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.
Hey there! One of my colleagues recently noticed that her grandson still couldn’t read properly even though he’s going to be six next year. I found it quite useful the moment you mentioned that even our kids’ eating habit could be a sign of their cognitive condition too. I’ll show this article to her so she can send him for a proper treatment pretty soon.
Hi Amy! Thanks for reaching out! So glad to hear that you found this post helpful and are passing it along to your colleague. We hope it can be of help to her and her grandson!
Hello, my baby is 1 years old and doesbot ear solids. I tried blw method also, she takes food to mouse but very little amount and not every food. She likes only fruits like kiwi and orange.. she only wants breastfeed. I dont know what to do.. should i end breastfeeding?
Hi Elenee! Thanks for reaching out! Definitely continue to offer solids with a no-pressure environment, allowing her to choose how much she eats. Keep practicing with self-feeding and allow her to touch/feel/play with her food, which will allow her to become more comfortable with food and different textures. In terms of breastfeeding, continue to do so for as long as you feel comfortable. However, in order to encourage her to eat more foods, try to gradually replace some breast feedings with food. We have a post that talks about this more, which you can read here!
Hi! My son is 8, and became a picky eater around 3 years old. I always thought it was just the normal childhood picky eating phase, but I’m afraid it has gotten worse. He had most of the characteristics of a food aversion disorder. Hoping to find some help for him. Any suggestions are greatly appreciated.
Thanks for reaching out. It’s so hard when our picky eaters get worse! We’d definitely recommend our new free picky eating mini course. It’s a great place to start. Sign ups are happening now. You can save your seat HERE.
Thank you for your response! I have signed up, and also followed on Instagram and FB.
Hello may i know how can i do EI my 30 month old won’t eat anything except snacks like puffs that easily melts? I just moved to Boston, MA.
If you’re looking for early intervention, each state/city is a little different. It would be most helpful for you to reach out to your child’s new pediatrician and let them know you’re interested. They would be the best person to get you in touch with the right people! In the meantime, you might find out Teaching to Chew Guide a helpful place to start.
Hi – We’re struggling with our 17-month-old, he will only eat puffs, dried fruit (sometimes) and baby food pouches. Still gets two bottles of formula per day because we don’t know how else to get him the nutrition he needs. Of course, all pediatrician tells us is to stop the pouches and bottles, but that would leave us with a starving child. We offer him table food 3x a day and he will put some things in his mouth, but spits them right out. We live in Washington, DC and I don’t see any resources listed for where we live. Do you think we need an evaluation?
It can be so stressful when our little ones don’t eat! If you’re interested in therapy, your state should have an early intervention program. Your pediatrician should have the info for that. You might also check out our free workshop for toddlers who are having difficulty transitioning to table foods. It might be a great fit for you! You can save your seat HERE.
The past two times we have taken my daughter to the pediatrician they told me they believe she has sensory integration/ processing disorder and wanted me to see an OT. I contacted my insurance and they said it’s not considered an actual diagnosis so there is no coverage. I saw your link about possible free help and wondered about it. She definitely presents sensory issues with some sounds and things like socks and tags in clothes but for the most part she is functioning just fine. My main issue is food, she is 2 and refuses meat, cheese, vegetables, noddles and pretty much anything that isn’t a peanut butter sandwich or a squeeze pouch. I can’t nail it down to textures that she is opposed to because she doesn’t mind yogurt or squeeze pouches and likes bread and crackers but she’s not eating much protein and she can’t do dairy so we do pea milk and coconut milk yogurt. So I’m concerned about her growth and health. Do Children need to present other delays to get help or can food alone be an issue enough to receive help. She’s not under weight, she’s just not eating anything with protein or good vitamins. And each sitting she doesn’t eat much she just says all done and won’t touch anything or even taste it. The most I can get her to do is smell the food. Thanks for your insight!
So happy you found our article! If you are in the US, I would reach out to your Early Intervention organization in your state/county. It does vary by state, however you should be able to get a free evaluation for your concerns, regardless of what they are. Yes, I have seen children qualify for feeding/sensory concerns at this age, so it’s worth digging into!
Hope that helps!
My babe is 11 months. She loves food! Loves baby food, and wants food off of our plates, but the thing is anything with a more lumpy texture, she will sit and chew on it and suck on it, but won’t swallow what so ever. She swallows purées, dissolvable baby treats, and mashed foods okay. Anything lumpy she just won’t swallow, and the very few times that it happens, she gags on it. She loves her formula and still takes it all throughout the day, along with 2 jars of baby food per day and baby treats as snacks. She can sit up fine and crawl, but can’t sit up from a laying position or pull herself up and stand or walk in any way yet. She was diagnosed with reflux as she used to spit up and projectile vomit her formula ALL day long, but it seems to have subsided greatly as she got put on amino acid based formula and has gotten older. I’m just worried maybe she has swallowing issues, or maybe she just isn’t used to it. Would love some advice. Thank you!
Thanks for reaching out! It’s great that she’s able to swallow purees, mashed foods and meltables. Lumpy textures can be really hard for kids to eat. I’d try to start to work on soft cubes to see if she’s able to chew/swallow with that next texture. We do also have a free workshop that would be helpful with moving through these different textures. You can save your seat here
My niece is 2 1/2 years old and will not eat any food besides potato chips, and gold fish crackers. She drinks juice and vitamin water. We have tried to introduce other foods to her but she does not want to try it. We have observed that she has sensory issues. She don’t like her hands dirty, she don’t like certain textures and she covers her ears when she hears certain sounds. She was denied by the Early Intervention program because they noted they did not see any delays during their assessment. The did note that she will benefit from having a feeding therapist. I thought that the EI program assist by using a speech therapist? My friend sent me your website and the information you share is very informative, so we will now try to incorporate some of the things you have shared. What steps would you recommend that we take next?
Thanks so much for reaching out! Sorry that she didn’t qualify to help. Every state/program varies as far as adding a SLP or OT to work on feeding/sensory needs. However so glad that you landed here. I’d say your first step is to take our Free Workshop this will really walk you through some first steps that we recommend in setting up successful mealtimes! I’d also try to be doing some play with food/textures outside of mealtimes, as this can be helpful to get her touching foods which is the first step in eating!
Please I did all I could but my baby wouldn’t eat anything at all even at 12months
We get it, it can be so difficult to transition to table foods! I’d allow your child to do some play with foods, outside of mealtimes to see if you are able to get some interaction with the foods (this is the first step in eating). Also, we have a free workshop that will walk you through the steps of how to help with the transition to table foods, I think you’ll find very helpful. You can save your seat HERE
My wine will be 1 in 2 weeks and He still eats purées and formula only I’ve tried smashed food with texture baby puffs all kinds of melt in your mouth baby foods and he spits it out instantly it has to be some type of sensory issue I just don’t know what to do!
Thanks for reaching out! We understand how hard this stage can be. I’d try to work on having him play in the foods to get used to touching the different textures, you can even do this outside of mealtimes. If you have not seen it yet, our free workshop would be really helpful for other ideas and foods to utilize to move through. You can save your seat HERE
My Daughter is 15 months now and from 7 months or so she has been difficult when it comes to food. She is Mostly on formula because she doesn’t care for Food. Her days usually consist of oatmeal every morning with peanut butter or almond butter for breakfast. Fruit throughout the day ( likes most fruits) and then crackers, puffs, veggie straws. Sometimes she’ll eat meat (chicken, steak, etc) but it’s hit or miss. However, I am mostly substituting formjla for lunch and dinner because she doesn’t care for food. She’ll eat laughing cow cheese. She doesn’t like mashed potatoes. She doesn’t like macaroni. I don’t think it’s a sensory thing but she will play with some foods and doesn’t gag or react in any way. 90% of the time She refuses food. She doesn’t even wanna try it. Some times if I try to get her to taste it somehow she’ll eat but it’s very rare. She will eat one thing one day and 2 weeks later I will try same dish and she won’t open her mouth. I am not sure what to do. I am thinking to start “starving her “ So that she’ll eat vs giving her formula as a substitute. She isn’t delayed in any of her other milestones and have not seen any red flags in anyway!
I know it can be so hard trying to feed our kids, especially when it is hit and miss with foods. Have you taken our free picky eating workshop? This will provide you with a good plan on how to approach the picky eating and setting up mealtimes, I think you will find it helpful. Save Your Seat Here
Hi! My 7 month old son puts his thumb in his mouth after every bite of baby food. I’ve tried thin and then thicker purée but he persists with his thumb. He hasn’t rejected any foods so far. I’m wondering if he just hasn’t developed the ability to swallow without sucking. Would this be a delay?
We know how hard it is to maneuver through all these feeding skills!! Since he is just 7 months, I’d wait a little to see how he progresses through with the feeding. Try to have him hold a spoon and “help” with the feeding to see if he is distracted enough with the spoon and not putting his thumb in. If he does continue, and you are concerned it never hurts to get a feeding evaluation for some suggestions!
My Bub will be 12months old in next couple of weeks. He doesn’t have any teeth yet. He refuses to eat any solids. He lives on formula. I tried different purées but he will eat for first few bits and then will stop and will throw food and spoon in the air. I am not giving him finger food because I fear of choking as he doesn’t have any teeth. He used to have purée when he was 5 to 6 months old. He had it for few weeks and thn he suddenly stopped everything. I am worried that he isn’t getting nutrients that he needs
We know how hard this can be on you as you just want your son to eat! I’d try to have him play in the food to get him used to the texture. We also have a free workshop that would be really helpful for you to make this transition. Save Your Seat Here
Hi there! My son is 20 months old. He has trouble with some texture. I think that’s why he won’t eat raw fruit or steamed veggies… I mean zero fruits zero veggies. Even at 6 months he had a hard time eating a variety of fruits and veggies. I had to mix purées into his infant oatmeal or yogurt to even get it into his mouth. I have spent endless hours hiding fruits and veggies in smoothies, pasta sauces, muffins, pancakes, veggie nuggets whatever I can think of. He will eat most dehydrated or freeze dried fruit and loves the dehydrated snap peas. He has no trouble touching fruits/vegetables. He has in the past eaten peas here and there and some broccoli. At this point he will only eat potatoes. My doctor just says this is common and will stop at some point. Would this qualify for EI?? I have so much anxiety daily about what he’s going to eat. Any help would be appreciated.
Hey Lexi, thanks for reaching out!! Breathe Mama!! I can understand your worries as it is very challenging when your child will not eat fruits or veggies and mealtimes seem stressful. EI varies from state to state, however it never hurts to reach out to obtain an evaluation. You could get some great suggestions just from the evaluation from an OT to help you along! I’d recommend checking out our free workshop, it has some suggestions for picky eating help and how to set up mealtimes! You can save your seat here
Hi, Thank you for the nice advices. My baby is 13 months now. I introduced food at 4 months. He was a very good eater and he’s big. He had an episode of diarrhea 2 months ago and I stopped feeding him veggies foe 3-4 days except potatoes. After that he refused eating veggies again except after I put melted cheese on it or may be tomato sauce but no plain steamed veggies.
Also, he has to be holding something in his hands while eating, a spoon a cup a cheerios anything. and after 3-4 mins he throws what’s in his hands and wants another thing. And sometimes I keep giving him stuff and he throws them until I give him something that he likes so he’ll eat. It’s driving me crazy.
I never let him watch TV sometimes I do it to make him eat but this doesn;t happen very often.
is that normal??
Toddlers can do all sorts of “things” that are a little odd, but sometimes a significant illness can have a huge impact on their feeding. I’d keep your doctor in the loop and try to give him spoons, cups, etc. to hold.
My son is 7 months old. Hates baby food..been trying it since 6 months old. Dislikes mashed banana, avocado as well. Loves puffs and teething wafers, but the problem is that they fall out of his mouth. He has a prominent tongue tie but pediatrician said not to get it clipped because he nurses fine. Could that be why he can’t keep food in his mouth?
We get it!! Yes, tongue tie can cause difficulties in some babies. I’d recommend checking out our free workshop on transitioning to table foods, as we do touch on the tongue tie, but also what to do when the puffs are coming back out. You can learn a lot of tips! Save your seat HERE
Hi Alisha. First of all thank you for creating this amazing, extremely helpful and one of a kind website.I have a 20 month old and I’m also a Special Ed teacher. I’m finding myself frustrated with the EI services of my state (CA) and we haven’t even signed anything yet. I was told my son won’t qualify for services unless he has a significant disability like downs syndrome and that my sons feeding should be treated medically. Initially, he wouldn’t tolererate thicker foods with bits and pieces and now he is getting used to mashed foods with some texture, he eats rice but one grain at a time! He takes extremely tiny bites of any food like bread, cheese pr tortillas. Pulls apart chicken in microscopic pieces. He won’t take spoonfuls of rice or anything loose and will scratch his tongue with his fingers when I try to do so.
Okay, you definitely need my post on Transitioning to Table Foods, I think it would be a big help! There’s also a free printable in there too that would help. So sorry that EI is frustrating in your state:(
Also, email us at email@example.com, if you need some more help with this- I have a free workshop that could be really helpful!
Hello, I know this is an old post but I’m hoping you can give me some advice.
My little girl will be 11 months tomorrow. We started transitioning her to table foods around 8-9 months with all the normal first foods; Puffs, Cheerios, etc. Along the way she would still eat puréed food. Usually 1 to 2 hard per meal and even 3 at dinner along with the table foods. As we’ve tried to introduce her to more foods diced carrots, fruits, etc she wants nothing to do with them. She just pushes or throws them on the floor. It wasn’t a big deal at first because I figured we had time to get her eating those and she was still good about eating the purées. However, in the last couple of weeks she is refusing to eat anything that isn’t crunchy; puff, cracker, you name it. She’ll MAYBE take two bites of baby food and done, screams if we don’t give her something else. I’ve even tried giving her a couple of puffs in between spoonfuls of food and nothing she pushes it away and: or screams for more crunchies.
What do you think I should do to help her transition away from crunchies to more healthy options?
PS: she still drinks formula and is picky about how much of that she takes from day to day. Also, the ladies at daycare have never said that she seems to be eating less for them but she didn’t eat a lot while she was there to begin with.
I’d definitely recommend getting an eval from EI at this point if you live in the states, but I have another post that I think will be very helpful: transitioning to table foods. Check out the transitioning to table foods guide. Once you check that out let us know if you have more questions
I actually used that post when we first started transitioning to table food. It was a huge help! She did great with step one and two, but refused all of the softer food options and jumped straight to step 5. She will eat some toast with a very small amount of peanut butter and she loves Cheerios. She did take a couple of small bites of steamed broccoli but when we offered it to her the next two days she refused it. What else can I do? Should we wait it out and just keep giving her different things? I want to exhaust all options before broaching early intervention with my husband.
I know this sounds strange, but I’d focus on brushing her gums, tongue, teeth, and inside of cheeks 2-3 times a day. This desensitizes the mouth to textures and improves how the tongue moves.