What is feeding therapy? Does your child or toddler need therapy, and if so, how do you get a feeding evaluation for them? Get answers from a feeding specialist!
For well over a decade, a big part of my job as an occupational therapist was doing feeding therapy with toddlers and kids, from mostly in people’s homes through early intervention, but also in a private school setting, too.
And, over the last 5 years, there have been more emails than I can count from parents asking if their kids that were struggling with picky eating or transitioning off baby food actually need more help.
In many cases, feeding therapy is one of the best ways to get help from a feeding specialist. While some of you have heard of feeding therapy and are considering it, I know for others it is a very new concept and may be something brand new to you.
Either way, by the end of this post you will know exactly what feeding therapy is, who it’s for, and how to get help. Plus, a bunch of other important tips, too!
What is Feeding Therapy?
Basically, in its simplest terms, feeding therapy helps children learn how to eat or how to eat better. Feeding therapists provide feeding therapy and are usually occupational therapists (like myself) or speech-language pathologists (SLP).
Some dietitian/nutritionists provide direct treatment, but more often provide support with additional services for some children to manage any weight or growth concerns when it is necessary.
No matter what their background, it is important to note that “feeding” is a specialty within a specialty. Not all OT’s and SLP’S are trained in pediatric practice, and not all pediatric therapists have advanced feeding therapy education and practice either.
Feeding therapy often happens on a weekly basis, but can be every other week or once a month during a scheduled block of time, usually 30-60 minutes long. Feeding therapy sessions can be individualized or in group settings, each with their own benefit and goals that we will discuss below.
Most often, this time is spent teaching your child how to eat new foods (if they have a very limited diet) or how to eat (if they don’t know how to chew or manage food in their mouth).
But, depending on the child’s underlying challenges, you may see your child participating in sensory integration activities or completing exercises to strengthen oral motor skills and the muscles they need for eating.
Exercises will likely be things like blowing bubbles, making silly faces, or using whistles.
Before you get to weekly appointments, an evaluation is completed first, which usually consists of the occupational or speech therapist observing the child eat and interviewing the parent. Not very invasive at all.
A combination of standardized testing and skilled observation will help build goals for your child based on what is considered typical and what skills your child might be lacking.
After the eval, a team of professionals or the therapist that completed the eval makes a recommendation for how often feeding therapy takes place and what the treatment plan will be.
At this time, goals are written that guide the direction of therapy. The goals are usually specific and include the parents’ concerns.
For instance, a feeding therapy goal might be: Suzie will drink from an open cup independently 75% of the time, or Logan will eat and swallow three new foods independently within 30 days.
Sometimes, feeding therapy is done one-on-one with a child and therapist. Other times, it’s with a group of children that all have similar goals because a group dynamic can be very motivating for kids.
But, feeding therapy may also be done with the parents, which is definitely the case in an early intervention setting, we’ll talk more about that in a minute.
Who is Feeding Therapy for?
While I gave you a general idea in the section above, I want to get really specific because I know a lot of you are here reading because you want to know if YOUR child needs feeding therapy.
Generally speaking, feeding therapy is extremely helpful and strongly recommended if your child is having difficulty actually eating. This is most common with children that have special needs or medical challenges that may make it physically difficult for them.
Pediatrician’s usually suggest feeding therapy early on in these instances, based on the child’s ability and the child’s individual needs, but there are two more common situations that are often overlooked…
Is Feeding Therapy for Picky Eaters?
Well, for me to answer that question you need to know that not all picky eaters are created equal.
It’s a blanket term that we use to describe any child that basically has food preferences or maybe doesn’t like vegetables, but also includes kids that gag or even throw up at the sight of new food or new textures, and only have 5 foods that they eat.
That’s quite a range! Obviously, feeding therapy isn’t necessary for all of them.
Feeding therapy is recommended for more extreme picky eaters that have a very limited diet and stress around trying new foods. Head over to When Won’t Eat and Extreme Picky Eating Red Flags to understand more.
You can also take our picky eating test to be sure where your child falls in this range.
Is Feeding Therapy for Toddlers?
Depending on the challenges a child is facing, infants can actually be in feeding therapy, so, just to be clear, age doesn’t matter.
But, if you’re asking this question, it may be because your toddler is behind on some feeding milestones, and you’re wondering how long you should wait to see if it improves on its own.
For example, maybe your 14 month old is still only eating baby food and you’re not sure if they know how to chew in order to eat solid foods. Or, maybe they cough every time they drink from anything other than a bottle feeding. Another common concern is a sensitive gag reflex.
In any of these cases, reaching out for an eval is a good thing. Your child may or may not end up qualifying for therapy, but at least you will know if they need more help.
And, with any evaluation you will get some suggestions for activities to try at home during mealtime, which may be all you need! To read about more possible feeding challenges check out Feeding Red Flags.
Also, keep in mind that picky eating often starts for children when they are toddlers, and that it is a normal phase. If you feel like it is getting out of control or is beyond any limits of normal, then this would be another instance that a toddler may need feeding therapy.
If picky eating continues and worsens, and your child becomes an “extreme picky eater,” they may qualify for a feeding diagnosis called Pediatric Feeding Disorder (PFD).
This is a relatively new diagnosis that has offered a more sensory-based treatment approach to advanced picky eating.
How to Get Feeding Therapy
At this point, you should have a pretty good idea if feeding therapy is something you should consider or not. Let’s look at your options.
First things first, it’s always a good idea to talk to your pediatrician. They should know the best options in your area. BUT, and this is really a big BUT, if you explain your concerns and don’t get an answer that sits well with you, don’t hesitate to get a second or even third opinion.
Sometimes feeding issues may seem like typical development on the surface, especially to a doctor that is getting a quick run down, which is why I want you to listen to your gut. As an OT, pediatric feeding therapist, and mom, I cannot express enough how important early intervention can be.
As soon as your gut tells you that something might be wrong, it is completely okay (and recommended!) to pursue opinions and expertise on your own, despite hearing that “nothing is wrong” from your doctor.
It’s also important to know that in many cases you don’t need a referral or recommendation from a doctor to proceed with feeding therapy. However, whenever possible it’s best to have your child’s doctor on the same page as you.
If your doctor doesn’t give you any feeding therapy suggestions, you have a couple of options you can explore on your own:
- Clinic or hospital – Children’s hospitals and many of their satellites offer feeding therapy.
- Private clinic – These may be smaller, but may be in a better location. Some privately owned clinics specialize in specific types of treatment that might appeal to you. (See the next section)
- Early intervention – For children under 3, and in some cases under 5, for children that live in the USA. This therapy takes place in your home.
- School – This is much more rare, but if your child is in a school for special needs, feeding therapy will be covered at school. In the majority of typical public schools this will not be an option.
With the first two options, it’s very important that you check with your health insurance provider about what is covered before you make any appointments. Once you know what will be covered and to find locations near you, just do a simple Google search: “feeding therapy in ‘your city””
Early Intervention is free or mostly free. I have a whole post completely dedicated to early intervention, check it out for how to get in touch with your specific state. I was an early intervention therapist for many years, it’s very near and dear to my heart!
Lastly, if your child is in an approved private school for children with special needs and you think your child would benefit from feeding therapy, ask the team about it!
What to Expect with Feeding Approaches
As you can imagine, there are different approaches to feeding therapy, some of which you may be comfortable with and some that you may not be. Whether you are calling clinics or have early intervention in your home it is okay to ask what type of approach they are using to help your child.
There are dozens of specific, different approaches and a variety of techniques that would be much too cumbersome for me to cover in this post, but most of them can be summed up into two different categories:
1.Behavioral – The traditional method of feeding therapy that uses rewards to gain new foods eaten. For example, your child may be given a sticker, toy, or electronic device for successfully taking a bite of a new food.
To get another sticker, toy, or more time with the electronic device, they need to take another bite. Over time, these rewards should be phased out, although that isn’t always the case.
2. Child directed – This is a more modern approach and is positive in nature. Parents are more involved with this type of treatment and there is a focus on addressing the underlying cause of the problem (i.e. sensory, medical, etc.).
While this approach can take longer to see results initially, there is research that supports the effects are longer lasting. The SOS approach to feeding and Ellyn Satter’s work fall under this category. You can read more about Satter’s technique in my favorite Picky Eating Strategy.
I will be completely honest in saying that I use and support the child directed approach, but I respect parents and other therapists that choose to go the behavioral route.
If it’s important to you that your child’s feeding therapy does or does not include one of the above approaches, make sure you ask when you schedule an appointment what approach they use and the experience level of the therapists.
If the clinic or therapist can’t accommodate you, then it will be best to call other facilities until you find a good fit.
Are There Other Options for Help?
If I haven’t been direct enough yet, I think feeding therapy can be great for you and your child. But, I know there are many reasons it sometimes isn’t possible, whether it’s due to financial constraints, location challenges, or simply not a lot of therapists being available.
If that is the case, or if you want to also be able to help your child at home day in and day out then grab a seat in our free 1 hour workshop:
3 Keys to Turn Your Picky Eater Around
You’ll learn my 3 most basic strategies that are totally essential to making eating progress with your child, and you’ll learn the entire plan I teach inside of my picky eating program, Mealtime Works.
And, if after reading this you are concerned about possible sensory issues with your child, either related to their eating or outside of it then you’ll want to stop over to sensory integration therapy to learn if it would help your child.
More on Feeding Therapy and Picky Eating
How to Get Your Child to Explore New Foods
Turning My Picky Eater Around: A Complete Plan
Sensory Processing and Picky Eating
Pocketing Food Strategies and Causes in Kids
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Alisha Grogan is a licensed occupational therapist and founder of Your Kid’s Table. She has over 19 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.
My son is 18 months and has been a pain with eating. He absolutely does not eat enough calories. He only eats enough food maybe 40-50% of each week. He constantly fights with us. 1 day he eats okay, the next, he eats almost nothing. He will spit foot out, fight, has no interest in sucking any pouches or bottles of milk. Nothing that is a high calorie liquid he will eat.
When he is doing well, he does eat a wide range of foods, but every day he changes his mind on what he wants to eat. He has not gained any weight or height in 6 months. He is at about the 10th percentile for his age and it is very concerning. He is extremely energetic though, walking everywhere, building with blocks, he loves books and pretends to read. He definitely is very smart. Makes me wonder if all his calories are only going to his brain.
Some days he eats well. He will eat about 4-5 meals. Other days, I feel like we are lucky if he eats 200 calories. On a good day, he will eat eggs, noodles, beef, fruit, crackers with peanut butter, veggies, avocado, yogurt etc… you name it. He will eat it.
Then tomorrow, I will go to feed him breakfast, and he pushes everything away. Then when he will eat 1 bite, but the second bite he will spit out immediately. Then every repeated attempt for the next 30 minutes consist of him pushing the food away, turning his head, or spitting it out. This will repeat until we give up and wait a bit.
My wife and I co-sleep with our son, and she still breastfeeds occasionally. He only consistently drinks breastmilk just before bed. Over the last few months, he has self weened off breastmilk. He used to drink more breastmilk in the morning, and have a little bit around lunch and afterwork, but as of the last 2-3 months, it is mostly just at bedtime. So we know the issue is not that his stomach is full of milk before eating.
Any ideas what is going on here? He isn’t picky, because when he does eat well, he will eat a huge variety. He is not on the spectrum for any mental illness, nor does he show signs of poor development because he is smart, laughs a lot, and is very active. He just is not gaining weight or any height and that greatly concerns my wife and I.
We have tried adding structure to meals, but that only works for a week before he gets annoyed and starts spitting food again. We have tried letting him feed himself, but 1 day it works, the next he only wants to smash and throw all the food.
He also refuses to hold a bottle or glass to drink for himself. He prefers if we hold it for him as he drinks water. He refuses whole milk, he refuses any pouches, he refuses any type of liquid that is high calorie. He only occasionally drinks a few sips of water.
Any ideas or suggestions. I am concerned and it makes me want to see a feeding therapist, but anytime I call some place, they basically say they will only see kids who don’t eat at all or are on the spectrum. Even on a good day, he requires almost an hour for each feeding. On bad days, we spend hours endlessly trying to make him eat, but he refuses. As parents it feels like we are panicking that he will not eat 50% of the time. Why is he not feeling the desire to eat? Shouldn’t hunger be driving him to eat? He is consistently under eating and we are concerned that he will continue to not grow at all.
I appreciate your time and insights.
Hi John, thank you for this thorough description about what is going on with your son. It can be very frustrating. The fluctuation that is going on between days is more common than you think for this age range, as many kids will vary greatly in the calories consumed day to day. However, the lack of weight gain is scary as a parent and may be a sign that something is going on that can be addressed. The range of foods you described is good, and it sounds like he is eating a variety of textures, flavors, etc. If you haven’t taken it, try our free picky eating workshop that describes some of the mealtime routines and suggestions we recommend. I know he is not overly picky, but there are layers to what’s going on so this is a place to start. You will see that the workshop also has a paid course that you can take if you think you need more. It can be really hard to get into feeding therapy for the reasons you stated so if you needed it, it’s an option. What you are doing by continuing to offer a range of foods daily is a great start, but I think the workshop may help offer more clarity. Let me know if you have more questions!
Best,
Laura
Your Kid’s Table team member
Help!! Reading through all of this, I still don’t know if this is Hands-On at your location, or virtual? And I don’t know if you’re in the Richmond Virginia area. We have an extreme 9-year-old picky eater who reads labels for product age, refuses to try new foods, cleans up with antiseptic.
Linda,
All help is virtual and public due to regulations regarding providing private services across state lines. We do have a free picky eating workshop and a paid course you can take if you’re interested. Start with the free workshop and go from there to see if it helps!
Best,
Laura
Your Kid’s Table team member
My 4 year old (born as a micro preemie) chews only with his front teeth. He has not figured out how to chew with his back teeth. This causes him to take very long to eat most table foods and can’t eat any hard to chew foods. We keep trying to get him to learn without much success. What do you advise for him?
Hello there,
He might be having some oral sensory or motor difficulties. Check out this post to improve ability to chew!
Best,
Laura
Your Kid’s Table team member
hi my daughter is 3 her only source of nutrition is milk in a bottle and nido toddler beverage i do add vitamins to the milk anyway she’s been in therapy for 2 years within the first year she learned to not gag from just looking at a food we introduced her to many foods she excepts them now but after meeting that big mile stone we haven’t been able to get her to chew or swallow she’s never chewed anything ever she only licks foods she won’t drink from a straw i feel like i need to do more i feel like this feeding therapy is not the answer any more i’m thinking on top of the sensory she may not have strong muscles to chew maybe ? also she has ONH optic nerve hypoplasia i don’t know what to do i’ve heard of children almost dying from drinking just milk what can i do
Hi Elizabeth,
This can feel so stressful. Definitely see if increasing her oral motor skills may help, since you’ve made such important gains in her sensory processing. Also, as much as you can get her to play in sensory bins for tactile stimulation will really help!
Best,
Laura
Your Kid’s Table team member
My daughter Sarina is turning 2 in January. She used to eat orally but after getting RSV last January she stopped eating completely and began to lose lots of weight. Doctors gave her an NG tube and she is still on that for her nutrition. Her weight is back up but she will only drink from the breast and water from a bottle. She sometimes will taste chips but never chew or swallow. If anything goes in her mouth she picks at it until it is off of her tongue which sometimes leads to her throwing up. She won’t drink anything else either. We are working with an OT but it doesn’t seem to be helping.
Hi Atiqa,
It sounds like she may have developed an aversion from being sick. I would start with some oral sensory activities to help increase her ability to tolerate food in her mouth. Let me know if you have questions after checking this out!
Best,
Laura
Your Kid’s Table team member
My 4 yr old son witnessed another child throw up in front of him. He was scared to eat after because of his fear of throwing up. About 2 weeks later he caught a stomach bug where he was the one throwing up and ever since then, he take really small bites of food and has become extremely picky with his food also. It has been a struggle of 5 months now. Before all this he used to eat his food quickly and would take normal and big size bites. Now it’s the complete opposite.
Hi Adriana, this can be stressful and for many kids, this is extremely common when they have a set back getting sick. While he will likely slowly get back to normal as he becomes more confident and comfortable being healthy, I do want to point you to our free webinar on picky eating just so you have some of these strategies in your back pocket, should this continue. Let us know how it goes.
Best,
Laura
Your Kid’s Table team member
Our 13 yo son with ASD was trached/g tube as an infant. He is not a picky eater but seems to tire easily and pockets. If I blend his food and mix with apple sauce there is no pocketing. I cant’ decide if this is an oral motor or sensory issue. Is there exercises we can do to strengthen his jaw? We did years of feeding therapy and it seems some of those skills are just emerging. He takes about 45 min to eat 1/2 cup of chopped food (washing down w/apple sauce). 30 min to eat the same amount when blended. He has a heart condition so to wean from the g tube he needs to take in a lot of calories, he just seems to get so tired from eating.
Hi Erin,
While it might be both, this sounds like oral motor skills due to decreased chewing ability and pocketing. Check out this article for increasing strength and see if it helps.
Best,
Laura
Your Kid’s Table team member
Hi my son just turn two years old in may . He only wants to eat Blended fruits and veggies he doesn’t like no texture foods once I put a put a piece of rice into his mouth he gags and doesn’t wanna swallow it . His dr suggested to do a throat test to see why he doesn’t wanna swallow. I asked her if she can help me get him into some type of food therapy cause I tried my best idk what else to do . I’m scared he’s not getting his nutrients in . He doesn’t even wanna drink out of his sippy cup
Hi Mandy, it can be stressful when your child gags on different textures. This sounds like an oral sensory aversion. Check out this article and see if it helps.
Best,
Laura
Your Kid’s Table team member
Hi, my son is turning 23 mos and does not want to eat other than blended fruits and veggies with cereal or oatmeal. He does not feed himself with his fingers yet and does not want drink anything from other cups other than his old sippy cup and milk from his bottle. We tried to wean him and train him but he would turn his face away, throw his plate on the floor or not eat at all. I think the fault was mine bec i made him get used to spoon feeding with pureed food now he is stuck. Pls., pls help
Hi Joy! Thanks for reaching out! You are not alone! Due to his age, we would recommend consulting with your pediatrician about maybe starting feeding therapy- some hands on help could be beneficial for him. Try practicing with sensory strategies, like sensory bins, teethers and vibrating toothbrushes. Try to allow him to touch/feel/play with food and different textures. Try pre-loading a spoon with food and set it in front of him to see if he picks it up and brings it to his mouth. Have him watch you eat, where you can over-exaggerate chewing/swallowing. Lastly, we have a free table food workshop that can offer more in-depth help!
Best,
Kalyn
My baby just turned 1 yr old and would only eat anything pureed foods.
She doesnt like to eat food with texture/or any table food. She only likes to drink her milk in a bottle and only likes to drink water in her sippy/straw cup.
Doesnt even like to drink cows milk thats why we just let her drink toddler formula. Im so stressed already especially im a working mom and she stays in daycare when im at work. Im already having anxiety knowing shes not eating anything in daycare.
Hi Vivian, if you haven’t already, check out our free baby/toddler table food workshop here. This is a great place to start.
Best,
Laura
Your Kid’s Table team member
My daughter is 2.5 years old and we have meal time struggles every meal . She takes a bite and keeps food on the side of her cheeks for longer times. If we give small bites or big bites it’s going to get accumulated there. It’s only with the foods made of grains like pizza , tortillas, rice , pancake, waffles or veggies like broccoli stem . She otherwise eats her fruits very good like cucumber carrot raw beets , crunchy food like cookies , chips , popsicles, chicken nuggets . But it’s just the main course I think she does not eats . Can you please help what could be wrong ?
Hi there! Thanks for reaching out! It could be a sensory reason behind why she does this, or it could be related to oral motor skills. Here is one of our blog posts that talks all about food pocketing and how to help!
Best,
Kalyn
Hello! Our son is 19 months old and has no desire to try new foods. He only eats oatmeal, bananas and bread. We did not started solid by using the blw method. We eat together the whole family, I constantly offer him the food we eat, but he doesn’t try anything. Throws everything on the floor and also his plate, gets upset and wants to get off the dining chair. Would you please give us advise and is online therapy possible as we are from Europe. Thank you!
Hi Desi! Try putting very small portions on his tray in front of him— maybe even one piece of food at a time. This might make mealtime less overwhelming for him, and therefore reduce the amount of food he throws. Try food play- let him touch/feel his food with different textures, have him feed you, have him feed a doll/toy. Sensory bins may also help! For more help, check out our free picky eating workshop online- save your seat here!
Best,
Kalyn
My 4 year old takes 2 plus hours to eat his dinner. We used to have to spoon feed him to try hurry him on. He’s always been a slow eater but it’s especially bad with dinner truly at my wit’s end we’ve tried everything, getting him involved in cooking, giving deserts, lots of praise, not making a fuss, screens, no screens everything….help please
Hi Sara! Thanks for reaching out! We know how stressful eating issues can be. We definitely recommend consulting with your pediatrician regarding this issue. Your pediatrician can then refer you to a feeding therapist for some hands-on help. If he is taking long to eat due to chewing/swallowing issues, he may need help with his oral motor skills. For that, try using a toothbrush to brush the insides of his mouth before mealtimes. Other oral motor exercises include making silly faces, blowing bubbles, sipping from straws, and licking lollipops/popsicles. These exercises will help strengthen his oral muscles, which are what he uses to chew/swallow his food. We have a post with more exercises here. Hope that helps!
Best,
Kalyn
Hi. My baby is a breast fed baby. At around 6 months i introduced puree food and he took a fancy and was eating fine up until he started to throw up. We were diagnosed with food allergies and at the sight of a spoon he would throw up. I am trying to WLB and leaving appropriate amounts of food (non allergic) on his tray and let him experiment but unfortunately he takes one bite and puts it down. It’s frustrating because he solely depends on me and i go to work. During day time he stays at his grandparents but no success with eating. Help! I don’t know what to do. I cannot do anything. I followed up with the paediatrician and the advice was to force him to eat and stop breastfeeding. That sounds cruel. I followed up with a nutritionist and advised to follow a routine but my kid tries a bit and then stops. And cries until he is fed milk. I don’t know ehat to do 🙁