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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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.

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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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.

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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Drooling – Getting to the Root of the Problem

I was looking at some of the tools and videos on your site.  I have a 9 year old daughter with low tone in her face and some periodic drooling.  I have taken her to various speech therapists in the area for help with this issue and most say to remind her to swallow.  Now she is 9 and still has this issue – reminding her does not seem to help.  The dentist said maybe strengthening her chewing and jaw muscles might help.  I think there might also be an issue with closing her lips from what I can see from the videos on your site.  I do not think most of the time she is aware that she is drooling as well.  Would the Z-Vibe, etc. help?  Any suggestions for her I would appreciate.  

If reminding her to swallow hasn’t working by now to stop the drooling, then it’s not going to work, most likely because that’s not the root of the problem.

What to do when saying "remember to swallow!" isn't working

Drooling can be caused by a few different things.  You mentioned that you don’t think she is aware that she’s drooling – this could very well be true.  Sometimes children have limited to no awareness in their mouths, which means they can’t feel the saliva.  And if they can’t feel it, they won’t know to swallow it.  There are a few strategies you can try to “wake up” the mouth so to speak (including using the Z-Vibe).  For more information on these strategies, click here.

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Food Refusal – Is It Oral Motor or Sensory Related?

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.

Feeding Therapy Issues: Oral Motor vs Sensory
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):

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5 Reasons Why Playing with Food Can Lead to Trying New Foods

5 Reasons Why Playing with Food Leads to Trying New Foods

We’ve all heard the popular “Don’t play with your food!” mantra. But contrary to popular belief, playing with food is actually a wonderful way for kids to learn about and discover new foods. Why?

1.  Trying a new food can be stressful, particularly for kids with sensory issues and/or food aversions. If you introduce a new food through play, you’re removing the pressure/anxiety of having to take a bite and consume it.

2.  Food play allows kids to take a step back from the fork. Food must never be forced, so you can use play as a a pre-feeding strategy to get kids to interact with foods that they normally would not, and to establish familiarity in a non-confrontational way.

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Not Chewing Soft Foods?

My 2.5 year old daughter has down syndrome. She has had feeding issues since birth and we are trying to work with her on chewing.  She will bite and chew crackers and other hard foods, but will swallow soft things whole. We are working with a speech therapist as well as an occupational therapist, but they do not have a lot of experience with the grabbers, and other bite tools. Can you recommend a tool that will promote chewing?

You may need to teach her that soft foods (such as bananas, macaroni, etc.) need to be chewed just like hard foods, even though they feel closer to puréed foods, which can be swallowed without chewing.  Whatever’s on the menu, take a bite yourself first.  Concentrate on what your tongue is doing with the food.  Are you just swallowing it immediately?  Are you moving the food from side to side in your mouth?  How many times do you need to chew the food?  Count how many chews so you know how many is enough.  As your daughter chews, actually count the number of chews out loud to help her keep track of her chewing.  I count on and stick up my fingers as well.  You can put on some music and chew to the music.  It can also help to pretend to chew as she chews.  Overemphasize and exaggerate your jaw and mouth movements, saying “yum, yum, yum.”  Begin with foods requiring only a few chews, such as a banana.  Then progress from there.


Another reason she’s not chewing soft foods could be related to oral sensitivities.  In my experience, children who have Down syndrome can be hyposensitive with limited oral awareness.  Soft foods do not have a lot of texture, and so they may not provide enough tactile information inside her mouth.  If she can’t feel the food, she won’t know that she needs to chew it.  Gum massage and textured oral motor tools can help increase oral awareness by providing proprioceptive feedback inside the mouth.  Sensory chews are also an excellent way for the tongue, lips, jaw, and cheek to exercise and ‘practice’ movements.  The textured ones simulate the feel of real food to help introduce new textures.  You can also dip them in sticky foods (like mashed potatoes, yogurt, applesauce, etc.) to promote chewing.

Since she’s already biting and chewing crackers, you can also try Food Chaining, which is essentially gradually “connecting the dots” between foods to expand one’s diet.  Dip her favorite crackers in soft foods (dips, jams, sour cream, creamy peanut butter, cheese whiz, etc.).  This will give the soft foods some texture variety so she can slowly feel and experience with them.

I hope this helps!  Let me know if you have any other questions.

All my best,


An Overview of the Z-Vibe Tips

ARK’s Z-Vibe and Z-Grabber offer a vast range of possibilities for tactile learning and oral sensory motor stimulation.  These vibratory oral motor tools are compatible with a whole menu of attachments (“tips”) that can be used for feeding, gum massage, jaw grading, tongue lateralization, and much more.

Most of the tips come in two versions – a standard option as well as a softer, more flexible option.  The soft options (usually in a purple color) are recommended for individuals with a bite reflex.  The soft ones are also sometimes preferred for individuals with sensory issues, as the soft provides less resistance/input to start.

Z-Vibe Tips.

  The Probe Tip is a rectangular tip that has three different surfaces – bumpy, striated, and smooth.  The Mini Tip is a smaller version of this tip designed for infants and smaller mouths.  Both tips are to be used for oral stimulation, awareness, and exploration.  You can also dip them in whatever the individual is eating to spark interest and work on texture acceptance.  Or stroke the sides of the tongue to promote tongue lateralization.  Or use them to pinpoint where the tongue needs to go for certain specific speech sounds.  Etc.

Tips for Toothbrushing with Oral Defensiveness

Oral defensiveness falls into two main categories: HYPOsensitivity and HYPERsensitivity.  Individuals with hyposensitivities have low oral tone and very little awareness of what’s going on inside their mouths.  This “oral numbness” so to speak can cause anxiety and fear when it comes to toothbrushing.  On the other hand, individuals with hypersensitivities are overly conscious of and sensitive to oral stimulation.  Even the slightest touch can be overwhelming and even painful.  In both cases, it is important to normalize sensation within the oral cavity in order to take care of those pearly whites!

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Easy Oral Motor Exercises to Try – Today!

Oral motor therapy works on the oral skills necessary for proper speech and feeding development.  These skills include: awareness, strength, coordination, movement, and endurance of the lips, cheeks, tongue, and jaw.  The activities below are an easy way to work on these skills.  Incorporate them into your daily routine whenever you have time.  Practice them on the way to school/work, during commercials, while you’re making dinner, etc.  Make it a game and have fun!  Please note, however, that these exercises should not replace therapeutic intervention.  It is best to see a speech-language pathologist and/or occupational therapist trained in oral motor therapy.  They will be able to assess the situation, prescribe a course of action, and guide you through the process.


•  Use the Z-Vibe to normalize sensation within the oral cavity.  Hyposensitive individuals (with low oral tone) have little to no awareness of what’s going on inside their mouths.  On the other hand, hypersensitive individuals (with oral defensiveness) are overly sensitive and often experience aversions to texture, temperature, taste, etc.  Both cases can significantly affect speech and feeding development.


•  The tip attachments for the Z-Vibe come in various shapes, textures, and scents.  Use them to stroke and apply gentle pressure to the lips, cheeks (both inside and out), and the tongue.  Vary the pressure, the direction of the strokes, the length of the pressure, etc.  For hypersensitivities, introduce the Z-Vibe gradually.

•  Gum massage is also a simple and effective way to provide oral stimulation.


•  Say “ooo” with exaggerated lip movement.  Then say “eee.”  Combine them for “oo-ee.”  Really round the lips.

•  Say “puh” and pop the sound with emphasis.

•  Make a big smile.  Relax and repeat.

•  Puff out the cheeks while keeping the lips sealed.  Relax and repeat.  Puff out one cheek, then the other, then both.  Then puff out the upper lip followed by the lower lip (or vice versa).  Relax and repeat.

•  Purse the lips to make a kiss.  Slide the kiss to the right and then to the left or vice versa.

•  Blow bubbles.  You can also blow whistles, horns, kazoos, etc.

•  Drink through a straw rather than drinking from a cup.  This is also a great activity for the tongue and cheeks.  Drinking from a straw requires a lot of oral motor work: the cheeks tighten, the tongue tightens and retracts, and the lips purse.  For tips on how to teach straw drinking, click here.

•  In the above exercises, observe to see if the lips are symmetrical.  If not, document what they look like and compare them to future practice sessions to monitor progress.

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