general, feeding difficulties are relatively common during childhood. Some children, especially toddlers, may be picky eaters and consume a limited number of foods, but the foods eaten typically span all the food groups and provide a balanced diet.

On the other hand, an infant or child with a feeding disorder may present with the following difficulties during and/or right after feedings:

  • Coughing, choking, and/or gagging
  • Apnea/breath holding spells
  • Wet, “gurgly” breath sounds
  • Frequent respiratory infections
  • Noisy, messy feedings
  • Excessive gassiness
  • Oral hypersensitivity/gag easily
  • An extremely limited diet
  • Difficulty eating an age-appropriate diet
  • Difficulty chewing or biting foods
  • Difficulty drinking from a cup
  • Difficulty eating enough food
  • Limited self-feeding skills
  • A history of non-oral (ex. g-tube) feedings
  • Behavior difficulties that have a significant impact on mealtimes

Often, infants and children with a feeding disorder will have difficulty gaining weight and meeting their nutritional needs without the use of dietary supplements and/or special formulas.

When is a feeding evaluation recommended?
General guidelines for when to schedule a feeding evaluation include:

  • Difficulty with bottle or breast feedings
  • Wet, “gurgly” breath sounds during feedings
  • Frequent respiratory infections
  • Pauses in breathing/apnea spells during feedings
  • Difficulty gaining weight
  • Difficulty transitioning to baby food or food with more texture
  • Difficulty chewing or biting
  • Difficulty drinking from a cup
  • Frequent gagging during eating
  • Limited variety in diet
  • Introducing oral feedings to children who are non-oral eaters (ex. g-tube, j-tube, NG/NJ tube feedings)

What to expect during a feeding evaluation
During a 60-minute feeding evaluation, the therapist will collect information about your child’s medical history, developmental milestones, current diet, and your current concerns. Depending on your child’s age and feeding skills, the therapist may also observe your child:

  • Completing oral motor tasks (ex. chewing) with food and non-food (ex. teething toys) items
  • Drinking thin liquids (bottle, breastfeeding or cup drinking)
  • Feeding himself/herself
  • Eating foods they enjoy
  • Eating or touching challenging foods
  • Engaging in messy play (ex. playing in shaving cream, sand, rice, water)

Results and recommendations will be discussed at the end of the evaluation. If your child is having difficulty safely swallowing liquids or solids, your child’s primary caregiver and therapist may recommend a videofluoroscopic swallow study. Depending on your child’s needs feeding therapy may be recommended and home activities may be discussed/demonstrated.

What to bring to a feeding evaluation
To ensure the most accurate and complete evaluation, it is recommended that parents/caregivers bring the following items to the evaluation:

  • A hungry child: It is very important that your child is hungry during the evaluation. Children who are hungry tend to be more willing to eat in a new environment and try new foods.
  • Special foods, formula and/or breast milk: We have a wide variety of foods and liquids to offer your child, however if your child has food allergies or is taking formula or breast milk, we request that you bring these items from home.
  • Bottles: If your child is bottle fed, please bring the bottle and nipple used for most feedings.
  • Food inventory checklist If your child is eating some purees (ex. baby food, applesauce) and/or solids (ex. cereal, crackers, pizza), please complete the food inventory prior to your child’s evaluation.

What to expect during feeding therapy
Based on the results of your child’s evaluation, feeding therapy may be recommended. During treatment the therapist may work on:

  • Oral motor skills (ex. chewing, biting, tongue movement)
  • Breast and/or bottle feeding skills
    • Improving latch for breast and bottle feedings
    • Changing the nipple used for bottle feedings
    • Helping your child coordinate the suck-swallow-breath pattern better
  • Cup drinking
  • Eating foods with more/mixed texture (ex. mac-n-cheese, yogurt with pieces of fruit) or less texture (ex. smooth yogurt, pudding)
  • Adding new foods to your child’s diet
  • Increasing strength/endurance for feeding
  • Increasing oral intake
  • Increasing tolerance of messy play
  • Self-feeding skills and using appropriate utensils
  • Using optimal positions/seating during meals

Depending on your child’s age and abilities, activities will most likely be completed in a meal-like setting (ex. highchair, seated at the table). However, the therapist may also incorporate play activities. The goal is to make feeding therapy as comfortable and enjoyable as possible for your child.

At Children’s, we believe that it is very important for families to be involved in all aspects of their child’s care. Depending on the child’s needs, parents are encouraged to view the sessions via monitors, observation mirrors, or in the therapy room. In addition, your child’s therapist will discuss progress, provide activities for home practice, and demonstrate beneficial therapy techniques to ensure maximum benefit is received from therapy. The therapist will also work closely with your child’s medical providers such as the pediatrician, gastroenterologist, pulmonologist (breathing specialist), psychologist, and otolaryngologist (ENT/ear, nose and throat).

Find additional information on feeding development, feeding tools and diagnoses commonly associated with feeding disorders: