I am a pediatric occupational therapist, but the bulk of my experience has been in Pennsylvania’s Early Intervention program. Do you know what early intervention (EI) is? I hope so, but I know that many of you don’t. I want to rectify that because if you are living in the United States and have a child under the age of 5 you may qualify for these free services. Each state’s rules and guidelines are a little different, my state is known for their excellent services, but others aren’t so much. One thing each state does have in common is that if your child is 0-3 and has a delay in any area of development, a qualified and licensed speech, physical, or occupational therapist will come to your home to work with you and your child. In our state we also have developmental therapists, which usually have backgrounds in education or development, as well as vision/hearing therapists and social workers. That is pretty awesome, right? Your child has a need, which may be minor, and the state sends someone to your home to help. You don’t even have to drive anywhere! If your child is 3-5, it may not be too late for EI, but the model is a little different. I’ll elaborate more on that briefly.
Okay, so let me back up a little here. Before you get services set up in your home, you will have a developmental screening completed. A therapist(s) will come to your home and basically “play” with your kiddo. This play will be targeted to specific skills as they evaluate if your child is meeting typical milestones for their age. This evaluation or screening is formal though, therapists are following specific tested guidelines. Of course, there is a lot of leeway here, therapists know better than anyone that development varies from child to child. The therapist evaluating will likely ask you a lot of questions as well, to fully understand your concerns and the needs of your child. They will score the evaluation and let you know the results and their recommendations If therapy is recommended, it will be up to you as the parent to continue with services, there is no pressure. Sometimes the screening is completed and your child doesn’t qualify. That is a very quick overview of EI! Now, onto some FAQ’s!
What kinds of things can EI help with?
Generally speaking EI will address any area of development that your child is delayed in, which is determined by the state and screening tool used. In most states, that means (but could include more or less):
- Gross Motor Skills (rolling over, crawling, walking, managing stairs, jumping, climbing)
- Fine Motor Skills (pincer grasp, pointing, puzzles, stacking blocks, coloring, cutting, handwriting, etc.)
- Speech/Communication (following directions, speaking, speaking clearly, participating in conversations, etc.)
- Social Skills (playing with peers, separating from parents appropriately, behaviors such as biting, hitting, headbanging, etc.)
- Daily Living Skills (dressing, using utensils, drinking from a cup, understanding caution in dangerous situations)
- Vision and Hearing..
I want to remind parents reading this list, again, that many of the milestones listed can vary. Also, some of the social skills listed may be age appropriate, some kids go through minor phases of biting or hitting. If you aren’t sure, talk to your pediatrician or call for a screening in your state. Keep in mind that you can call on your own, it’s always a good idea to talk to your doc, but if you have a nagging feeling, I would recommend giving your state a call (I’ll give you a resource for that in a minute.)
What about Feeding and Sensory Processing?
I think this comes as a surprise to most people and I wish I could send a letter to every parent across the US and let them know that YES if your child is having difficulty eating your state probably considers this a delay and will provide EI therapy in your home. Most states provide help for feeding and sensory processing difficulties. As an EI therapist, these are the skills I have worked on the most – hence this blog. Below are some of the common types of feeding and sensory processing issues that are addressed, but this list isn’t inclusive, so if you aren’t sure call and ask!
- Feeding/Eating (picky eating, difficulty transitioning to table foods, food refusal, poor nutrition, low weight, gagging/vomiting during eating, difficulty chewing or swallowing, etc.)
- Sensory Processing (refusing to touch or eat certain textures, crying or discomfort while touching different textures, excessively seeking out movement, dangerous climbing and jumping, poor attention, frequent rocking/swinging/headbanging, difficulty with hair washing or bathing, etc.) *Please note many of these behaviors may be due to other factors, a qualified therapist would be able to determine if there were sensory based.
What are other options for therapy? What if I need more help?
If your child didn’t qualify for services in your state and you want another opinion or still feel like you need help you can consider outpatient services. These services can also be used in addition to EI therapy. Pediatric hospitals and private clinics are just about everywhere now. Medical insurance is accepted at most, but paying out of pocket is possible, but not likely. Make sure you speak with your insurance provider before scheduling an evaluation.
Services for kids 3-5 aren’t available in every state and in the ones that do it is often preschool based. This really varies a lot from state to state, so it’s something you will want to look into. In this case, you may want to consider one of the the other options I described, as school based therapy likely won’t be as regular.
Why do states offer this free* help?
States are required to offer free help for children under the age of 3 because of a law that congress established in 1986 called Part C of IDEA (Individuals with Disabilities Education Act). The act requires states to establish what they consider a developmental delay is and if it puts them at risk for disabilities. Some states have managed to find ways to create minimal fees, but most are free and should be. If you are interested in more information on the law click here because I am giving you the watered down version.
How can I find services in my state?
My original plan was to provide a list of each and every state with all of the needed contact info. But, I Can Teach My Child already took care of it, so I thought… why reinvent the wheel? Click here to check out their awesome and thorough list of phone numbers, addresses, and emails by state. NICHCY is also a wonderful resource.
Still have a question about how this all works? Leave a comment- I will answer! If you have experience with a particular state, PLEASE leave a comment. I would love to have more information about the quality and ease of services in each state, as well as, if any services such as feeding weren’t provided.
Alisha Grogan is a licensed occupational therapist and founder of Your Kid’s Table. She has over 20 years experience with expertise in sensory processing and feeding development in babies, toddlers, and children. Alisha also has 3 boys of her own at home. Learn more about her here.
One of my twins (2yo) was already evaluated by EI in our state and unfortunately, they do not provide services for sensory OR feeding. He passed all areas with flying colors, which is great, but very clearly struggles with sensory processing and it greatly affects his eating and our family mealtimes. It is so frustrating that they are not able to help, but I really appreciate all of the information you are sharing and for the online webinars that have been SO helpful. Thanks so much for helping us along this journey.
Hi Alicia! Thank you for reaching out! We are so glad you’ve found our resources helpful! If you havent already, check out our free sensory workshop! Please let us know if you have any questions.
Best,
Kalyn
Hello,
Three-year-old my nephew just consumes baby fruit pouches of one sort (banana and strawberries) and refuses to eat any solid foods. I’ve tried to mash up food for him with the help of his mother, but every time it hits his mouth, he vomits. Now, all he eats is strawberry yogurt, 2% milk, and occasionally, if we’re lucky, apple sauce. Due to the fact that he has always been a picky eater, his mother is concerned about his condition. He currently attends daycare, but he doesn’t consume any food there. And he consistently feels more exhausted than other kids. We’re anxious and out of ideas, so if you have any advice, please share.
PS: His mother has four other children, and none of them were like this.
Hi Hawo! Thanks for reaching out! We know how stressful eating issues can be. Due to his age, we definitely recommend consulting with his pediatrician if possible, since they can refer you to a feeding therapist for some hands-on help. Since he’s still stuck on purées, he may need help with chewing/swallowing. In the meantime, practice with some sensory and oral motor exercises by using sensory bins, food play, and allowing him to touch/feel/play with his food. Try using a toothbrush to brush the insides of his mouth before mealtimes— this can help work those oral muscles and also desensitize his gag reflex. Other oral motor exercises include making silly faces, blowing bubbles, sipping from straws, and licking lollipops/popsicles. Try food play, where you have him feed you or feed a doll/toy. We also have a free workshop that can help more with eating solids- save your seat here!
Best,
Kalyn
My son just turned 21 months and does not eat. He touches and smells food then leaves it or throws it. The only food he likes are apples. He’s not underweight because all I do is trying to put at least bite in his mouth. He won’t have anything- no bananas , meats, breads, potatoes, no eggs , no pasta or rice . Sometimes he’ll eat 2 spoons of couscous.his pediatrician is focused on percentile and says he’s ok despite my struggles. I had tried everything and still do. Like leave him 7-8 h without food just water then let him pick from many options i make but he just looks at the food and smells and won’t eat it
Hi Sanela! Thanks for reaching out! Ask your doctor if they can refer you to a feeding therapist that can offer some hands on help. In the meantime, try using some sensory activities and oral motor exercises to help with the sensory sensitivities and oral muscles that work to chew/swallow. With food, the main thing will be to keep offering without any force or pressure. Allow him to touch/feel/play with his food and different textures. For more in-depth tips, definitely check out our free picky eating workshop— save your seat here!
Best,
Kalyn
Hi,
My bay is 14 month old and she has difficulty in feeding/eating. She has pretty much all the symptoms that you mention above: difficulty transitioning to table foods, food refusal, poor nutrition, low weight, gagging/vomiting during eating, difficulty chewing or swallowing.
We still spoon-feed puree food to her because she does not like lumpy or chunky food, she would gag or spit out. She can chew on food but does not swallow, she will spit it out and chew again and eventually swallow.
When I practice her to eat different food (watermelon, green bean, broccoli) she will squeeze the food really hard, play and throw them away. If she put them in her mouth, she spits them out right away. The amount of food that she self feed is very little, we have to give her extra puree food to make sure she gets enough nutrition.
I am not sure what to do next, is it too late to train her to self feed and eat proper amount of food?
Hi there! Thanks for reaching out! Due to her age and issues regarding her weight and eating, we strongly encourage consulting with your pediatrician, who can potentially refer you to a feeding or occupational therapist for some hands-on help! In the meantime, it sounds like she needs more help with chewing and swallowing. Oral motor exercises can help with this. Try using a toothbrush to brush the sides of her mouth + tongue a few times per day- this will help to desensitize her gag reflux. Allow her to touch/feel/play with her food and different textures. For more help, check out our free table foods workshop- save your seat here!
Best,
Kalyn
Hey there! One of my colleagues recently noticed that her grandson still couldn’t read properly even though he’s going to be six next year. I found it quite useful the moment you mentioned that even our kids’ eating habit could be a sign of their cognitive condition too. I’ll show this article to her so she can send him for a proper treatment pretty soon.
Hi Amy! Thanks for reaching out! So glad to hear that you found this post helpful and are passing it along to your colleague. We hope it can be of help to her and her grandson!
Best,
Kalyn
Hello, my baby is 1 years old and doesbot ear solids. I tried blw method also, she takes food to mouse but very little amount and not every food. She likes only fruits like kiwi and orange.. she only wants breastfeed. I dont know what to do.. should i end breastfeeding?
Hi Elenee! Thanks for reaching out! Definitely continue to offer solids with a no-pressure environment, allowing her to choose how much she eats. Keep practicing with self-feeding and allow her to touch/feel/play with her food, which will allow her to become more comfortable with food and different textures. In terms of breastfeeding, continue to do so for as long as you feel comfortable. However, in order to encourage her to eat more foods, try to gradually replace some breast feedings with food. We have a post that talks about this more, which you can read here!
Best,
Kalyn
Hi! My son is 8, and became a picky eater around 3 years old. I always thought it was just the normal childhood picky eating phase, but I’m afraid it has gotten worse. He had most of the characteristics of a food aversion disorder. Hoping to find some help for him. Any suggestions are greatly appreciated.
Hey Jenni!
Thanks for reaching out. It’s so hard when our picky eaters get worse! We’d definitely recommend our new free picky eating mini course. It’s a great place to start. Sign ups are happening now. You can save your seat HERE.
Best,
Andrea
Thank you for your response! I have signed up, and also followed on Instagram and FB.
Hello may i know how can i do EI my 30 month old won’t eat anything except snacks like puffs that easily melts? I just moved to Boston, MA.
Hi Shreemila,
If you’re looking for early intervention, each state/city is a little different. It would be most helpful for you to reach out to your child’s new pediatrician and let them know you’re interested. They would be the best person to get you in touch with the right people! In the meantime, you might find out Teaching to Chew Guide a helpful place to start.
Best,
Andrea
Hi – We’re struggling with our 17-month-old, he will only eat puffs, dried fruit (sometimes) and baby food pouches. Still gets two bottles of formula per day because we don’t know how else to get him the nutrition he needs. Of course, all pediatrician tells us is to stop the pouches and bottles, but that would leave us with a starving child. We offer him table food 3x a day and he will put some things in his mouth, but spits them right out. We live in Washington, DC and I don’t see any resources listed for where we live. Do you think we need an evaluation?
Hi Jessica,
It can be so stressful when our little ones don’t eat! If you’re interested in therapy, your state should have an early intervention program. Your pediatrician should have the info for that. You might also check out our free workshop for toddlers who are having difficulty transitioning to table foods. It might be a great fit for you! You can save your seat HERE.
Best,
Andrea
The past two times we have taken my daughter to the pediatrician they told me they believe she has sensory integration/ processing disorder and wanted me to see an OT. I contacted my insurance and they said it’s not considered an actual diagnosis so there is no coverage. I saw your link about possible free help and wondered about it. She definitely presents sensory issues with some sounds and things like socks and tags in clothes but for the most part she is functioning just fine. My main issue is food, she is 2 and refuses meat, cheese, vegetables, noddles and pretty much anything that isn’t a peanut butter sandwich or a squeeze pouch. I can’t nail it down to textures that she is opposed to because she doesn’t mind yogurt or squeeze pouches and likes bread and crackers but she’s not eating much protein and she can’t do dairy so we do pea milk and coconut milk yogurt. So I’m concerned about her growth and health. Do Children need to present other delays to get help or can food alone be an issue enough to receive help. She’s not under weight, she’s just not eating anything with protein or good vitamins. And each sitting she doesn’t eat much she just says all done and won’t touch anything or even taste it. The most I can get her to do is smell the food. Thanks for your insight!
Hey Lindsey,
So happy you found our article! If you are in the US, I would reach out to your Early Intervention organization in your state/county. It does vary by state, however you should be able to get a free evaluation for your concerns, regardless of what they are. Yes, I have seen children qualify for feeding/sensory concerns at this age, so it’s worth digging into!
Hope that helps!
Best,
Desiree
Hi there!
My babe is 11 months. She loves food! Loves baby food, and wants food off of our plates, but the thing is anything with a more lumpy texture, she will sit and chew on it and suck on it, but won’t swallow what so ever. She swallows purées, dissolvable baby treats, and mashed foods okay. Anything lumpy she just won’t swallow, and the very few times that it happens, she gags on it. She loves her formula and still takes it all throughout the day, along with 2 jars of baby food per day and baby treats as snacks. She can sit up fine and crawl, but can’t sit up from a laying position or pull herself up and stand or walk in any way yet. She was diagnosed with reflux as she used to spit up and projectile vomit her formula ALL day long, but it seems to have subsided greatly as she got put on amino acid based formula and has gotten older. I’m just worried maybe she has swallowing issues, or maybe she just isn’t used to it. Would love some advice. Thank you!
Hey Destiny,
Thanks for reaching out! It’s great that she’s able to swallow purees, mashed foods and meltables. Lumpy textures can be really hard for kids to eat. I’d try to start to work on soft cubes to see if she’s able to chew/swallow with that next texture. We do also have a free workshop that would be helpful with moving through these different textures. You can save your seat here
Best,
Desiree
My niece is 2 1/2 years old and will not eat any food besides potato chips, and gold fish crackers. She drinks juice and vitamin water. We have tried to introduce other foods to her but she does not want to try it. We have observed that she has sensory issues. She don’t like her hands dirty, she don’t like certain textures and she covers her ears when she hears certain sounds. She was denied by the Early Intervention program because they noted they did not see any delays during their assessment. The did note that she will benefit from having a feeding therapist. I thought that the EI program assist by using a speech therapist? My friend sent me your website and the information you share is very informative, so we will now try to incorporate some of the things you have shared. What steps would you recommend that we take next?
Thanks so much for reaching out! Sorry that she didn’t qualify to help. Every state/program varies as far as adding a SLP or OT to work on feeding/sensory needs. However so glad that you landed here. I’d say your first step is to take our Free Workshop this will really walk you through some first steps that we recommend in setting up successful mealtimes! I’d also try to be doing some play with food/textures outside of mealtimes, as this can be helpful to get her touching foods which is the first step in eating!
Best,
Desiree
Please I did all I could but my baby wouldn’t eat anything at all even at 12months
Hey Linda,
We get it, it can be so difficult to transition to table foods! I’d allow your child to do some play with foods, outside of mealtimes to see if you are able to get some interaction with the foods (this is the first step in eating). Also, we have a free workshop that will walk you through the steps of how to help with the transition to table foods, I think you’ll find very helpful. You can save your seat HERE
Best,
Desiree
Hey
My wine will be 1 in 2 weeks and He still eats purées and formula only I’ve tried smashed food with texture baby puffs all kinds of melt in your mouth baby foods and he spits it out instantly it has to be some type of sensory issue I just don’t know what to do!
Hey Dani,
Thanks for reaching out! We understand how hard this stage can be. I’d try to work on having him play in the foods to get used to touching the different textures, you can even do this outside of mealtimes. If you have not seen it yet, our free workshop would be really helpful for other ideas and foods to utilize to move through. You can save your seat HERE
Best,
Desiree
My Daughter is 15 months now and from 7 months or so she has been difficult when it comes to food. She is Mostly on formula because she doesn’t care for Food. Her days usually consist of oatmeal every morning with peanut butter or almond butter for breakfast. Fruit throughout the day ( likes most fruits) and then crackers, puffs, veggie straws. Sometimes she’ll eat meat (chicken, steak, etc) but it’s hit or miss. However, I am mostly substituting formjla for lunch and dinner because she doesn’t care for food. She’ll eat laughing cow cheese. She doesn’t like mashed potatoes. She doesn’t like macaroni. I don’t think it’s a sensory thing but she will play with some foods and doesn’t gag or react in any way. 90% of the time She refuses food. She doesn’t even wanna try it. Some times if I try to get her to taste it somehow she’ll eat but it’s very rare. She will eat one thing one day and 2 weeks later I will try same dish and she won’t open her mouth. I am not sure what to do. I am thinking to start “starving her “ So that she’ll eat vs giving her formula as a substitute. She isn’t delayed in any of her other milestones and have not seen any red flags in anyway!
Hey Gabriela,
I know it can be so hard trying to feed our kids, especially when it is hit and miss with foods. Have you taken our free picky eating workshop? This will provide you with a good plan on how to approach the picky eating and setting up mealtimes, I think you will find it helpful. Save Your Seat Here
Best,
Desiree
Hi! My 7 month old son puts his thumb in his mouth after every bite of baby food. I’ve tried thin and then thicker purée but he persists with his thumb. He hasn’t rejected any foods so far. I’m wondering if he just hasn’t developed the ability to swallow without sucking. Would this be a delay?
Hey Kelli,
We know how hard it is to maneuver through all these feeding skills!! Since he is just 7 months, I’d wait a little to see how he progresses through with the feeding. Try to have him hold a spoon and “help” with the feeding to see if he is distracted enough with the spoon and not putting his thumb in. If he does continue, and you are concerned it never hurts to get a feeding evaluation for some suggestions!
Best,
Desiree
Hi Alisha
My Bub will be 12months old in next couple of weeks. He doesn’t have any teeth yet. He refuses to eat any solids. He lives on formula. I tried different purées but he will eat for first few bits and then will stop and will throw food and spoon in the air. I am not giving him finger food because I fear of choking as he doesn’t have any teeth. He used to have purée when he was 5 to 6 months old. He had it for few weeks and thn he suddenly stopped everything. I am worried that he isn’t getting nutrients that he needs
Hey Renee,
We know how hard this can be on you as you just want your son to eat! I’d try to have him play in the food to get him used to the texture. We also have a free workshop that would be really helpful for you to make this transition. Save Your Seat Here
Best,
Desiree
Hi there! My son is 20 months old. He has trouble with some texture. I think that’s why he won’t eat raw fruit or steamed veggies… I mean zero fruits zero veggies. Even at 6 months he had a hard time eating a variety of fruits and veggies. I had to mix purées into his infant oatmeal or yogurt to even get it into his mouth. I have spent endless hours hiding fruits and veggies in smoothies, pasta sauces, muffins, pancakes, veggie nuggets whatever I can think of. He will eat most dehydrated or freeze dried fruit and loves the dehydrated snap peas. He has no trouble touching fruits/vegetables. He has in the past eaten peas here and there and some broccoli. At this point he will only eat potatoes. My doctor just says this is common and will stop at some point. Would this qualify for EI?? I have so much anxiety daily about what he’s going to eat. Any help would be appreciated.
Hey Lexi, thanks for reaching out!! Breathe Mama!! I can understand your worries as it is very challenging when your child will not eat fruits or veggies and mealtimes seem stressful. EI varies from state to state, however it never hurts to reach out to obtain an evaluation. You could get some great suggestions just from the evaluation from an OT to help you along! I’d recommend checking out our free workshop, it has some suggestions for picky eating help and how to set up mealtimes! You can save your seat here
Best,
Desiree
Hi, Thank you for the nice advices. My baby is 13 months now. I introduced food at 4 months. He was a very good eater and he’s big. He had an episode of diarrhea 2 months ago and I stopped feeding him veggies foe 3-4 days except potatoes. After that he refused eating veggies again except after I put melted cheese on it or may be tomato sauce but no plain steamed veggies.
Also, he has to be holding something in his hands while eating, a spoon a cup a cheerios anything. and after 3-4 mins he throws what’s in his hands and wants another thing. And sometimes I keep giving him stuff and he throws them until I give him something that he likes so he’ll eat. It’s driving me crazy.
I never let him watch TV sometimes I do it to make him eat but this doesn;t happen very often.
is that normal??
Toddlers can do all sorts of “things” that are a little odd, but sometimes a significant illness can have a huge impact on their feeding. I’d keep your doctor in the loop and try to give him spoons, cups, etc. to hold.
My son is 7 months old. Hates baby food..been trying it since 6 months old. Dislikes mashed banana, avocado as well. Loves puffs and teething wafers, but the problem is that they fall out of his mouth. He has a prominent tongue tie but pediatrician said not to get it clipped because he nurses fine. Could that be why he can’t keep food in his mouth?
Thanks,
Caitlin
Hey Caitlin,
We get it!! Yes, tongue tie can cause difficulties in some babies. I’d recommend checking out our free workshop on transitioning to table foods, as we do touch on the tongue tie, but also what to do when the puffs are coming back out. You can learn a lot of tips! Save your seat HERE
Best,
Desiree
Hi Alisha. First of all thank you for creating this amazing, extremely helpful and one of a kind website.I have a 20 month old and I’m also a Special Ed teacher. I’m finding myself frustrated with the EI services of my state (CA) and we haven’t even signed anything yet. I was told my son won’t qualify for services unless he has a significant disability like downs syndrome and that my sons feeding should be treated medically. Initially, he wouldn’t tolererate thicker foods with bits and pieces and now he is getting used to mashed foods with some texture, he eats rice but one grain at a time! He takes extremely tiny bites of any food like bread, cheese pr tortillas. Pulls apart chicken in microscopic pieces. He won’t take spoonfuls of rice or anything loose and will scratch his tongue with his fingers when I try to do so.
Okay, you definitely need my post on Transitioning to Table Foods, I think it would be a big help! There’s also a free printable in there too that would help. So sorry that EI is frustrating in your state:(
Also, email us at hello@yourkidstable.com, if you need some more help with this- I have a free workshop that could be really helpful!
Hello, I know this is an old post but I’m hoping you can give me some advice.
My little girl will be 11 months tomorrow. We started transitioning her to table foods around 8-9 months with all the normal first foods; Puffs, Cheerios, etc. Along the way she would still eat puréed food. Usually 1 to 2 hard per meal and even 3 at dinner along with the table foods. As we’ve tried to introduce her to more foods diced carrots, fruits, etc she wants nothing to do with them. She just pushes or throws them on the floor. It wasn’t a big deal at first because I figured we had time to get her eating those and she was still good about eating the purées. However, in the last couple of weeks she is refusing to eat anything that isn’t crunchy; puff, cracker, you name it. She’ll MAYBE take two bites of baby food and done, screams if we don’t give her something else. I’ve even tried giving her a couple of puffs in between spoonfuls of food and nothing she pushes it away and: or screams for more crunchies.
What do you think I should do to help her transition away from crunchies to more healthy options?
PS: she still drinks formula and is picky about how much of that she takes from day to day. Also, the ladies at daycare have never said that she seems to be eating less for them but she didn’t eat a lot while she was there to begin with.
I’d definitely recommend getting an eval from EI at this point if you live in the states, but I have another post that I think will be very helpful: transitioning to table foods. Check out the transitioning to table foods guide. Once you check that out let us know if you have more questions
I actually used that post when we first started transitioning to table food. It was a huge help! She did great with step one and two, but refused all of the softer food options and jumped straight to step 5. She will eat some toast with a very small amount of peanut butter and she loves Cheerios. She did take a couple of small bites of steamed broccoli but when we offered it to her the next two days she refused it. What else can I do? Should we wait it out and just keep giving her different things? I want to exhaust all options before broaching early intervention with my husband.
I know this sounds strange, but I’d focus on brushing her gums, tongue, teeth, and inside of cheeks 2-3 times a day. This desensitizes the mouth to textures and improves how the tongue moves.
I’m kinda confused on how to find the information for my state to get an OT to come to my house to evaluate my son I clicked on both links my son is having a really hard time eating foods he’s going to be ten months soon I love in Hawaii on Oahu and I cannot find the contact information
Here is the contact info Hawaii:
Early Intervention Section
Department of Health
1350 S. King Street, Suite 200
Honolulu, HI 96814
(808)-594-0006
Hopefully I am not jumping the gun here but I am a little concerned about my 7 month (almost 8 months) old daughter. She is strictly breastfed might I add. At 6 months old I decided to introduce her to baby food since her pediatrician wanted us to wait until then and she seemed to actually like it. After a couple of feedings however, she seemed to turn her nose up at it. Well, because she seemed to swallow perfectly fine too begin with, I started her on stage two baby food and again, within the first two weeks, she seemed fine. Not long after, no matter what flavor baby food I give her (I have even gone to the extent of buying fresh fruits and veggies to puree them myself) she stopped eating them. I’ll do the airplane and get it in her mouth and the moment it’s in there, she’ll turn her face up and start to gag until she finally swallows it or spits it out. This is with fruits, veggies, even the chicken and turkey flavors, etc. I have never had an issue with my other two children so I am a bit confused. Am I doing something wrong? I’m curious to know if whether or not she should be evaluated or is this just something normal. Maybe she still needs more time and I’m rushing things!? It brings my spirit down a little because I thought that she’d love the food and want more since she makes the chewing gesture every time she watches me eat. I even tried with mashed potatoes and she actually cried (it wasn’t hot so it’s not like her tiny tongue had been burned). I try to make it as exciting for her as possible. Should I just give her a little more time? Again, she is strictly breastfed, NEVER uses a bottle so I know that it’s different and new for her however, she’ll be 8 months in about a week and a half. Is this normal?
Hi Tityana, I think its fair to be concerned. She’s still young and has time but some of this is cause to be a little concerned. I’d look into early intervention for sure. But in the mean time you could also start with some table foods, crunchy one’s that melt. I have a whole guide here:
Hi Alisha,
I struggle to get my 7 month old daughter to finish a whole pouch or jar of food in one sitting. She just loses interest. We’ve also had a few instances where she’s eaten a piece of a teething cracker or PB puff or one time a scrambled egg and she gagged and ended up vomiting from her gag reflex. She’s always had a sensitive gag reflex even with her bottle. Is this all something she needs to grow into/get used to, or should I be concerned?
I should add that she has eaten puffs successfully, but every once in a while she gags and ends up vomiting.
Hey Stephanie!
So glad you are being proactive and reaching out for answers. I’m going to attach an article all about gagging, as it is normal for all babies as they are first learning to eat, however it sounds like your daughter has had this consistently so there are some things to help such as brushing her gums/teeth. You can read all about it HERE.
Best,
Desiree
Similar question. 8 month old WILL NOT EAT. He’s a great happy baby and mom is awesome. He’s exclusively breastfed. He had issues latching on one side from day one. Now that he’s older it’s not a problem, he can nurse on both sides. The few times he’s put food in his mouth he gags, vomits, cries, spits it out and/or just holds it there staring like he doesn’t know what to do. He will put everything in his mouth except what is for chewing. He won’t chew on toys for teething but he will chew on the ring holding them together. He won’t eat food but will chew on his bib. He seems to have an strong aversion to certain textures, especially hard things like crackers. His whole body tenses up when he touches certain textures. He’s also not “talking”. Occasionally says “da” and some noises but won’t engage in a “conversation” when others talk to him. No reciprocity. Mom is either overwhelmed or in denial or both. I asked if she thought a developmental behavioral pediatrician might be helpful and she got very upset and said she’s going to wait another couple months before looking into it. It’s her first kid. I’m trying to be sensitive but my gut tells me this isn’t normal and I’m worried he won’t get early intervention. Do you think this is a problem? If so, do you have suggestions how to encourage his mom to seek out professional help? Any feedback is appreciated. Thanks.
Hi Charlie,
You would be looking for interactive engagement with caregivers at this age. Use of facial expressions and gestures is typical if babbling hasn’t quite started yet. You might check out our post about putting toys in baby’s mouth. It has some great suggestions of teethers that we love that can make a difference if there is some sensory concerns going on.
Best,
Andrea
Thank you!
You’re welcome!
Alicia,
my daughter who is almost 2. Does not want to eat anymore. At 9 months we tried to transition from baby foods to table food such as soft noodle, i.e., spaghetti, mac n chs, etc. eggs, mash potatoes, you name it. The usual first foods for her age. She tried everything once or twice but never a third time. We’ve tried and tried, Give options, etc. But still, she’d only eat baby food. Cereal/oatmeal in the AM. With yogurts or fruits. Mixed veggies and meats (puréed baby food) for lunch/dinner. And we’d still try with the table foods in between. In the last 3 months she’s shown less and less interest in the baby food, but we can always count on her full breakfast everyday. She ALWAYs ate her breakfast. Today, and 23.5 months old, we’re on day 5 of no breakfast what so ever, and only Snaking on cheerios, ritz crackers and veggie sticks through out the day (after we attempt breakfast lunch and dinner). She’s full of energy and in a great mood ALWAYS. Never weak or lethargic from lack of food. We usually would give her half a pediasure after each meal (when she was eating) but now we give her a whole pediasure In the AM and afternoon, after we’ve attempted foods first. So we know she’s getting some nutrients and fiber on a daily basis. As well as a daily vitamin (liquid). SHE ALSO still drinks formula because I was scared she wasn’t getting enough with her bad eating habits. At her last check up, 18 months: her doctor wasn’t too concerned that she was still ONLY on baby food, cause she was growing at a good rate and she was learning and doing everything she should be. Doctor said if she’s not eating by her 2year check up then we’d “revisit” it. Well, she still refuses table food and now she’s refusing all meals (baby food and table food options) I already know that I could not give her anything, drinks or snacks, so that she gets So hungry that she’ll eventually just eat, but, it’s so hard. And, I live in a small complex and I’m afraid of noise complaints of a screaming child all day/night. Any suggestions? She has teeth, and she likes crunchy snacks. I don’t know what else to do
Christa, I totally here you and I definitely don’t agree with waiting kids out because they’ll eventually eat- its just not true. Have you seen the free workshop? I think it would be really great for you to check it out, I think it will answer all of your questions. If you have anymore after watching, please let me know. You can sign up here.
Yes, there was one event, although I didn’t think it was THAT significant. He was gumming a cracker about two months ago and got a little piece off, and began to cough/choke. I patted his back (hard) and he coughed it out and threw up. Could that really scar him? And how do I undo the damage?
I got some rice cake things, since he won’t eat the puffs anymore, and stuff for sensory bins and food play. I’ve also scheduled for him to have an EI appointment in a month.
Hello and thank you for this blog! My son has just turned 10 months and eats almost no solid food (table food nor purees). I have followed a lot of your advice for giving him different textures and tastes, making meals not stressful, etc, but he just won’t eat. Most of the time, he just touches the food with his fingers, maybe puts it to his lips, and then drops it. Sometimes I can get him to gnaw on a piece of bread, There used to be one or two purees he would eat, but now he won’t eat those either. I’m concerned because his weight is low, but he only wants to breastfeed or drink cow milk (we offered him cow milk while attempting to get him to take formula to supplement, but he will only drink the milk plain, without formula powder). Often times, he won’t even touch the food to his lips, but will just feel it with his fingers, shiver, and refuse to even taste. I’m worried about his weight, but also worried that this is extreme pickiness, or that he has some sensory problem with all textures. Do you have any advice?
For what it’s worth, my 3.5 year old also didn’t take to solid food quickly, but she was willing to try almost anything and was eating VERY well by 11 months. We did a month or so of purees, then mashed table foods, then chunky table foods/self feeding. She’s not picky at all and still eats well. I’ve tried to do this for my son, but it just doesn’t seem to be working.
Thank you.
Hi Emelia, I’m sorry this response has taken a few days, I know you’ve been waiting. It does sound like something is going on… First, I would definitely recommend getting an eval as I described in this post. Second, I just published an article yesterday on sensory and picky eating that I think will be helpful.
I want you to start with dry crunchy textures that melt. If he won’t take them, demonstrate your brains out in a stress free way. Give him these textures to play with three times a day. Have him and your daughter eat together as much as possible. Start brushing his teeth and brush his tongue as well. This will help him begin to desensitize to textures. I would also experiment with getting him to interact with food outside of meals. Try putting jello in a big bowl and letting him play for example. There is no pressure at all, but I am also available for consults if you want to discuss strategies or for me to coach you live via skype/facetime.
Does he chew on his toys? Does he put a lot of things in his mouth?
Thank you so much for your reply. I read your blog about puffs, so I bought him some about a month ago. For about two weeks he would feed himself the puffs and let me spoon feed him a few different purees (prunes, pumpkin, carrots, and squash soup with peanut butter), but now he refuses ALL foods on a spoon and won’t eat the puffs either. I thought maybe he was bored, so I bought a new flavor, but he won’t even pick them up, or if he does, he just touches them to his lips and drops them. It’s strange to me that he used to tolerate purees and put the puffs in his mouth, but now he won’t. As far as I can tell, he’s not teething at the moment.
I will try the other things you’ve suggested. I’ve been chewing in front of him and having him eat with my daughter at the table, but I’ll do more food play.
And yes, he puts everything in his mouth! Any object I had him goes straight to his mouth and gets chewed on. But when I put food in front of him, he will MAYBE take a taste or two, and then just reaches for his pacifier, cries, and won’t take any more.
Forgot to say… I got the email to contact someone in Ohio about a consultation, but I may contact you for a Skype call as well, depending on how quickly I hear back from them. Thanks again.
That’s great! Hopefully they will be able to come out soon.
As for the purees it is normal for babies to be over them, that should happen. The problem in this case is that he hasn’t begun to eat any other foods. Try some of the other foods I mention in the post as well, he may need a bit of a change. I would also make that pacifier disappear when meal time comes around without him realizing of course.
I’m glad he is mouthing things! That is very good. Has he ever had a significant choking/gagging event, or perhaps an illness that resulted in a lot of vomiting? Any of those can create a negative association.
Hi Alicia,
My baby son is 5.5months old and has been having issues with feeding times for milk.
Basically around 2 months of age he started screaming and pulling off while breastfeeding despite being hungry. I reverted eventually to express pumping my breast milk and feeding to him out of a bottle after trying to breastfeed him for a week with the same reactions. He seemed more at ease with a bottle but sometimes would still pull off but I guess not as much.
After growing out of the newborn phase, we realised he would only actively drink milk when sleepy and basically nodding off to dreamland. Every time we try to feed him while he is awake or not sleepy he will just nibble on the bottle nipple even for a whole hour – at most I have checked the bottle and realised he had only sipped 1oz in the whole hour! He will just play with the nipple or leave it floating in his mouth the whole time.
We have tested this in so many scenarios such as waiting until he is hungry or supposed to be hungry up to the 6hour mark yet he still won’t drink if he’s awake! He cries and fussed from hunger but won’t actively suck to drink. He has never been a big drinker and has consistently drank 3-5oz each feeding (usually every 3-4hrs) but every single feed has been a sleep feed up to now! When we are out there is just no luck in having him consume any milk since we seem to have to be in a quiet place for him to slowly nod off before actively sucking. It is all rather baffling and stressful because if he doesn’t have a nap, he basically won’t drink and if he naps and we don’t get to him before he starts nodding off, we miss the opportunity for him to have a feed.
Is this something that EI can help with?
Hey Connie,
We know how hard this must be as you are just trying to feed your baby! You are doing great!! YES, this is something that EI can help with. They can take a look to see what is happening that is causing him to have difficulties sucking while away on bottle or breast and ideas/strategies to come up with to help you along the way!! Please keep us posted!
Best,
Desiree
Hi and thank you!! As I’ve only read two of your articles so far. We are at a lose our 22month old will refuse food and ask to breastfeed even while at the dinner table she nurses approximately 12+ times during the day and almost all night long. She is developing strongly in all other areas except the mentioned food and sensory area, as she even refuses to lay down in the bath tub even while I would offer my arm as support. I usually revert to using the big cup to get her hair wet and rinsed.
Thanks for your comment. I think an eval would be a great idea, sensory processing difficulties can have a huge affect on eating. Let me know if you need any help.
Just stumbled onto your sight today desperate to help my son. Hadn’t thought before reading through your articles that he almost definitely is a problem eater. Unfortunately, he has missed the age bracket. He is three and a half. I first started seeing signs that he was a problem eater when he was two, but at the time we were living out of the country, in France. I think all of the transition internationally has aided in his eating dilemma significantly, as before we left for France he was the better eater of my two kids and displayed no overly irrational signs of picky eating. We are currently living in Ohio, but only till the end of of the summer. Possibly California after that. I tried to follow the string of linked websites to see if either of these states offer free help for kids under five but couldn’t find any clear information. Maybe I wasn’t looking in the right places? Nevertheless, I couldn’t find any concrete resources. Any help or advice you have to offer would be wonderful. This is completely new territory for me!
I don’t want to be the bearer of bad news but from my understanding California’s services aren’t very good even for kids under 3. I would look into it still, though. Of course, if your insurance covers it private therapy is always an option. Here is all the info for Ca and OH:
California:
Part C Coordinator
Children and Family Services Branch
Department of Developmental Services
1600 9th Street, Room 330, MS 3-8
Sacramento , CA , 95814
(800) 515-2229
(916) 654-2773
ringraha@dds.ca.gov
Ohio:
Bureau of Early Intervention Services
Ohio Department of Health
246 N. High Street, 5th Floor
Columbus , OH , 43215
(614) 644-8389
wendy.grove@odh.ohio.gov
http://www.ohiohelpmegrow.org
Please let me know if you need more help. This info is from the I Can Teach My Child website.
I’m in the process of getting my 22 month old screened for a speech regression issue as well as a eating sensory issue. Just a FYI: West Virginia has a FREE (both the evaluations and the therapies) Birth to Three program.
Thank you so much for sharing that information! It is very helpful!
Update: my little stinker waited until our EI rep came and then decided to start finger feeding the next day! Too funny. He has his favorites but he’s trying much more now and also mouthing toys. Learning new tricks everyday, I feel so much better! Thanks for your support and I’ll be sure to keep the blog bookmarked!
Thanks so much for getting back in touch! I’m glad you were able to get an eval quickly and that things are turning around quickly! Yay!!!
Just stumbled upon your page. I have a ten month old boy who hasn’t learned to self-feed. We do lots of practice and I offer him finger foods, but he really only wants puréed food. He is breastfed, and all other milestones seen to be on track. Wondering if I should pursue an evaluation. Also feeling silly because I have a masters in special education but know nothing about early intervention with babies/eating! His ped says not to worry, but something seems off to me. Thank you!!
Hi Bryana, please- feeding is truly a specialty all in itself, I’d be more surprised if you were expert! You know, he could grow out of it, but I all too often see this as a first red flag. One that docs often blow off, if there is a problem it will continue to get worse. Because, your gut is telling you something else is going on I would definitely get an eval- at the very least it will give you peace of mind. Make sure you read my posts on transitioning to table foods- see the article index or popular posts in the side bar. Let me know how it goes.
I have 6 month-old boy/girl twins. They were born a bit early, and because my partner had complications from the birth, her milk took a very long time to come in, so the the babies were bottle fed initially. We worked with lactation specialists to get both of them breast feeding, and my daughter got the hang of it first. Then, when they were about a month old or so, she started refusing the breast–crying hard when offered. We again worked with lactation specialists, and eventually they concluded that she had just developed a strong preference for the bottle and that we really couldn’t do anything about it. Then, she started having issues with the bottle. She’d push the nipple out of her mouth, or clamp her mouth shut, even when she had to be hungry. By 3 months, we found that she would eat more readily if she was swaddled, and most reliably if she was swaddled and in her swing.
Now at 6 months, she still is really finicky about the bottle. She’ll make a gagging sound as we approach her with it–it seems to indicate that she doesn’t want it. She also gags or chokes and coughs while drinking pretty frequently. Now that we’re introducing solids, she is exhibiting some of the same signs in reaction to the spooned food. (Cereal, various pureed vegetables and fruits). Her brother is enthusiastically gobbling up the food and has no problems with the bottle.
I’m not sure if she really has issues of concern, or if she just seems difficult in relation to him. So one question is whether her issues seem like they are in the realm of normal, or are concerning? Her doctor says not to stress about it as long as she’s gaining weight. (She’s in the 20th percentile now after being as low as 7th as a newborn). I also don’t know whether I should “trick” her into opening her mouth by getting her to smile so that I can get the spoon in, or try to get her to actually open for the spoon? I don’t want to cause additional problems by doing the wrong thing.
Any other advice?
I would definitely not trick- I know it’s tempting, but your instincts are right- in the long run it can cause more damage. I hear that response from doctors often- they are usually only concerned with the bottom line. I don’t want to freak out, but I would get her evaluated, just to make sure nothing else is going on. Silent reflux is jumping out at me -see the article index at the top menu for more on this. However, there are a variety of issues that could cause that behavior. In the meantime, keep meals as positive as possible. Try to just let her explore the food, keep it light and fun through play. Let me know if I could be of more help.
This is a very old comment but I had exact similar issues. I thought its silent reflux and then my son had issues with purees too- (gagging, vomiting). with solids- he wanted to eat but could never chew and swallow- used to choke. Bottle and breast feeding nothing worked. He stopped feeding at 3 months. Struggling till date with his feedings and he is now 2. started with feeding and OT therapies- its helping but its just a start. I contacted EI but they mentioned feeding issues are not part of eligibility which I know is not true. I know as per the feeding clinic he has adaptive delay and sensory issues. He might have some delay in Gross motor. I am looking for more information on feeding issues so that I can email the EI coordinator and request an EI assessment. This article has great information and lot of the things thats mentioned under feeding and sensory, my son has most of these.
Hi Indy- yes, it should be covered! Use the search bar, you will find a lot, but also check this out, it might be helpful: yourkidstable.com/2014/08/eatingfeeding-milestones-for-babies-and.html
Thank you for sharing this information. I was lucky in that when my son started showing red flags for developmental delays I had a lot of people in my life that explained EI and its benefits to me but I know a lot of parents have no idea and can find it intimidating. I still found it intimidating. But as a parent I can’t agree enough what a difference EI can make. I know it has helped my son (and me) so much over the past 8 months. I would encourage any Mom (or Dad) who is on the fence about whether to have their child evaluated or not to go ahead and do it.
In the state of Massachusetts, all services (as of March/April 2013) are not charged to the parents but to your health insurance and to the State Department of Public Health (I think…) I received a bill when I first enrolled but haven’t received one since and was told that Massachusetts residents no longer pay out of pocket for services.
In addition to EI – blogs like yours offer tremendous support. I have referred a lot of Moms to your site – as it was a tremendous help getting my son past his sensory challenges with table food. Thank you.
Thanks so much Lindsey for your comment, I’m sure it will help parents reading this post! I’m so glad Your Kid’s Table has been a resource for you!!!
Yes, our EI therapy (in AZ) does have a cost, dependent on one’s income. But’s it less than private therapy, they come to our house(!), and we’re very happy with our therapist. 🙂
Thank you so much Eileen- helpful information!
Just to clarify, across states- the Early Intervention coordination is free but many states have to charge for the therapies that are usually contracted out. Assessment and evaluation are required to be free. Therapies are not. Wish all states covered these!
Thank you Frannie- that is my understanding as well. At a minimum the screening or eval is done, which I hope will give families some direction.
Thanks for sharing all this info in a post! I got early intervention for my son when he was 2 he is now 4 & has done a complete turn around! I love sharing info with others who may not know about these types of services.
Thanks Jenny, that is such a helpful comment! What state are you in? Just want people to know where services are covered.