What is feeding therapy? Does your child need it, and if so, how do you get it for them? Get answers from a feeding therapist to help your child!
For well over a decade a big part of my job as an occupational was doing feeding therapy with kids, mostly in peoples homes through early intervention, but also in a private school setting, too. And, over the last 5 years, there have been more emails then 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 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 to 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 and 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. 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 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 observing the child eat and interviewing the parent. Not very invasive at all.
After the eval, a team of professionals or the therapist that completed the eval makes a recommendation for how often feeding therapy takes place. 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, 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 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.
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 their 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. Or, maybe they cough every time they drink from anything other than a bottle. Another common concern is a sensitive gag reflex.
In any of these cases, reaching out for an eval is 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, 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, than this would be another instance that a toddler may need feeding therapy.
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, its 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.
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, its 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 that would be much to cumbersome for me to cover in this post, but most of them can be summed up into two different categories:
- 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.
- 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 be can great for you and your child. But, I know there are many reasons it sometimes isn’t possible, whether its 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 be proactive and get a foundation of really great program in place that you can use in your home, then come watch the free 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. It’s packed with simple tips you can start using today! Get a seat here.
There are also a treasure trove of really specific articles and posts here for different feeding challenges. You can head to my Start-Here Guides to find the best resources for whatever feeding challenge you’re trying to help your child overcome (i.e.: picky eating, transitioning to table foods, and sensory processing).
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
Children’s Books to Help with Picky Eating
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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