75+ Feeding Therapy Tips & Strategies

For any therapist seeking to specialize in feeding, the best piece of advice I could give you is to become a sponge.  Take courses and workshops, read as many articles as you can, talk to and learn from your colleagues, join special interest groups on Facebook and ASHA etc., follow blogs, observe other therapy sessions, and don’t forget – learn from the children you treat as well.  They will be your best teachers.

 

Feeding issues are complex.  So take in as much information as you can from as many outlets as you can.  But, take it all in with a grain of salt, because not every strategy will work for every child.  Over the past 35 plus years, a number of people have told me that their way was the only way.  Although that certainly would have made my job easier if it were true, I’ve never been able to use any one method “by the book.”  Each child is different, so it will be up to you to evaluate their needs and cater treatment accordingly.

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The Oral Motor Benefits of Straws

Whenever a parent asks me what they can do to improve their child’s oral motor skills, one of my first questions is usually:  Are they drinking from straws?
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Drinking from a straw is a very simple yet effective way of improving one’s oral motor skills.  It works on lip seal, tongue retraction, cheek strength, correct jaw position, suck-swallow-breathe coordination, consecutive swallows, and more.  Sucking can also help some individuals organize, increase their attention, and soothe/calm themselves.
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Straw drinking usually starts around 8-10 months of age.  An easy way to teach beginners is with the Bear Bottle Kit, which has a special valve that keeps liquids at the top of the straw (so only a small amount of effort is required to drink).  Or, older kids may prefer the Cip-Kup, which functions the same way but has a more ‘grown-up’ design.  For more information on how to teach straw drinking, click here.
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Feeding Issues from Reflux

Question:  I’m seeking help for our son. The short story is that my son was born at 25 weeks and was in the nicu for 3.5 months and has overcome many things.  When he left the nicu he was always a tough feeder (fussy) but always ate plenty by bottle. Then during a re admission, his feeding slowly declined and after a few weeks he was no longer willing to try anything.  The nurses were fairly forceful in their efforts in my opinion.  He has now been ng tube fed for 4 months.  He is 9 months, 6 adjusted.  He is going to go again to see a feeding specialist and back to GI but I’m looking for any possible help.  I should also mention that he has severe reflux and it really bothers him.  He vomits violently 2 or 3 times every day.  Please, any tips.  We currently offer him tastes of purees but he does not want to swallow the food I think because he is afraid of choking.  Thank you for any help you can provide.


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All medical issues that affect feeding must be managed first.  He’s not going to eat unless he feels well, and can’t be expected to before then.  So definitely no forcing – that will be your number one “feeding therapy commandment” so to speak.  I can understand why some parents / caregivers do this – they are hoping to prevent the child from having to be tube-fed.  But forcing can end up causing more damage than good.  Everything must be child-led.
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Food Pocketing in the Lips, Cheeks, and/or Gums

Question:  My four year old daughter pockets food in her lower gums.  Foods like pizza, chicken, egg whites, etc. (that do not melt like crackers or cookies).  She will simply let it stay in her gum pockets until she looks like a chipmunk and eventually we will have to remove it with our fingers.  She is not able to automatically understand the natural process of not allowing the food simply stay in her gum pockets.  How can we help her get the natural biting and chewing action which will prevent her from pocketing food in her gums?  We have a Grabber already and have her practice chewing on both the left and right sides.


Food Pocketing - possible causes & what you can do

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Great question.  There may be a few different reasons involved and a few different strategies to try: Continue reading Food Pocketing in the Lips, Cheeks, and/or Gums

The Right and Wrong Way to Spoon Feed

The Right and Wrong Way to Spoon Feed

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Did you know that there is a right and wrong way to spoon feed?
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The wrong way involves lifting your hand upward as you remove the spoon from the child’s mouth.  This method scrapes the spoon against the teeth, gums, and/or upper lip to get food off of the spoon.
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Scraping is not the normal, natural way to feed.  And specifically for children with oral motor delays, it’s a missed opportunity, as it doesn’t allow the lips to do their job and close around the spoon.  It can also force the child’s head back as they try to “chase” the spoon upward.  You can see this happening in the image above and also in the beginning of the video below.
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7 “Think Outside the Plate” Feeding Therapy Techniques

Kids naturally like to discover and learn new things – that’s why they break things, take them apart, get into trouble, etc. – it’s all a part of the learning experience.
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But when it comes to feeding/eating, sometimes kids get stuck.  For one reason or another they stop trying new foods and exploring different textures.  When this happens, one of the best things I can recommend is to “think outside the plate.”

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"Think Outside the Plate" feeding therapy ideas.

When something’s not working, try switching things up!  Tap into the child’s inquisitive and playful nature to help them get unstuck and back to the discovery process.
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The Importance of Supporting Children Who Have Eating Problems

Hello, I am the mother of an almost 12 year old daughter.  It has been a struggle ever since she moved from baby food to regular foods to get her to eat fruits or vegetables.  Thankfully, she remains healthy so far, but I am concerned about her health long-term with her limited intake of nutritional foods.  Mealtimes have always been a battle between trying to get her to try things and also not letting the situation monopolize family time.  She absolutely will not try any fruits – not even apple sauce.  Recently she tried a strawberry and just mulled it around in her mouth until she almost gagged and then spit it out.  I have tried “sneaking” pureed veggies into her diet over the years, sometimes with success, but sometimes I’m found out because she has an acute awareness of new tastes and textures.
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Long story short, I recently had her evaluated by a pediatrician, and after much questioning, he feels she has an oral sensory integration disorder (hypersensitivity) and has referred us to a speech therapist who specializes in this area.  I understand that this may well be the case, but have very little data from others who may have experienced this same thing with a child.  My husband is not on board at all with having her start therapy because he feels she is being stubborn and just needs to start eating.  This has been going on for 9+ years and I don’t see her changing anytime soon without some help.  Can you please give me some advice on how to best approach my husband?  I need good, accurate data showing why this sort of therapy would help her now as well as into the future.  I apologize for this lengthy story, but would appreciate any help/advice you can offer.
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Training the Oral Musculature with Lip Bloks

Hi!  I have a 2 year old patient (12-14 month old skill level) who has significant tongue protrusion when attempting to drink out of a cup – this is not noted during any other feeding activities.  I think it’s because she was exclusively bottle-fed for up to 20 months.
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I bought some lip blocks and the bear bottle for her to use.  She does great with the blue lip block, but has not transitioned to turquoise.  Is there a recommended frequency of use for the lip blocks (how much time per day) or an expected duration of time that a child may be expected to spend on one block before transitioning to a shorter one?
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Also, the blocks do not fit into most straw cups that mom uses; her straws are too big.  Any suggestions for fitting the blocks into other straws to increase compliance?

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Assisting Lip Closure

Teaching the concept of lip closure.

Just like its namesake, lip closure (also known as lip seal) is the ability to close one’s lips.  It’s important for several different speech/feeding/oral motor skills:
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•  Being able to close one’s lips around a straw, spoon, a piece of food, etc.

•  Being able to pronounce the speech sounds /p/, /b/, and /m/

•  Being able to chew food with one’s lips closed so that food stays inside the mouth (and also for good table manners – I’m not concerned with table manners in feeding therapy, just getting the child to eat well, but post-therapy it could be a goal for the parents)

•  To prevent drooling (poor lip closure can be one reason why some children drool)

•  Correct oral resting posture – lips are closed when our mouth is at rest (when we’re not eating, drinking, or speaking)

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So, how do we work on improving lip closure?  There are several different ways (I’ll link out to more at the bottom of this post).  Specifically here I’m going to show you a simple trick on how to use the Y-Chew to assist lip closure:
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Continue reading Assisting Lip Closure

Practicing a Rhythmic Chewing Pattern

Rhythmic chewing is one component of a mature chewing pattern.  There’s a tempo to the way we chew – it’s not sporadic;  we don’t chew fast then slow then fast again.  We chew to a silent yet steady beat in order to properly break down food.
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Practicing a Rhythmic Chewing Pattern - Feeding Therapy Strategies

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In the video below, however, this young man has a very sporadic chewing pattern.  In fact, he’ll often try to skip chewing altogether and “wiggle” food toward the back of his tongue where it will then trigger a swallow.  This is of course a choking hazard, so we’re working on establishing a rhythmic chewing pattern so that he will consistently and adequately chew the food before attempting to swallow it.
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You may notice that before I do the exercises, I tell the young man what I’m about to do, “I’m going to put this in between your teeth and I want you to chew on it.  I’m going to count up to 10.”  And so forth.  By explaining the exercise beforehand, he knows what’s going to happen and what’s expected of him.  This leads to better results as well as less anxiety if the individual is hesitant/unsure.  It’s particularly important to do this when the individual doesn’t know you very well yet.
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1.  Place the loop of the Z-Grabber (or Grabber) in between the front teeth and have the individual chew 10 times.  Provide support/guide the jaw with your opposite hand if necessary for stability.

2.  Give him a chance to swallow.  Then place the yellow Textured Bite-n-Chew Tip XL (or the extension of the Grabber) in between the molars on the right side.  Count to 10 chews.

3.  Repeat on the left side.

4.  Then repeat the whole set again: 10 chews on the loop at midline, 10 chews on the extension on the right side, 10 chews on the extension on the left side.  Then a final 10 more chews on the loop again.

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So we’re practicing chewing on both sides of the mouth, as well as in the center of the mouth for symmetry.  If the chewing speeds up or slows down in pace, tap out a rhythm with your hand or try chewing to the beat of music.  Tapping out the rhythm can be very helpful in the meantime before that silent beat becomes second-nature.
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This exercise also helps build jaw strength and stabilize the jaw if you find it sliding to the right or left during speech (which can make certain speech sounds / phonemes sound “slushy” or unclear).
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As an alternative, you could also do this activity with the Z-Vibe:  for step 1 you would place a Bite-n-Chew Tip laterally in front of the mouth instead.  Or if using a Y-Chew instead of the Grabber, you would similarly place one of the extensions laterally in front of the mouth for step 1.
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Debbie

Debra C. Lowsky, MS, CCC-SLP
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