Eating is a primary human activity needed for survival. But for very young children, feeding can be a complicated task that needs complex coordination of different skills—biting, chewing, and finally, swallowing. Most babies and toddlers learn instinctively over time how to suck, bite, chew, and swallow food, and how to drink from a nipple, straw, and cup. But there are some who demonstrate difficulty learning these skills, interfering with their feeding development. 

Young children begin their feeding journey by first learning how to suck liquids and then chew single grain cereals or pureed food. When introducing solids, it is a messy process that needs plenty of practice and monitoring from parents. Certain difficulties like gagging, pushing food back, spills, and trouble with swallowing are normal and correct themselves over time. But for children with a feeding delay or disorder, these challenges will persist even as they get older. 

Read about Feeding Milestones.

Pediatric feeding disorders are characterized by challenges in oral intake that are not typical for a child’s age. It often involves delays and difficulties in eating, drinking, chewing, sucking, and swallowing as well as food aversions, food refusal, and food and texture selectivity. Swallowing problems or dysphagia refers to problems in one or more areas of the three phases of swallowing. These phases or stages are:

  • Oral phase – The sucking, chewing, and moving of food or liquid into the throat. Feeding is part of the oral phase.
  • Pharyngeal phase – The squeezing of food down the throat, which begins the swallowing action.
  • Esophageal phase – The opening and closing of the esophagus as it squeezes food down to the stomach. 

Feeding disorders can occur alongside developmental delays or medical conditions, such as autism spectrum disorder, Down syndrome, cerebral palsy, or respiratory disorders. 


Causes of Feeding Disorders

Several factors can cause feeding and swallowing disorders. Infants who were hospitalized at birth and received tracheotomy for an extended time will often have difficulties adopting proper feeding patterns. In some cases, even children with no known conditions or relevant medical histories can develop a fear of food.

Other possible factors that could lead to feeding and swallowing disorders include:

  • cerebral palsy, meningitis, and other nervous system disorders
  • autism
  • stomach problems, such as reflux
  • premature or low birth weight
  • heart disease
  • cleft lip or palate
  • asthma or other respiratory problems
  • muscle weakness in the face and neck and other head or neck problems
  • medication that causes sleepiness or loss of appetite
  • sensory issues
  • behavioral problems


Signs and Symptoms of Feeding and Swallowing Disorders

Feeding and swallowing disorders in children are often difficult to spot at first. Most of the time, children who struggle during mealtimes are simply assumed to be picky eaters. And while this is true for many, there are other signs and symptoms that family members can consider to distinguish between a child who is a picky eater or one with a feeding problem. These include:

  • back arching and stiffening during meal times
  • crying, fussing, or falling asleep when feeding
  • throwing tantrums when presented with new or unfamiliar foods
  • trouble breathing while eating or drinking
  • coughing, choking or gagging during meals
  • preference for specific textures of food (crunch or soft food) or aversion to a particular food group
  • taking a long time to eat or simply refusing
  • struggling to chew or swallow
  • excessive drooling during meals, has liquid come out of mouth or nose or gets stuffy
  • frequently spitting or throwing up
  • not gaining weight or growing
  • eating less than 20 types of foods
  • refusing to eat meals with the family or a group

Meanwhile, a child who is a picky eater may sometimes exhibit similar behaviors as someone with a feeding disorder. However, there are key differences to monitor. Typical signs of a picky eater are:

  • eats a limited variety of foods (around 30 types)
  • consumes enough calories daily for growth and nutrition
  • often loses interest in a particular food but will accept it again after a certain period
  • accepts and eats at least one food from all food groups
  • allows new or unfamiliar food on the plate even if they do not touch or eat it


How to Treat Feeding Disorders

Treatment for feeding or swallowing disorders starts with getting a comprehensive check on the child’s general health. A pediatrician can assess the child’s growth and weight based on what is appropriate for his or her age. Children must also be checked for any condition that interferes with feeding skills. If your child’s doctor determines that there is cause for concern, a speech-language pathologist (SLP) may be consulted to conduct an assessment and provide a diagnosis.

During the evaluation, the SLP will:

  • ask questions about the child’s medical history and overall development
  • observe how the child moves his or her mouth, tongue, and jaw when eating and drinking various foods and liquids. 
  • watch how the child eats and take note of the way he or she picks up food, chews, swallows, and drinks
  • observe the child’s behavior during meals
  • consider the parent child interactions
  • assess mealtime routines 
  • conduct additional special tests, if necessary

Once a diagnosis is made, the SLP may work as part of a team to design a feeding therapy plan for the child. This team may include an occupational or physical therapist, a dietitian or nutritionist, a physician or nurse, or a developmental specialist.

As part of the multidisciplinary team, the SLP can help your child address the following issues:

  • improving the child’s tongue and jaw movement
  • Improving lateral chewing
  • introducing new foods and drinks
  • improving the way the child sucks from a bottle or drinks from a cup
  • adjusting textures of food and thickness of liquids to make swallowing easier
  • encouraging good behavior during meals, such as increased focus at meal times, not refusing food, and not fussing
  • addressing the child’s sensory issues (how the food feels in his or her mouth or hands)


The SOS Approach to Feeding
The Sequential Oral Sensory (SOS) approach to feeding therapy addresses not only the child’s eating difficulties but also its underlying causes. It is based on the feeding steps, stages, and skills found in typically developing children. The SOS approach relies on several factors, including motor, oral, behavioral/learning, medical, sensory, and nutrition, in determining the root cause of a child’s feeding problems and managing it successfully.
 In conducting SOS feeding therapy, it is important to create an environment wherein a child can interact and get familiarized with food in a non-stressful way. Therapy may be done individually, as a group, or at home, with the primary goal of helping the child develop and master the necessary skills to become a healthy and safe eater.
 Therapy meals are done to help children work on feeding skills and expose them to new foods. It typically starts with foods the child is already familiar with and able to tolerate before moving on to new ones. The therapist encourages the child to smell the food, learn about its texture, and explore its taste. Modeling and reinforcement are crucial during therapy in order to help the child develop a positive relationship with food.
 The SOS approach can also be applied during family meals, wherein the goal is to improve the volume or amount of the child’s food intake. Feeding strategies may include:
  • Serving a piece or spoonful of every food offered on the child’s plate. Whether the child eats it or not, the goal is to familiarize them with the food’s texture, smell, color, and where it comes from.
  • Including at least one food that the child is guaranteed to eat in order to expose the child to new foods while still ensuring they are eating the right amount of food.
  • Parents modeling good eating habits and describing the food and its taste.
  • Praising the child’s attempt to eat or explore new foods but taking care to not let the child be the sole focus of the meal.

At Brooklyn Letters, our feeding therapy involves improving the underlying feeding skills and eating habits of babies, toddlers, and preschoolers. We assess the child’s sucking, swallowing, chewing patterns, diet, behavior, and the home environment during meal time time. Once we pinpoint the underlying problem(s), we create a family treatment plan. Some children require additional one-on-one feeding therapy. We demonstrate to the parent how to tackle their child's feeding and/or eating delay.

Schedule a free consultation today!

Phone: (347) -394-3485

Text: (917) 426-8880

Email: info@brooklynletters.com

Our speech-language pathologists are ready to help you!

Feeding Evaluation Therapy, Brooklyn Letters
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Feeding Evaluation Therapy, Brooklyn Letters

Melissa is a New York State licensed Speech-Language Pathologist who received her undergraduate degree from American University and a Master’s degree in Speech-Language Pathology from New York Medical College (a medically oriented master’s program). She holds her Certificate of Clinical Competence in Speech-Language Pathology (CCC-SLP) from the American Speech-Language-Hearing Association (ASHA) and is a recipient of ASHA’s Award for Continuing Education. Her advanced clinical education has included ongoing education in the specialized area of feeding and swallowing, including SOFFI (Supporting Oral Feeding in the Fragile Infant) training. Since graduating in 2016, Melissa has worked in a variety of acute care, inpatient rehabilitation, and outpatient medically-based settings including the Neonatal Intensive Care Unit (NICU), Pediatric Intensive Care Unit (PICU), and CCVCU (Congenital Cardiovascular Critical Care Unit), and has taken her experience from working with this high acuity/medically involved population and further applied these skills to more stable populations in the home and outpatient settings. She also serves as an Adjunct Professor at New York Medical College, training post-graduate licensed clinicians in pediatric feeding and swallowing. She specializes in complex, medically-based feeding/swallowing disorders, as well as sensory and behaviorally based feeding difficulties. Her area of passion is working with infants with feeding and swallowing difficulties.

Melissa prides herself on a holistic approach to assessment and treatment including extensive parent education and empowerment while taking the child’s needs and family’s goals into consideration to achieve the best, most functional outcomes possible. She employs evidence-based therapy and has extensive experience collaborating with the interdisciplinary team, including medical doctors and a variety of subspecialists (GI, ENT, Pulmonology, Registered Dietitians). She believes in a child-led, family-focused approach to feeding therapy and strong collaboration to best serve the child’s needs. 

LOCATION: BROOKLYN: Park Slope, South Slope, Prospect Heights, Windsor Terrace, Carroll Gardens, Clinton Hill, Gowanus, Boerum Hill, Cobble Hill, Downtown Brooklyn, and Brooklyn Heights
TYPE OF SERVICES: Individual therapy, feeding/swallowing evaluation, and treatment, parent consultations.
EXPERTISE: Feeding and Swallowing Disorders, Oral Motor and Feeding Skill delays, oropharyngeal dysphagia, infant feeding and swallowing
AGES: i.e. birth through high school

Our speech-language pathologists are ready to help you!

Schedule a free consultation today!

Phone: (347) -394-3485

Text: (917) 426-8880

Email: info@brooklynletters.com