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.
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.
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. .Continue reading Feeding Issues from Reflux
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 foodsimply 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.
Did you know that there is a right and wrong way to spoon feed? .
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. .
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. .Continue reading The Right and Wrong Way to Spoon Feed
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. .
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.”
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. .
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. .
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. .Continue reading The Importance of Supporting Children Who Have Eating Problems
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. .
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. .
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. .
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.
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. .
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). .
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. .
Feeding therapy tip: if a child won’t eat with a spoon, use whatever he/she WILL accept. In this feeding session, for instance, his favorite spoon was at home and he didn’t like any of the other spoons we had. So, we tried a twizzler and voila! He ate the entire container of food. .
You can also try dipping a Grabber, Y-Chew, or ARK Probe into whatever the child’s eating. Getting them to eat the food comes first. Getting them to use the right utensil can come later. For ideas on how to de-sensitize kids to plates, cups, utensils, etc., click here. .
Having a child with feeding issues is one of the hardest problems to handle both for therapists and parents, and it’s stressful for the child as well. Our lives often revolve around food! And so does healthy growth and development. I commend you for looking for more information on this topic and hope that you find this post helpful. So, take a deep breath and let’s roll up our sleeves. .
Before we begin, please keep in mind that only a speech language pathologist (SLP) who can evaluate your child in person will be able to tell you why he/she is refusing foods. If you are concerned that your child has eating problems, please consult with your pediatrician and ask for a referral to see a SLP with feeding experience. If it’s sensory-related, you’ll likely want/need an occupational therapist (OT) involved as well. .
In the meantime, I can tell you that the children who I see with feeding issues typically fall into one of two camps (or a combination of the two): oral motor issues and/or sensory issues. Below is some information that you may find helpful, along with strategies that have proven successful with the children I personally see and treat (assuming that all medical issues, such as reflux, GI problems, medication side effects, etc. have been ruled out / managed already):
I recently completed a Clinical Swallow Evaluation and today a Videofluoroscopic Swallow Study of a 10 yr old boy’s swallow (both revealed a safe swallow that is within normal limits) and observed that his is not an age-appropriate chew pattern. He engages in a Nonstereotypic Vertical Movement during mastication. As a result, oral prep phase is significantly extended and his mother reported that it takes him (at times) up to 1.5 to 2.0 hours to complete a meal. In one case, he informed me that he does not like powder (i.e., flour or powdered sugar) and the meal in question consisted of scrambled eggs and French Toast that had only powdered sugar on it – sans syrup. However, I have found no information regarding immature mastication patterns in older children. Any information or resources you may provide or suggest in this regard will be greatly appreciated.
In a vertical chewing pattern, the jaw moves up and down in a vertical motion. Since the tongue and jaw are connected, the tongue will follow suit, also moving up and down. This is sometimes referred to as a “tongue pump.”
On the other hand, in a mature chewing pattern, the jaw moves in a rotary (circular) motion to grind the food – imagine a cow chewing its cud as an exaggerated example. At the same time, the tongue moves from side to side in order to manipulate the ground food particles into a bolus (ball of food). Without this grinding motion and tongue lateralization, it makes sense that he’s having difficulties breaking down and manipulating his food, and why mealtimes are very long and exhausting. Try chewing your food today without moving your jaw or tongue from side to side – it’s not easy!
So your goal would be to develop a rotary chew so that he can properly chew and manage food. Once his chewing skills improve, he’ll be able to eat different kinds of foods, particularly those requiring good chewing ability. And a rotary chew will drastically decrease the time needed to properly break down food, which is typically no longer than 30 minutes.