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 🙁
I have a 3 year old girl she had medical issues and a feeding button she will hardly eat or not at all that’s way she is on Pedia sure we are trying to get her off the button but it just seems hard she was feed by the tub ever since she was a baby
Hi Chelsey! Thanks for reaching out and sharing some of your story! So sorry to hear about your daughter’s struggles with feeding. We have a post that talks all about weaning off of tube feedings and helping with oral feedings! Check it out here!
Best,
Kalyn
My son is 3 years now he doesn’t chew directly swallow the food, mostly he prefer puree food with limited food items, If I try with new solid food he don’t want to eat he vomit so is it normal… Plz help
Hi Nilofar! 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. Since he’s 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. 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 information regarding throwing up food here. Hope that helps!
Best,
Kalyn
Hi,
I have a 13 month old who is still exclusively breastfed. I’ve been trying to introduce foods to her for months now, but she just screams and lets the food drool out of her mouth anytime it’s placed in there. I’ve tried both purees and solid foods, let her play with them, put them in mesh teething toys…I feel like I’ve tried it all. She’s my 6th baby, and I’ve never had this issue before. I don’t understand it and don’t know what to do. And our Dr was no help either. Do you have any suggestions? Is this what a feeding therapist would address? Oh, she also won’t take a bottle or sippy cup. I just need to figure something out. I can’t breastfeed her forever.
Hey Melody! So sorry to hear that she’s struggling to eat. We definitely understand how hard this must be for you! As for feeding therapy, yes, this is what would be addressed. Your pediatrician can refer you to an Occupational Therapist or Speech Language Patholgist who can initiate feeding therapy to help your child practice and learn how to eat. Since she’s not accepting anything to eat and let’s the food spill out of her mouth, check out this post Conquer Your Child’s Oral Aversion with a Powerful Plan. It will help with ideas for getting things in her mouth, which is the first step in getting her more comfortable with eating. We also have a free workshop that talks all about this and more. Save your seat here!
Best,
Kalyn
Hi!
I have a 10mo with some medical issues that have required him to get oral medication (which he HATES). I think this is why he’s developed a mild oral aversion and won’t let us feed him & doesn’t put food in his own mouth. He drinks milk fine from bottle and breast, and loves stuffing toys in his mouth as well. Just not food.
We haven’t been able to find decent feeding therapy in the country where we live. Is there anyone you know of who provides support over zoom?
We’re running out of ideas fast here….!
Hey Juliana,
Oh that sounds to tough, especially that you haven’t been able to find help. We don’t provide direct therapy here, but do have an awesome table foods course that I think would be hugely beneficial for you guys. We have a free workshop that offers a great introduction and gives you some ideas to try out right away. You can save your seat HERE. Please reach out if you have any questions at all! We’d be happy to help 🙂
Best,
Andrea
Hi. I have an 18 months old who will not eating anything with a soupy or slimed texture . she just lets it slip out of her mouth almost like she doesn’t know what to do with it. He has 4teeth and is generally a pretty temperamental baby and is obviously still on purées he doesnt even like milk at all .His pedi is not concerned at all but I am worried sick seeing everyone else’s babies explore tons of new foods. I have tried so many things he still slips them out of his mouth! He is still on teething but I have to forcefully feed him. Any tips or words of advice? Thank you
Hey Saba,
That sounds like a challenge! It can be really tough to watch other toddlers make strides eating while you feel like yours is stuck where he’s at. Some oral motor exercises might be helpful in strengthening his mouth and making him more aware of where the slippery food is. You can check out some resources HERE.
Best,
Andrea
My son is 10 months today & I’ve tried him with all sorts of table foods in the last 2 months as he’s gone off purée & porridge completely. Trouble is he’s interested but just putting in mouth, chewing & spitting out. The only thing I’ve seen him swallow are raspberries & maybe a bit of banana! Am I overwhelming him with too many textures too soon? He’s down too 3 bottles & a dreamfeed
Hey Danielle,
Spitting out food it really frustrating, it can actually be surprisingly common too. You might look for some signs to see if your little one is having trouble actually chewing (that might look like using his tongue and roof of his mouth to mash food, vs. actually chewing it with gums/teeth). Our article on spitting out food might be helpful to give you more ideas. You can check that out HERE.
Best,
Andrea
I have a 2 year old grand son with down syndrome. He will not eat anything but baby food. He has a full set of teeth. But when you put anything with any consistency in his mouth he gags and spits it out. What can we do for him
Any Suggestions? We have exact similar challenge for our child?
Thanks for reaching out! That sounds like it is really frustrating for you. Addressing possible oral sensory concerns can be a good first step! Brushing teeth, tongue and the inside of cheeks regularly can be really helpful. You might also want to check out our free transitioning to table foods workshop. It’s a great resource. You can save your seat HERE. I hope that helps! Let us know if you have any questions.
Best,
Andrea
We have similar problem for my son. He is not drinking and eating anything over mouth. All feeds are through NG tube since 8 months.
Have you found any treatment for this, I know kid to kid its different.
Please let me know your suggestions on this..
Appreciate your help on this..
Thanks,
Lakshmi Kilaru
Hi Alisha! Do you have any tips for feeding cleft palate babies? … there are so many different approaches out there that is quite confusing
TIA!
Hi -any tips for an almost 14 month old (premie 12month adjusted) who will only drink during dream feeds since 5 months.
We give her straw and sippy cups during the day she’s capable of using however does not want to drink more than a sip or two while awake. Limited interest in eating all food generally but Loves any cheese ~
She’s on half dose of Pepcid for reflux
Thank you!
Jane
Ps- sorry if this posted as a reply 🤷♀️To previous message
Hi- my kid will eat anything… when she wants to. Sometimes she’ll just keep putting things in her mouth till it’s full and want to get out of her high chair and play….With a full mouth… and I find pieces of food and drool all over the place. Sometimes she’ll be hungry and completely refuse to eat or drink her bottle, and gets hangry. And sometimes she’ll just eat like a normal kid.
How do I stop the squirreling of food? And how do I get her to eat when she won’t?
Christy
I forgot to say she is 11 months old.
Hey Christy,
Thanks for reaching out! There are a few causes of kids pocketing food. From what your describing, it sounds like she may be seeking the sensory input/sensation of having a full mouth. You can try providing her with thick liquid through a straw ie: smoothie or milkshake as this works the muscles in the mouth. We do have an article, Pocketing Food Strategies and Causes in Kids, that will walk you through reasons as well as some other tips to try!
Hope that helps!
Best,
Desiree
I have a 9 month old who doesn’t seem to know what to do with food. She usually lets food (Puree or small chunk) sit in the middle of her tongue. I’ve never in my life seen her spit it out, try to remove it with her hands, or move the chunk to the side/back of her mouth. I do believe I see her chewing sometimes, it’s mostly swallowing she doesn’t seem to want to attempt. She relies heavily on drinking water to wash things back and then gags (or even vomits) because it was so difficult for her. Any tips? Is this something that warrants feeding therapy?
Hi Rockie! Thanks for reaching out! Just like with any milestone, it’s totally normal for babies to need some more time. It may not be until 9 or 10 months when they figure the whole chewing thing out. But, we do look for chewing and eating table foods by 11 months. Since she’s just barely at the 9 month mark, she probably just needs some more practice with chewing! We have a post all about it with lots of tips. Check it out here!
Best,
Kalyn
Hi Alisha, I have an 8 month old who will not eating anything with a soupy or slimed texture (such as berries, avocado, bananas, eggs, zucchini) she just lets it slip out of her mouth almost like she doesn’t know what to do with it. She has 2 teeth and is generally a pretty temperamental baby. She’ll eat brocolli, rice and toast all day If wede let her and is obviously still on purées and milk. Her pedi is not concerned at all but I am worried sick seeing everyone else’s babies explore tons of new foods. I have tried coating things with graham crackers and she still slips them out of her mouth! Any tips or words of advice? Thank you
Hey Adriana,
Thanks for reaching out! I’d first make sure that you are providing opportunities for her to touch and explore these textures, this can have a huge impact on helping them to eat. We do also have a free workshop that is full of great information for this age. You can save your seat HERE
Best,
Desiree
Hi Alisha!!
I am so glad to find your website and thank you for all of your information.
I have a 2 and half year old toddler who only swallow purred food; she does not swallow any solid food after chewing she spit the food out of her mouth. I have informed her Pediatrician about a year ago and he told me that she will grow out of it… Now almost two years later she still doesn’t swallow her food; few days ago I told her doctor that she still doesn’t swallow her food and He told me to try some exercises such as blowing bubbles… Should we seek for feeding therapy or continue with the bubbles exercise? This has been very frustrating and I really want to get some help.
Thank you for reading and I hope to hear from you.
Trish
Hey Trish!
So sorry you are dealing with this! And sorry you are not getting much help or any referrals. I’d definitly get her checked by a specialist just to make sure there are no swallowing difficulties. You can also reach out for a feeding evaluation (typically done by an OT or SLP). We do have our free picky eating training series (closing today at midnight) but could be helpful for you for setting up mealtimes and following through with a good plan. Sign up here: yourkidstable.com/learn
Best,
Desiree
Hi, I have a15yr old son who’s picky eating started at 4yrs old. His pediatrician said” it’s all a phase he will grow out of” now at 15 on the obese side of the spectrum, low calcium levels and high cholesterol levels,teetering on the verge of pre-diabetes.
I feel guilty and scared to death! I’m a type 1 diabetic who has a system for controlling my food intake to keep my Diabetics controlled. My son seems to have bits and pieces of all types of picket eaters you listed!
Lately it seems he only eats high-carb high-fat, unhealthy foods and he over eats, snacks all day on junk food and always says he’s hungry. I know these types of foods do not full you for longer periods, like healthy choices and this is probably why he’s always feeling hungry.
After the scariest conversation I had with his Dr. about his lab results, I started a rule that he must write down every food he eats, how much and the date/time, so I can Get a better handle on his habits and eating times. I stopped buying chips and various sweets, junk food. Example I would buy the family size chips, his brother, father, him and myself would get a serving size during certain dinners I make, then he would finish the rest of the bag, by himself for a snake. During the course of two days the bags gone and he ate the majority. I’m stressed, feeling guilty for not doing more to control this and at a loss. I don’t have the first clue on how to limit then finally stop his horrible, unhealthy eating habits. I thought by speaking with him about my diabeties and about Type 2,
which stems from bad eating habits,obesity and completly ignoring all the red flags and advice thrown at you.
I’m so frightened for my son and I have to get a handle on this Now!! He’s stubborn and impossible
He says “I will” when U discuss trying new foods with him. I know his brother must back off or I’ll never get a handle on this, like most siblings your going to dig in your heals when they try to help you.
So will read and try anything and everything possible to save my boy. Please leave me your,hints,advice, encouragement because I’m lost and really need
help.
His Dr. Suggested us seeing a nutritionist, o don’t mean to be negative, I just known son, so I’m doubtful.
Hey Gayle,
So sorry you are dealing with this situation, we know it can’t be easy! I’m glad you found our site as we do have some articles that can help. However I’d start with our free workshop. This will walk you through setting up mealtimes, having a positive environment, etc. It is full of great information and place to start! You can save your seat here
Best,
Desiree
Hi Alisha and Team! First of all, thanks so much for all you’re doing! I’m about halfway through Mealtime Works and am finding it full of great information. My 4.5 year old daughter’s pediatrician is aware of her extreme picky eating and texture aversions and has recently referred us to an occupational therapist to work through some of the sensory issues. She said that in her experience, feeding therapy can actually backfire and make any feeding problems worse so recommends focusing solely on the sensory issues. I am just not sure if I agree. I have been taking this time during quarantine to do my own research (hence your class, hence reading all your posts!) and in my heart of hearts feel she needs feeding therapy. I am just not sure which options would be best: SOS feeding approach, group setting (daughter is highly sensitive, very shy, easily overwhelmed in new situations), individual setting, in-home consultation…. Can you offer any insight???
Hey Brita,
So happy you are enjoying our information! We do have a philosophy of working on both sensory and feeding together (as there are is so much overlap). Our feeding programs are based off of an SOS feeding approach. I’d look more on what may be available to you within those settings and what you think might be best for your daughter. Overall different therapists have different a philosophy. If you are looking to stick to more of what mealtime works is geared towards, looking for a therapist with SOS will be a great fit, but this method can be done in any of those settings. Typically for the in home that is with Early Intervention which is birth-3. I’d find a good therapist to get to know your daughter and see if she recommends individual or group. You can also reach out in our Mealtime Works FB group or discussion board as well!
Best,
Desiree
Hi! I’m wondering if feeding therapy is right for my daughter. She is just a little over 3 months and breastfeeds wonderfully but she will not take a bottle. She was in the nicu for the first 3 weeks of her life (she wasn’t premature just had a bad infection) and during that time she took a bottle but would refuse to latch on the breast. The day she came home it was as if a switch flipped because she wouldn’t take a bottle anymore (even the exact same ones we fed her with in the nicu) and she latched perfectly. I have tried EVERYTHING. Different bottles, different temp milk, offering her the bottle when she’s sleepy, or wide awake, I’ve tried having her dad feed and and my mom and myself, I’ve tried fresh and frozen milk, I’ve tried cup feeding, syringe feeding, pace feeding with a bottle I’ve even tried using a few different sippy cups. I feel so lost about how to get her to start taking the bottle again. Usually I wouldn’t mind just breastfeeding but I have to return back to work to help with income for a few months but I can’t go to work if she won’t eat while I’m gone.
Hey Hannah,
So sorry you are dealing with this, and does look like you have tried some great ideas. I’m not sure where you are located, but it never hurts to reach out to see if you can get an evaluation. If in the US you may be able to get an Early Intervention evaluation. Also we do have an article full on tips for Transitioning To The Bottle Hope this helps!
Best,
Desiree
I cryed when you used my sons name and him eating and chewing three new foods in a month. If i could get that for my Logan…that would be, blissful. Need to go back and finish reading now.
AWW Heather,
We totally get it!! Hope you enjoyed the rest of the article just as much 🙂 Let us know if you have any questions!
Best,
Desiree
My 2.5 year old is in OT for sensory issues related to eating and it has been a huge help so far. The work you do is amazing!
YAY Sue!! Thanks for sharing!! We love working to help our kids!
Wow! Fantastic read! As an SLP student, I would LOVE to specialize in paediatric dysphagia/feeding/lactation.
Thank you for the insightful article.
Awesome, so glad this was helpful for you 🙂 We love providing information to our fellow professionals! Let us know if you have any questions along the way!
Best,
Desiree
Any advice on bottle weaning with a 3yr old with Down syndrome? aside from the sappy cup/staw suggestions.
Hey Dani,
Here is an article with some suggestions, yes there are some tips for cup/straws but there are others you may find helpful 🙂 Check it out HERE
Best,
Desiree
Can you recommend any food therapists of your experience in New York City/Westchester area?
Hi Hayley,
We do not have anyone specific that we recommend, I’d just be looking for a therapist that has true feeding experience. I’d call around your area and talk with a few to see who is knowledgeable and uses the approach you are looking for!!
Best,
Desiree
Hi,
It’s new to me to hear feeding therapy, I’m struggling with my son 8 year old has mild autism, picky eater, never takes food in the school or outside, I tried to break this challenging behaviour, tried with all means. We aren’t providing junk foods, milk, glutamic food items, and not even packed food items. We came to know with the assessment done at the age of 1.5 years, still I’m working on it. Earlier he loves to et only tiffen very particular towards idly and dosa, so slowly we have make him to take fruits and veggies and slowly towards rice. He is not eating anything apart from home
Strictly no outside food too
Pl help me how to change this behaviour.
Checked several times with pediatrics, but they suggest to treat only with medicines.
He is going to OT . Pl suggest how to overcome the same. Few exercises pl
Hi, We understand how challenging this can be and hopefully you are getting some advice from your OT that you are seeing as well!! I’d recommend our free picky eating workshop, to really look at changing of mealtimes and decreasing pressure over foods, so that everyone feels more at peace! You can learn more and save your seat here
Hope this finds you well!
Desiree
Hello,
My wife and I are desperate for some help. Our 3 1/2 month old daughter has some major feeding issues. She doesn’t breastfeed and is a very difficult bottle feeder. She had a tongue and lip tie, we’ve gone thru speech therapy, physical therapy, cranial sacral therapy, chiropractors. It is getting so hard on my wife especially, who’s home with her all day. She will occasionally take a max 2 oz at a time. But she takes FOREVER to finish a bottle. Her tongue muscles are very weak. We do the necessary exercises that our speech therapist gave us. Things just aren’t getting any better. Does anyone know any specialists in the Chicagoland area?
Hi David,
I’m so glad that you reached out. I totally get how frustrating this could be! I see that you have looked into a lot of different therapies. Have you looked into getting an OT evaluation? You can do this through Early Intervention or outpatient as suggested in this article. I would just look for a feeding specialist specifically. These can be speech therapists (so your speech therapist may have this training)? But can also be an occupational therapist. Feeding will take some time to really work, so also think about how long you have had the speech therapy and definitely reach out to your therapist about your concerns.
Hi – I am in need of some help. My son was just declined services from IU. He is currently getting feeding therapy from EI 3 hours a week. Is there anything I can do to continue services? He is 3 and only eats purees.
Oh I’m so sorry, it really depends on the state. You could look at your private insurance and see what they cover and take him to outpatient.
This seems relatively minor compared to other challenges that young children face, but my 14.5-month-old refuses to drink anything other than milk – no water, no juice – and has made next to no progress in moving away from bottles. I wouldn’t worry much about it, except that she only seems to drink milk for hunger (or comfort-she stills nurses a couple times a day), not thirst, and she has chronic constipation. We have to give her Miralax every day. And we think it is due to too-low fluid intake (it’s much lower than the guidelines I’ve seen). Is this something that we should see a feeding therapist about?
Oh, and thank you!! 🙂
To be honest, she probably won’t qualify, but I think getting an eval is always a good idea, at the least, you’ll get some specific tips for her.
Hello ,
I’m so happy I found this page , I thought my son was the only one . I’ve been searching for answers to which I thought was only a problem with my son . He is a problem eater , he is about to be 5 yrs old on Tuesday and I’ve been struggling with his eating since he was about a year old . He had no real interest in foods , has ALWAYS been extremely picky . His ‘food inventory’ has been getting smaller and smaller . Some Foods that he would eat before, he won’t touch anymore . He has a huge anxiety about being presented with new foods/meals and has anxieties when events at school come up where they will be taking foods . When all the other kids are excited to being treated to foods, he will come home saying he doesn’t want to go to school because there will be snacks or food for them . I had been hoping for past few years that the feeding issue would naturally resolve on its own .. but it’s just gotten harder . Not to mention the comments I receive from people about him not eating like everyone else as if I’m not doing my job as a mother . I have a 6 month old and can absolutely tell the difference from when my 5 yr old was this age. My 6 month old already wants to grab all foods in front of him and my eldest was not like that, still isn’t . I’ve tried bribing my son to take just a bite of any new foods and that’s only worked very few times . How do I find a feeding therapist near me? We have Kaiser as his doctor told me they don’t have that .
Thank you so much
Hi Michelle, I know how frustrating it can be. Know that you’re not alone and this is an issue a lot of people face. I have a post about feeding therapy that you can check out here. There is some info and links in there on how to get feeding therapy. Also, have you been able to watch my free workshop: 3 Keys to Turning Picky Eating Around. I think it could be helpful for you as well. You can sign up for that here.
I think I’m the one who needs feeding training. I’m not sure how to move up the scale from soft foods to harder to chew foods…how do I know when my baby girl is ready?! She is pretty good about eating foods….but I’ve never had the best diet and am not really sure what exactly to feed her…help she’s 11 months old…I can get into more detail if I could email you
Cheryl we have an article that’s perfect for you at How to Transition Your Baby to Table Foods, it breaks down the steps!
I am an OT and looking to get some additional feeding training. I’ve heard the SOS feeding trading is the best, what do you suggest? Is that a good one or would you recommend another? Thanks so much.
I would highly recommend the SOS training!
great article. I have a 14 year old who I always thought was “just picky” but now hes a slow slow grower and he just strated feeding therepy
Hello! How is the treatment going for your teen? My daughter is 12 and we are seeking food therapy.
My nephew almost 12 months old now has had reflux all his life and we have done all investigations from blood tests to endoscopy to rule out any physical causes and all are normal but he refuses to eat anything infact does not even open his mouth…moves his hand to cover his mouth whenever you try to feed him..only breastfeeds and takes fluid but no semisolid or solid foods….seems no one is able to figure out what is wrong with the child. Although his wt and ht are within normal limits, he is very vertical difficulty to feed. What are your recommendations for this refusal problem. I hope to find a solution..thanks
Hey Anish,
We understand how hard this can be but you are great for looking for resources to help! First I’d make sure that the reflux is under control. Also I’d work on him self-feeding so that he feels in control over his meals. You can read more about that HERE. Also if you are interested you can save your seat HERE in our free picky eating workshop, to learn more tips.
Best,
Desiree
Anish, did you ever get any solutions for your nephew? My babe is about to be 12 months and sounds identical to what you described! He won’t put anything into his mouth except his bottle! When I force something into his mouth he spits it out and makes a face like something very sour is in his mouth. I have been trying to get an appointment for a food therapy Evaluation but have been unable to get one so far. Just wondering if your situation was resolved and if so what helped your nephew!
I am very concerned my niece of 10 years of age does not want to eat, because she is scared that she is going to throw up she had a very bad experience where she threw up after eating some hot Cheetos and she threw up all over her mom and then she saw one of her classmates throw up in front of her and ever since she is scare that she is going to throw up. She has lost a lot of weight. I am very concerned because she is starting to have bad breath as well. Please help.
This is something that feeding therapists are quite familiar with. I have additional tips in 5 Reasons Kids Don’t Eat, that I think will be helpful, as well as a free workshop you all can watch.
That is emetophobia, not a developmental or sensory issue. I have been emetophobic for more than 20 years. It affects my life in a huge way every day. Definitely talk to her mom about seeking some sort of help.
Although it may sound strange, some eating issues can stem from infection and is not behavioral at all, but rather neurologically based due to brain inflammation. Please look up and alert parents to the possibility of PANS/PANDAS. We experienced this with my child where he refused to eat many foods and would throw his dinner on the floor; he was also quite irritable. As a psychologist, I immediately tried many behavioral strategies that were ineffective. It was only when we tested and treated for strep throat (and took blood work as well) that he spontaneously recovered from his disordered or picky eating.
Thanks for sharing this! Recently, I’ve become aware of a few cases of this occurring. It’s definitely something to consider.
Hi MD, How did you treat the strep throat?. My son gets sick with strep throat a lot and we used antibiotics but his eating habits are still bad. He refuses to eat any food as well. What did you do to get your son eat? Please help. We are desperate to get him
Eat.
Hi, I ran across your post and decided to look up the PANS/PANDAS because my son has major issues with feeding. My son has almost every symptom of PANS. What type of testing has to be done to find out if a child does have PANS? What if they test negative for strep throat? Could they still have PANS without having strep throat?
Hey Meredith,
For any medical diagnosis I’d run it by your pediatrician. They will be able to let you know if they can do the testing or if you need a specialist!
Best,
Desiree
Hello! I am actually a student who is very interested in occupational therapy and feeding therapy. I have been searching and researching to learn more about feeding therapy, especially from therapists who can help me understand more about the day-to-day life of a feeding therapist. I know this might be a stretch, but I would love to talk with you about your experiences if you be willing! I have recently graduated with a Bachelor’s and plan to go to OT school in August. I am just searching for more advice before I commit to 3 years of school. I understand if this is not possible. Thank you for considering! Please just email me privately if you would not mind talking with me.
Thanks.
Hi mam,
What is the best ways to teach a child to blow?
I know a child who does not at all blow and even does not puff his cheeks out.
He is already 4 years old.
It can be really tricky, I’d start with cotton balls and demonstrate 1000 times!
My son has a g tube for eating, he dose not eat , he only drinks water. And we had a swallow test for him and everything was good. He has been retching/ vomiting more often. We make his food.
I’m so sorry Keith. Are you in feeding therapy?
I am concerned about my granddaughter who is 2&1/2 and wont eat table foods at all. She drinks alot milk, eats snac foods but very limited. Will have a pouch with pureed food but only the sweet ones, but cookies, candy, ice cream, cake- no problems getting her to eat these. She is however healthy and right where she needs to be on growth charts and very smart. Her mom and dad are not as concerned, but to appease me, plan to get their doc’s opininion, who has told them in the past that she gets all the nutrition she needs from milk, which I disagree with, what is your opinion?
This is so tricky Charlette, based on what you’ve told me I’d definitely want her to get a feeding eval. In the states this is free and they come to your home for kids under 3, you also don’t need a prescription, the parents can call. What I’d be most concerned with, is that she has some underlying challenges that can cause extreme picky eating as she gets older. I’m sure she’s growing, because she does get enough calories and fat from milk, but she isn’t learning to eat. I hope this helps!
Hi Alisha,
I just found your blog. My 23 month old has been going to feeding therapy since she was 16 months old and I’m getting very frustrated. I’ve seen very little improvement and I’m questioning the effectiveness of what we’re doing. She is still primarily eating purees for meals with little to no table food (veggie straws and ritz peanut butter crackers are some of the few finger foods I can get her to eat). She was eating a few bites of toast, but we had a set back and she won’t even eat that anymore. If I put any food on her plate at dinner she will immediately take it off of her plate and put it on mine. Her therapist uses a child-driven approach. I’m at my wits end and I’m not sure where to go from here. Should I be concerned that her current therapy isn’t working? Is there something else I can do?
It’s definitely something to consider and I always tell parents to trust their gut. Do you know if this therapist has a lot of feeding experience? I would expect to see more progress at this point, it has been quite a while. Child directed is great, but specific interventions and strategies are usually needed to, are you seeing that? Do you have specific things to be doing at home? If this is early intervention based services you can request a new therapist, just make sure they have feeding experience.
Also, there are some really helpful articles on here too that can help with some of her challenges. Let me know if you need some direction on that front.