I am a pediatric occupational therapist, but the bulk of my experience has been in Pennsylvania’s Early Intervention program. Do you know what early intervention (EI) is? I hope so, but I know that many of you don’t. I want to rectify that because if you are living in the United States and have a child under the age of 5 you may qualify for these free services. Each state’s rules and guidelines are a little different, my state is known for their excellent services, but others aren’t so much. One thing each state does have in common is that if your child is 0-3 and has a delay in any area of development, a qualified and licensed speech, physical, or occupational therapist will come to your home to work with you and your child. In our state we also have developmental therapists, which usually have backgrounds in education or development, as well as vision/hearing therapists and social workers. That is pretty awesome, right? Your child has a need, which may be minor, and the state sends someone to your home to help. You don’t even have to drive anywhere! If your child is 3-5, it may not be too late for EI, but the model is a little different. I’ll elaborate more on that briefly.
Okay, so let me back up a little here. Before you get services set up in your home, you will have a developmental screening completed. A therapist(s) will come to your home and basically “play” with your kiddo. This play will be targeted to specific skills as they evaluate if your child is meeting typical milestones for their age. This evaluation or screening is formal though, therapists are following specific tested guidelines. Of course, there is a lot of leeway here, therapists know better than anyone that development varies from child to child. The therapist evaluating will likely ask you a lot of questions as well, to fully understand your concerns and the needs of your child. They will score the evaluation and let you know the results and their recommendations If therapy is recommended, it will be up to you as the parent to continue with services, there is no pressure. Sometimes the screening is completed and your child doesn’t qualify. That is a very quick overview of EI! Now, onto some FAQ’s!
What kinds of things can EI help with?
Generally speaking EI will address any area of development that your child is delayed in, which is determined by the state and screening tool used. In most states, that means (but could include more or less):
- Gross Motor Skills (rolling over, crawling, walking, managing stairs, jumping, climbing)
- Fine Motor Skills (pincer grasp, pointing, puzzles, stacking blocks, coloring, cutting, handwriting, etc.)
- Speech/Communication (following directions, speaking, speaking clearly, participating in conversations, etc.)
- Social Skills (playing with peers, separating from parents appropriately, behaviors such as biting, hitting, headbanging, etc.)
- Daily Living Skills (dressing, using utensils, drinking from a cup, understanding caution in dangerous situations)
- Vision and Hearing..
I want to remind parents reading this list, again, that many of the milestones listed can vary. Also, some of the social skills listed may be age appropriate, some kids go through minor phases of biting or hitting. If you aren’t sure, talk to your pediatrician or call for a screening in your state. Keep in mind that you can call on your own, it’s always a good idea to talk to your doc, but if you have a nagging feeling, I would recommend giving your state a call (I’ll give you a resource for that in a minute.)
What about Feeding and Sensory Processing?
I think this comes as a surprise to most people and I wish I could send a letter to every parent across the US and let them know that YES if your child is having difficulty eating your state probably considers this a delay and will provide EI therapy in your home. Most states provide help for feeding and sensory processing difficulties. As an EI therapist, these are the skills I have worked on the most – hence this blog. Below are some of the common types of feeding and sensory processing issues that are addressed, but this list isn’t inclusive, so if you aren’t sure call and ask!
- Feeding/Eating (picky eating, difficulty transitioning to table foods, food refusal, poor nutrition, low weight, gagging/vomiting during eating, difficulty chewing or swallowing, etc.)
- Sensory Processing (refusing to touch or eat certain textures, crying or discomfort while touching different textures, excessively seeking out movement, dangerous climbing and jumping, poor attention, frequent rocking/swinging/headbanging, difficulty with hair washing or bathing, etc.) *Please note many of these behaviors may be due to other factors, a qualified therapist would be able to determine if there were sensory based.
What are other options for therapy? What if I need more help?
If your child didn’t qualify for services in your state and you want another opinion or still feel like you need help you can consider outpatient services. These services can also be used in addition to EI therapy. Pediatric hospitals and private clinics are just about everywhere now. Medical insurance is accepted at most, but paying out of pocket is possible, but not likely. Make sure you speak with your insurance provider before scheduling an evaluation.
Services for kids 3-5 aren’t available in every state and in the ones that do it is often preschool based. This really varies a lot from state to state, so it’s something you will want to look into. In this case, you may want to consider one of the the other options I described, as school based therapy likely won’t be as regular.
Why do states offer this free* help?
States are required to offer free help for children under the age of 3 because of a law that congress established in 1986 called Part C of IDEA (Individuals with Disabilities Education Act). The act requires states to establish what they consider a developmental delay is and if it puts them at risk for disabilities. Some states have managed to find ways to create minimal fees, but most are free and should be. If you are interested in more information on the law click here because I am giving you the watered down version.
How can I find services in my state?
My original plan was to provide a list of each and every state with all of the needed contact info. But, I Can Teach My Child already took care of it, so I thought… why reinvent the wheel? Click here to check out their awesome and thorough list of phone numbers, addresses, and emails by state. NICHCY is also a wonderful resource.
Still have a question about how this all works? Leave a comment- I will answer! If you have experience with a particular state, PLEASE leave a comment. I would love to have more information about the quality and ease of services in each state, as well as, if any services such as feeding weren’t provided.
I’m kinda confused on how to find the information for my state to get an OT to come to my house to evaluate my son I clicked on both links my son is having a really hard time eating foods he’s going to be ten months soon I love in Hawaii on Oahu and I cannot find the contact information
Here is the contact info Hawaii:
Early Intervention Section
Department of Health
1350 S. King Street, Suite 200
Honolulu, HI 96814
(808)-594-0006
Hopefully I am not jumping the gun here but I am a little concerned about my 7 month (almost 8 months) old daughter. She is strictly breastfed might I add. At 6 months old I decided to introduce her to baby food since her pediatrician wanted us to wait until then and she seemed to actually like it. After a couple of feedings however, she seemed to turn her nose up at it. Well, because she seemed to swallow perfectly fine too begin with, I started her on stage two baby food and again, within the first two weeks, she seemed fine. Not long after, no matter what flavor baby food I give her (I have even gone to the extent of buying fresh fruits and veggies to puree them myself) she stopped eating them. I’ll do the airplane and get it in her mouth and the moment it’s in there, she’ll turn her face up and start to gag until she finally swallows it or spits it out. This is with fruits, veggies, even the chicken and turkey flavors, etc. I have never had an issue with my other two children so I am a bit confused. Am I doing something wrong? I’m curious to know if whether or not she should be evaluated or is this just something normal. Maybe she still needs more time and I’m rushing things!? It brings my spirit down a little because I thought that she’d love the food and want more since she makes the chewing gesture every time she watches me eat. I even tried with mashed potatoes and she actually cried (it wasn’t hot so it’s not like her tiny tongue had been burned). I try to make it as exciting for her as possible. Should I just give her a little more time? Again, she is strictly breastfed, NEVER uses a bottle so I know that it’s different and new for her however, she’ll be 8 months in about a week and a half. Is this normal?
Hi Tityana, I think its fair to be concerned. She’s still young and has time but some of this is cause to be a little concerned. I’d look into early intervention for sure. But in the mean time you could also start with some table foods, crunchy one’s that melt. I have a whole guide here:
Hi Alisha,
I struggle to get my 7 month old daughter to finish a whole pouch or jar of food in one sitting. She just loses interest. We’ve also had a few instances where she’s eaten a piece of a teething cracker or PB puff or one time a scrambled egg and she gagged and ended up vomiting from her gag reflex. She’s always had a sensitive gag reflex even with her bottle. Is this all something she needs to grow into/get used to, or should I be concerned?
I should add that she has eaten puffs successfully, but every once in a while she gags and ends up vomiting.
Hey Stephanie!
So glad you are being proactive and reaching out for answers. I’m going to attach an article all about gagging, as it is normal for all babies as they are first learning to eat, however it sounds like your daughter has had this consistently so there are some things to help such as brushing her gums/teeth. You can read all about it HERE.
Best,
Desiree
Similar question. 8 month old WILL NOT EAT. He’s a great happy baby and mom is awesome. He’s exclusively breastfed. He had issues latching on one side from day one. Now that he’s older it’s not a problem, he can nurse on both sides. The few times he’s put food in his mouth he gags, vomits, cries, spits it out and/or just holds it there staring like he doesn’t know what to do. He will put everything in his mouth except what is for chewing. He won’t chew on toys for teething but he will chew on the ring holding them together. He won’t eat food but will chew on his bib. He seems to have an strong aversion to certain textures, especially hard things like crackers. His whole body tenses up when he touches certain textures. He’s also not “talking”. Occasionally says “da” and some noises but won’t engage in a “conversation” when others talk to him. No reciprocity. Mom is either overwhelmed or in denial or both. I asked if she thought a developmental behavioral pediatrician might be helpful and she got very upset and said she’s going to wait another couple months before looking into it. It’s her first kid. I’m trying to be sensitive but my gut tells me this isn’t normal and I’m worried he won’t get early intervention. Do you think this is a problem? If so, do you have suggestions how to encourage his mom to seek out professional help? Any feedback is appreciated. Thanks.
Hi Charlie,
You would be looking for interactive engagement with caregivers at this age. Use of facial expressions and gestures is typical if babbling hasn’t quite started yet. You might check out our post about putting toys in baby’s mouth. It has some great suggestions of teethers that we love that can make a difference if there is some sensory concerns going on.
Best,
Andrea
Thank you!
You’re welcome!
Alicia,
my daughter who is almost 2. Does not want to eat anymore. At 9 months we tried to transition from baby foods to table food such as soft noodle, i.e., spaghetti, mac n chs, etc. eggs, mash potatoes, you name it. The usual first foods for her age. She tried everything once or twice but never a third time. We’ve tried and tried, Give options, etc. But still, she’d only eat baby food. Cereal/oatmeal in the AM. With yogurts or fruits. Mixed veggies and meats (puréed baby food) for lunch/dinner. And we’d still try with the table foods in between. In the last 3 months she’s shown less and less interest in the baby food, but we can always count on her full breakfast everyday. She ALWAYs ate her breakfast. Today, and 23.5 months old, we’re on day 5 of no breakfast what so ever, and only Snaking on cheerios, ritz crackers and veggie sticks through out the day (after we attempt breakfast lunch and dinner). She’s full of energy and in a great mood ALWAYS. Never weak or lethargic from lack of food. We usually would give her half a pediasure after each meal (when she was eating) but now we give her a whole pediasure In the AM and afternoon, after we’ve attempted foods first. So we know she’s getting some nutrients and fiber on a daily basis. As well as a daily vitamin (liquid). SHE ALSO still drinks formula because I was scared she wasn’t getting enough with her bad eating habits. At her last check up, 18 months: her doctor wasn’t too concerned that she was still ONLY on baby food, cause she was growing at a good rate and she was learning and doing everything she should be. Doctor said if she’s not eating by her 2year check up then we’d “revisit” it. Well, she still refuses table food and now she’s refusing all meals (baby food and table food options) I already know that I could not give her anything, drinks or snacks, so that she gets So hungry that she’ll eventually just eat, but, it’s so hard. And, I live in a small complex and I’m afraid of noise complaints of a screaming child all day/night. Any suggestions? She has teeth, and she likes crunchy snacks. I don’t know what else to do
Christa, I totally here you and I definitely don’t agree with waiting kids out because they’ll eventually eat- its just not true. Have you seen the free workshop? I think it would be really great for you to check it out, I think it will answer all of your questions. If you have anymore after watching, please let me know. You can sign up here.
Yes, there was one event, although I didn’t think it was THAT significant. He was gumming a cracker about two months ago and got a little piece off, and began to cough/choke. I patted his back (hard) and he coughed it out and threw up. Could that really scar him? And how do I undo the damage?
I got some rice cake things, since he won’t eat the puffs anymore, and stuff for sensory bins and food play. I’ve also scheduled for him to have an EI appointment in a month.
Hello and thank you for this blog! My son has just turned 10 months and eats almost no solid food (table food nor purees). I have followed a lot of your advice for giving him different textures and tastes, making meals not stressful, etc, but he just won’t eat. Most of the time, he just touches the food with his fingers, maybe puts it to his lips, and then drops it. Sometimes I can get him to gnaw on a piece of bread, There used to be one or two purees he would eat, but now he won’t eat those either. I’m concerned because his weight is low, but he only wants to breastfeed or drink cow milk (we offered him cow milk while attempting to get him to take formula to supplement, but he will only drink the milk plain, without formula powder). Often times, he won’t even touch the food to his lips, but will just feel it with his fingers, shiver, and refuse to even taste. I’m worried about his weight, but also worried that this is extreme pickiness, or that he has some sensory problem with all textures. Do you have any advice?
For what it’s worth, my 3.5 year old also didn’t take to solid food quickly, but she was willing to try almost anything and was eating VERY well by 11 months. We did a month or so of purees, then mashed table foods, then chunky table foods/self feeding. She’s not picky at all and still eats well. I’ve tried to do this for my son, but it just doesn’t seem to be working.
Thank you.
Hi Emelia, I’m sorry this response has taken a few days, I know you’ve been waiting. It does sound like something is going on… First, I would definitely recommend getting an eval as I described in this post. Second, I just published an article yesterday on sensory and picky eating that I think will be helpful.
I want you to start with dry crunchy textures that melt. If he won’t take them, demonstrate your brains out in a stress free way. Give him these textures to play with three times a day. Have him and your daughter eat together as much as possible. Start brushing his teeth and brush his tongue as well. This will help him begin to desensitize to textures. I would also experiment with getting him to interact with food outside of meals. Try putting jello in a big bowl and letting him play for example. There is no pressure at all, but I am also available for consults if you want to discuss strategies or for me to coach you live via skype/facetime.
Does he chew on his toys? Does he put a lot of things in his mouth?
Thank you so much for your reply. I read your blog about puffs, so I bought him some about a month ago. For about two weeks he would feed himself the puffs and let me spoon feed him a few different purees (prunes, pumpkin, carrots, and squash soup with peanut butter), but now he refuses ALL foods on a spoon and won’t eat the puffs either. I thought maybe he was bored, so I bought a new flavor, but he won’t even pick them up, or if he does, he just touches them to his lips and drops them. It’s strange to me that he used to tolerate purees and put the puffs in his mouth, but now he won’t. As far as I can tell, he’s not teething at the moment.
I will try the other things you’ve suggested. I’ve been chewing in front of him and having him eat with my daughter at the table, but I’ll do more food play.
And yes, he puts everything in his mouth! Any object I had him goes straight to his mouth and gets chewed on. But when I put food in front of him, he will MAYBE take a taste or two, and then just reaches for his pacifier, cries, and won’t take any more.
Forgot to say… I got the email to contact someone in Ohio about a consultation, but I may contact you for a Skype call as well, depending on how quickly I hear back from them. Thanks again.
That’s great! Hopefully they will be able to come out soon.
As for the purees it is normal for babies to be over them, that should happen. The problem in this case is that he hasn’t begun to eat any other foods. Try some of the other foods I mention in the post as well, he may need a bit of a change. I would also make that pacifier disappear when meal time comes around without him realizing of course.
I’m glad he is mouthing things! That is very good. Has he ever had a significant choking/gagging event, or perhaps an illness that resulted in a lot of vomiting? Any of those can create a negative association.
Hi Alicia,
My baby son is 5.5months old and has been having issues with feeding times for milk.
Basically around 2 months of age he started screaming and pulling off while breastfeeding despite being hungry. I reverted eventually to express pumping my breast milk and feeding to him out of a bottle after trying to breastfeed him for a week with the same reactions. He seemed more at ease with a bottle but sometimes would still pull off but I guess not as much.
After growing out of the newborn phase, we realised he would only actively drink milk when sleepy and basically nodding off to dreamland. Every time we try to feed him while he is awake or not sleepy he will just nibble on the bottle nipple even for a whole hour – at most I have checked the bottle and realised he had only sipped 1oz in the whole hour! He will just play with the nipple or leave it floating in his mouth the whole time.
We have tested this in so many scenarios such as waiting until he is hungry or supposed to be hungry up to the 6hour mark yet he still won’t drink if he’s awake! He cries and fussed from hunger but won’t actively suck to drink. He has never been a big drinker and has consistently drank 3-5oz each feeding (usually every 3-4hrs) but every single feed has been a sleep feed up to now! When we are out there is just no luck in having him consume any milk since we seem to have to be in a quiet place for him to slowly nod off before actively sucking. It is all rather baffling and stressful because if he doesn’t have a nap, he basically won’t drink and if he naps and we don’t get to him before he starts nodding off, we miss the opportunity for him to have a feed.
Is this something that EI can help with?
Hey Connie,
We know how hard this must be as you are just trying to feed your baby! You are doing great!! YES, this is something that EI can help with. They can take a look to see what is happening that is causing him to have difficulties sucking while away on bottle or breast and ideas/strategies to come up with to help you along the way!! Please keep us posted!
Best,
Desiree
Hi and thank you!! As I’ve only read two of your articles so far. We are at a lose our 22month old will refuse food and ask to breastfeed even while at the dinner table she nurses approximately 12+ times during the day and almost all night long. She is developing strongly in all other areas except the mentioned food and sensory area, as she even refuses to lay down in the bath tub even while I would offer my arm as support. I usually revert to using the big cup to get her hair wet and rinsed.
Thanks for your comment. I think an eval would be a great idea, sensory processing difficulties can have a huge affect on eating. Let me know if you need any help.
Just stumbled onto your sight today desperate to help my son. Hadn’t thought before reading through your articles that he almost definitely is a problem eater. Unfortunately, he has missed the age bracket. He is three and a half. I first started seeing signs that he was a problem eater when he was two, but at the time we were living out of the country, in France. I think all of the transition internationally has aided in his eating dilemma significantly, as before we left for France he was the better eater of my two kids and displayed no overly irrational signs of picky eating. We are currently living in Ohio, but only till the end of of the summer. Possibly California after that. I tried to follow the string of linked websites to see if either of these states offer free help for kids under five but couldn’t find any clear information. Maybe I wasn’t looking in the right places? Nevertheless, I couldn’t find any concrete resources. Any help or advice you have to offer would be wonderful. This is completely new territory for me!
I don’t want to be the bearer of bad news but from my understanding California’s services aren’t very good even for kids under 3. I would look into it still, though. Of course, if your insurance covers it private therapy is always an option. Here is all the info for Ca and OH:
California:
Part C Coordinator
Children and Family Services Branch
Department of Developmental Services
1600 9th Street, Room 330, MS 3-8
Sacramento , CA , 95814
(800) 515-2229
(916) 654-2773
ringraha@dds.ca.gov
Ohio:
Bureau of Early Intervention Services
Ohio Department of Health
246 N. High Street, 5th Floor
Columbus , OH , 43215
(614) 644-8389
wendy.grove@odh.ohio.gov
http://www.ohiohelpmegrow.org
Please let me know if you need more help. This info is from the I Can Teach My Child website.
I’m in the process of getting my 22 month old screened for a speech regression issue as well as a eating sensory issue. Just a FYI: West Virginia has a FREE (both the evaluations and the therapies) Birth to Three program.
Thank you so much for sharing that information! It is very helpful!
Update: my little stinker waited until our EI rep came and then decided to start finger feeding the next day! Too funny. He has his favorites but he’s trying much more now and also mouthing toys. Learning new tricks everyday, I feel so much better! Thanks for your support and I’ll be sure to keep the blog bookmarked!
Thanks so much for getting back in touch! I’m glad you were able to get an eval quickly and that things are turning around quickly! Yay!!!
Just stumbled upon your page. I have a ten month old boy who hasn’t learned to self-feed. We do lots of practice and I offer him finger foods, but he really only wants puréed food. He is breastfed, and all other milestones seen to be on track. Wondering if I should pursue an evaluation. Also feeling silly because I have a masters in special education but know nothing about early intervention with babies/eating! His ped says not to worry, but something seems off to me. Thank you!!
Hi Bryana, please- feeding is truly a specialty all in itself, I’d be more surprised if you were expert! You know, he could grow out of it, but I all too often see this as a first red flag. One that docs often blow off, if there is a problem it will continue to get worse. Because, your gut is telling you something else is going on I would definitely get an eval- at the very least it will give you peace of mind. Make sure you read my posts on transitioning to table foods- see the article index or popular posts in the side bar. Let me know how it goes.
I have 6 month-old boy/girl twins. They were born a bit early, and because my partner had complications from the birth, her milk took a very long time to come in, so the the babies were bottle fed initially. We worked with lactation specialists to get both of them breast feeding, and my daughter got the hang of it first. Then, when they were about a month old or so, she started refusing the breast–crying hard when offered. We again worked with lactation specialists, and eventually they concluded that she had just developed a strong preference for the bottle and that we really couldn’t do anything about it. Then, she started having issues with the bottle. She’d push the nipple out of her mouth, or clamp her mouth shut, even when she had to be hungry. By 3 months, we found that she would eat more readily if she was swaddled, and most reliably if she was swaddled and in her swing.
Now at 6 months, she still is really finicky about the bottle. She’ll make a gagging sound as we approach her with it–it seems to indicate that she doesn’t want it. She also gags or chokes and coughs while drinking pretty frequently. Now that we’re introducing solids, she is exhibiting some of the same signs in reaction to the spooned food. (Cereal, various pureed vegetables and fruits). Her brother is enthusiastically gobbling up the food and has no problems with the bottle.
I’m not sure if she really has issues of concern, or if she just seems difficult in relation to him. So one question is whether her issues seem like they are in the realm of normal, or are concerning? Her doctor says not to stress about it as long as she’s gaining weight. (She’s in the 20th percentile now after being as low as 7th as a newborn). I also don’t know whether I should “trick” her into opening her mouth by getting her to smile so that I can get the spoon in, or try to get her to actually open for the spoon? I don’t want to cause additional problems by doing the wrong thing.
Any other advice?
I would definitely not trick- I know it’s tempting, but your instincts are right- in the long run it can cause more damage. I hear that response from doctors often- they are usually only concerned with the bottom line. I don’t want to freak out, but I would get her evaluated, just to make sure nothing else is going on. Silent reflux is jumping out at me -see the article index at the top menu for more on this. However, there are a variety of issues that could cause that behavior. In the meantime, keep meals as positive as possible. Try to just let her explore the food, keep it light and fun through play. Let me know if I could be of more help.
This is a very old comment but I had exact similar issues. I thought its silent reflux and then my son had issues with purees too- (gagging, vomiting). with solids- he wanted to eat but could never chew and swallow- used to choke. Bottle and breast feeding nothing worked. He stopped feeding at 3 months. Struggling till date with his feedings and he is now 2. started with feeding and OT therapies- its helping but its just a start. I contacted EI but they mentioned feeding issues are not part of eligibility which I know is not true. I know as per the feeding clinic he has adaptive delay and sensory issues. He might have some delay in Gross motor. I am looking for more information on feeding issues so that I can email the EI coordinator and request an EI assessment. This article has great information and lot of the things thats mentioned under feeding and sensory, my son has most of these.
Hi Indy- yes, it should be covered! Use the search bar, you will find a lot, but also check this out, it might be helpful: yourkidstable.com/2014/08/eatingfeeding-milestones-for-babies-and.html
Thank you for sharing this information. I was lucky in that when my son started showing red flags for developmental delays I had a lot of people in my life that explained EI and its benefits to me but I know a lot of parents have no idea and can find it intimidating. I still found it intimidating. But as a parent I can’t agree enough what a difference EI can make. I know it has helped my son (and me) so much over the past 8 months. I would encourage any Mom (or Dad) who is on the fence about whether to have their child evaluated or not to go ahead and do it.
In the state of Massachusetts, all services (as of March/April 2013) are not charged to the parents but to your health insurance and to the State Department of Public Health (I think…) I received a bill when I first enrolled but haven’t received one since and was told that Massachusetts residents no longer pay out of pocket for services.
In addition to EI – blogs like yours offer tremendous support. I have referred a lot of Moms to your site – as it was a tremendous help getting my son past his sensory challenges with table food. Thank you.
Thanks so much Lindsey for your comment, I’m sure it will help parents reading this post! I’m so glad Your Kid’s Table has been a resource for you!!!
Yes, our EI therapy (in AZ) does have a cost, dependent on one’s income. But’s it less than private therapy, they come to our house(!), and we’re very happy with our therapist. 🙂
Thank you so much Eileen- helpful information!
Just to clarify, across states- the Early Intervention coordination is free but many states have to charge for the therapies that are usually contracted out. Assessment and evaluation are required to be free. Therapies are not. Wish all states covered these!
Thank you Frannie- that is my understanding as well. At a minimum the screening or eval is done, which I hope will give families some direction.
Thanks for sharing all this info in a post! I got early intervention for my son when he was 2 he is now 4 & has done a complete turn around! I love sharing info with others who may not know about these types of services.
Thanks Jenny, that is such a helpful comment! What state are you in? Just want people to know where services are covered.