Written By Else Team
Reviewed By: Lauren Panoff, MPH, RD
Lauren specializes in plant-based living and vegan and vegetarian diets for all ages. She specializes in writing about parenting and a wide variety of health, environmental, and nutrition topics.
Eating doesn't always come easy and naturally. Some babies and young children don't have an appropriate appetite to support the optimal growth pattern for their age. Fortunately, feeding therapy is helpful for many little ones who need assistance to develop healthy eating habits and learn how to enjoy food.
Contrary to popular belief, feeding therapy is not intended for picky eaters in general. After all, most kids go through several periods of picky eating, which is completely normal. Just because your baby or toddler has food preferences, or simply doesn't like some types of vegetables, it doesn't mean that they need feeding therapy.
As a rule of thumb, feeding therapy is only recommended for the more extreme picky eaters who have difficulty trying new foods and have a very limited diet, to an extent that there are nutrition concerns
What exactly is feeding therapy?
The main purpose of feeding therapy is to help children develop effective feeding behaviors and patterns. This therapy is more than just teaching children to eat properly.
Rather, feeding therapists work closely with children and their families to determine the source of difficulties and develop personalized and specific therapies to make the eating process easier and more enjoyable. Addressing underlying issues early in life will have positive benefits for years down the road.
Children may benefit from feeding therapy with a trained therapist if they are severely picky eaters, they refuse to eat during mealtimes, or they have difficulty swallowing.
There could be many reasons behind feeding difficulties, ranging from choking when eating to sensory processing or motor deficits associated with a neurological diagnosis. No matter what causes mealtime to be a struggle in your home, a feeding therapist can help ease the stress on the child and the entire family.
Feeding therapy typically takes place once or twice a week for approximately an hour, depending on the child's underlying issues. Your therapist will develop a plan for addressing the underlying barriers that prevent your child from eating an age-appropriate meal.
Does my toddler really need feeding therapy?
In order to determine whether your toddler needs feeding therapy, the best thing to do is to start by consulting your pediatrician. If they deem it necessary for your little one to get feeding therapy, they will refer you to a recommended feeding therapist in your area.
Before deciding whether your child needs feeding therapy, your therapist will complete an evaluation by reviewing the child's complete feeding history and observing them eating a meal that is typical for them. Sometimes, therapists may require a meal journal detailing all the meals your child has had over the last three days.
If the child has a history of aspiration, your therapist may also require a copy of the most recent swallow study. A swallow study will show what’s happening in your child’s throat and esophagus while they eat and help to identify underlying swallowing issues.
Armed with all this information, the therapist can then better determine the cause of the feeding difficulties and offer solutions. Feeding difficulties may arise from sensory issues such as hypersensitivity to the texture of some foods or motor issues that impact your little one's ability to chew or swallow.
What are some techniques used in feeding therapy?
Feeding therapy may take place at a therapy center, hospital, dietitian’s office, or a doctor's office. The treatment approach and techniques used will vary based on the therapist you choose and your child's specific condition.
There are multiple pediatric feeding therapy techniques available, and approaches may include sensory, behavioral, or motor models. No matter the reason why your child may have difficulties eating, it's essential to find a good fit for them.
Therapists may be trained in one or more pediatric feeding therapy techniques. No matter the methods chosen by the therapist, it's vital to note that a therapist should never force food on your child.
Here are some of the most common pediatric feeding therapy techniques.
The "Get Permission" Approach
The "Get Permission" approach is one of the most frequently used in feeding therapy, and it outlines a treatment method based on the principles of trusting and healthy feeding relationships. Mealtime treatment and oral motor skills are most successful when parents follow the child's pace and set realistic goals.
This approach focuses on reading cues and moving forward only as a child gives permission. For example, your therapist may instruct the child to simply look at food first and then introduce various steps gradually, such as smelling the food, touching it, tasting it, and finally eating it.
This is a traditional method of feeding therapy that rewards children for eating new foods.
For example, your therapist may give the child a sticker or toy every time they successfully take a bite of a new food. This also works with electronic devices — in order to get more time with their favorite device, the child needs to take another bite. The rewards can be phased out over time, even though that isn't always the case.
What are the main benefits of feeding therapy?
If your little one is a very picky eater and has very strong opinions about whatever's on their plate, it's understandable to become frustrated as a parent. At the same time, you may be worried that your child isn't eating enough and it’s affecting their growth and development
No matter why you're considering feeding therapy, you may be wondering about the main benefits for your little one, and perhaps for the entire family. Below you'll find a list of the top benefits of feeding therapy for toddlers.
1. Health and growth
Children who struggle with feeding may also have problems with eating enough to maintain a healthy weight for their age and height. It's important for parents to first work with their pediatrician to rule out any medical conditions that may cause the child to struggle with gaining weight.
Once everything else has been ruled out, feeding therapy can be a great way to work on improving nutrition through eating more foods, increasing food intake and promoting growth.
2. Increase food diversity
If your little one is interested in eating fewer than approximately 20 foods and will refuse to eat anything else, feeding therapy may help them accept more types of food in their diet.
For example, if you're used to taking frozen waffles or chicken nuggets to a restaurant with you because you know your little one will only want to eat those and refuse anything else on the children's menu, that can change with the help of feeding therapy.
Your therapist will work with your child to help them become more flexible and increase the repertoire of foods they enjoy.
3. Less stressful mealtimes
Mealtimes with any toddler can be stressful, but factor in a toddler who struggles to eat or is very picky and fussy every time you put some food before them, and mealtimes can transform into a battlefield.
It doesn't need to be like this forever, though. One of the most important benefits of feeding therapy is that mealtimes become more peaceful and a more pleasant routine for the entire family.
In most cases, your therapist will work with your child and other family members to establish a routine that works for everyone, while also working on helping your child develop the necessary skills for peaceful eating.
4. Encouraging kids to play with food
Encouraging kids to play with their food as a way of discovering new tastes and textures is one of the cornerstones of feeding therapy. By allowing kids to get elbow-deep in oatmeal or use cookie cutters with just about anything, they'll be more likely to improve their sensory responses to unfamiliar sensations while also becoming more comfortable with new tastes.
However, playing with food doesn't come naturally to everyone, so your therapist will work with your little one to teach them how to engage in playing with food in an entertaining way. Even the parents can benefit from encouragement, as many of us have been told not to play with food growing up.
5. Establishing healthy eating habits
Since the early childhood years are essential for creating healthy eating habits and establishing a positive lifelong relationship with food, feeding therapy can prove to be invaluable for toddlers.
Children who have stressful interactions with food repeatedly may start to create negative associations with feeding. This can last for years and decades, so it's vital to create positive emotions associated with food as early as possible.
Feeding therapy can provide your little one with the tools they need in order to have a positive relationship with food for their entire life.
Can feeding therapy work at home?
If your little one has difficulty eating or is a very selective eater, you can implement some feeding therapy tips at home. You can do this every day to complement the feeding therapy session or simply try these techniques for a while before seeing a feeding therapist to see if anything improves.
One of the most common reasons for which toddlers struggle with feeding is that they find it difficult to touch different textures. For example, the juiciness or squishiness of a peach or strawberry may be too much for them to handle. The same goes for bumpy textures like broccoli or sticky foods like Jell-O, for example.
Messy play is a technique you can use to introduce more food textures in your little one's diet. Use various food and non-food textures to encourage your kid to touch and try new foods and textures. This is one of the easiest ways to make the texture aspect of feeding less intimidating.
It's a known fact that children thrive on routine, and this couldn't be truer for mealtimes. Toddlers who know when to expect their meals and snacks tend to eat better. Make sure you have meals around the same time every day. It would also help to sit at the same place for all meals. This includes snack times as well
Routine activities such as washing your hands together before sitting down to eat can also be helpful. Your little one will quickly start to associate the time of the day, their eating spot and washing their hands with being almost time to eat.
It's also essential to limit snacking or grazing when it's not snack time in order to make this routine effective.
Oral Motor Toys
The purpose of oral motor toys is to encourage movements of the tongue, coordinate muscles in the mouth and support jaw strength.
Some examples of oral motor toys include bubbles, straws, chewy toys, and windmills. By introducing some of these toys into your little one's routine, you can help them coordinate the movements in their mouth and control their muscles.
You can keep these toys available in a box for your child to reach freely for throughout the day. However, it's important to use them as a warm-up before mealtimes. For instance, he or she can chew on a toy or blow some bubbles before eating as a warm-up for the real thing.
One issue you may experience when trying feeding therapy at home is that kids aren't typically on their best behavior when they're with their parents or caregivers. This is especially true for those situations when you're trying to get them to do something challenging.
Many parents note that their kids are much more willing to follow the indications of their therapist than doing the same thing at home. However, it doesn't hurt to keep trying. It could also be a good idea to get other family members involved. For example, your child may be more interested in engaging in messy play when another sibling is involved.
When should I consider feeding therapy for my child?
Even though most babies and toddlers have healthy appetites, sometimes they may have a little trouble learning to eat correctly. If you notice that your baby has trouble with breastfeeding or the bottle or your toddler finds it difficult to swallow or is a very picky eater, feeding therapy may help them learn how to eat better.
The main symptoms that let parents know their baby or toddler may not be eating properly include:
- Not growing predictably or gaining weight
- Spits up or throws up very often
- Refuses to eat or drink
- Cries, fusses, or arches their back during feeding
- Has trouble chewing
- Has trouble breathing while drinking or eating
- Has a hoarse voice during or after meals
If your child has one or more of the symptoms above or you notice that they are only willing to eat a couple of different foods, it may be time to consider speaking with a feeding therapist. This is also true for children who are gagging during feeding or who seem to be unable to transition to various textures of food. If you’re ever in doubt or have concerns about your child’s eating behaviors, it’s always a good idea to speak to a professional.
There are also some conditions that may lead to feeding disorders in babies and toddlers.
- Reflux or other stomach issues
- Being premature
- Having a low birth weight
- Cleft lip or palate
- Breathing issues such as asthma
- Medicines that make the child sleepy or decrease their appetite
- Sensory issues or autism
- Muscle weakness in the face
- Diagnoses such as Down's Syndrome, cystic fibrosis, meningitis, or cerebral palsy.
What skills can toddlers learn in feeding therapy?
Therapists work with children to provide them with various skills required to make mealtime more enjoyable. The skills taught in feeding therapy differ from one child to another and are always based on the patient's needs.
The most common skills taught in feeding therapy include:
There are multiple reasons children may lack the skills needed to eat or drink, with the most common of them including illness, developmental delays, allergies, and other factors.
Therapists work closely with children to help them coordinate sipping, chewing, sucking, and swallowing when eating or drinking. Depending on the patient's needs, the therapist works with the child to gradually increase the range of motion and oral strength.
Many children who are referred for feeding therapy require assistance with the amount and type of food they eat. That's because allergies, illness, developmental delays or sensory aversion can make it difficult for little ones to expand the range of foods they're eating.
As part of the feeding therapy, therapists work to increase the number of foods a child enjoys. Patients who have only been exposed to a reduced number of foods or those with sensory aversion may be taught skills that will help them reduce their sensitivity to textures.
Improving the overall eating experience
No matter the reason a child has developed issues related to eating, they may have an overall aversion or at least negative feelings toward the eating process as a whole. In that case, therapists work with patients and their families to create positive associations with food and improve the overall mealtime routine.
Another way therapists can help children with eating difficulties is by teaching them how to enjoy mealtime. Moreover, they can offer advice for caretakers on how to create a positive mealtime experience.
How long does it take to see results?
The frequency and length of feeding therapy depend upon every child's needs. Feeding therapy doesn't look the same from child to child. Every child is different, and it's impossible to use the same approach with all children.
Your therapist will work with the child and the rest of the family to make sure they get the right amount of therapy so they can progress on their own without feeling overwhelmed. There is no set amount of time to see results from feeding therapy, with some children only needing a couple of weeks while others need a couple of months or more.
The role of sensory play in feeding therapy
Sensory play with food is one of the cornerstones of feeding therapy because it encourages toddlers to engage with their senses while discovering new textures and tastes.
Even though many parents firmly believe that playing with food is not a good thing, it's extremely important for toddlers to explore food in that way. That's because it's natural to be cautious of new things, so playing with it first is a toddler's way of exploring something new before trusting it enough to put it in their mouth.
By allowing toddlers to play with food, we offer them an opportunity to engage with the food and get to know it before tasting and eating it. Some toddlers are very anxious about unfamiliar foods. Sensory play is an excellent way to provide them with relaxation when faced with a rather overwhelming experience.
Poking, rolling, squishing and smashing food may act as stress relief for toddlers. This is also an excellent way to teach them how the food will actually feel in their mouth.
Toddlers who engage in food play get their senses stimulated while also learning new skills not necessarily related to feeding.
Here are some of the skills babies can develop with the help of sensory exploration.
- Mealtime skills (tasting, pouring)
- Fine motor skills (scooping)
- Gross motor skills (sitting, reaching)
- Play skills
- Social skills
- Language skills
20 tips to help picky eaters overcome their eating difficulties
- Offer them healthy foods with something to dip them into to encourage various textures, colors, and flavors. Ideas include hummus, ranch salad dressing, nut and seed butters or chocolate hazelnut spread.
- Present food in various ways, using new cups, containers, and utensils. If your little one is really picky, you can try a muffin tray with multiple choices.
- Cut food in various fun shapes to make it more attractive.
- Allow the child to feel and explore any of the tools or utensils you use to win their trust and improve the chances they'll taste the food.
- Try to always use transparent bottles and cups so your child can see what's in them before tasting the food or drink, thus reducing anxiety.
- If your child doesn't want to use a spoon, allow them to use whatever they want, including their fingers, carrots, or even chewing toys.
- Offer healthy alternatives so children feel like they have a choice — for example, you can ask them whether they want potatoes or peas.
- Encourage positive interactions with various foods using all five senses. For example, you may offer children crunchy foods if you notice that the sound helps them enjoy eating.
- Be calm and supportive. This can be easier said than done because dealing with picky eaters can be frustrating, but try to maintain a stress-free atmosphere by being patient and relaxed.
- Never force any food on a child. If they don't want to lick or taste something, remain neutral and try another time.
- If your toddler is old enough to do so, make sure they understand the vocabulary involved in the feeding process. Tell them to bite by showing them how to do it at the same time, so the child learns what you actually mean. By understanding what's requested of them, toddlers may be more willing to try the food.
- If the child has any sensitivities throughout the body, you should address these first with the help of a therapist. Your therapist may recommend sensory play, weighted blankets, swinging or jumping to regulate the sensory system. This will eventually result in the child being more open to exploring new foods.
- Try to only make very small changes to the foods your child already accepts. For example, if they like carrots, you can cook them differently by steaming them, for instance, or cutting them into a different shape. You can then try to add something like hummus on the carrot in very small quantities. Keep the changes small and your little one will be less likely to refuse the food.
- The best time to introduce new foods is at snack time because this way, you'll eliminate the pressure to get the right amount of calories in.
- Try to tell the child NOT to eat the food. Reverse psychology is typically very successful with toddlers, so the chances are that they will definitely want to bite into a cracker they know they're not supposed to eat.
- Remember that it's completely normal not to like certain foods and that's okay. This means that if you can't get your child to eat mushrooms, for example, even after multiple presentations, you should take the hint and give up. They may just not be a mushroom person.
- If your child is old enough, get them in the kitchen to help you cook or at least assist and see how the food is prepared. You may also encourage them to sample some of the ingredients.
- Never be afraid to make a mess. Toddlers who have difficulties at mealtime WILL make a mess, and you need to make peace with it. If you're really bothered by the mess, you can place a mat under their highchair for easy cleaning.
- Remember that sometimes toddlers refuse certain foods because of real fear. They may be intimidated by the smell, texture, and even color, so it's important to respect that. If your little one pushes away or grimaces, stop and move on to something else. Don't insist because that's a surefire way to lose their trust.
- Encourage your toddler to chew on an oral motor chew tool before meals. This type of tool is specially designed to help little ones develop their biting and chewing skills and work on their jaw strength.
Feeding therapy can be a great option for children and parents, when used appropriately. Its main purpose is to help little ones develop the necessary skills to enjoy mealtime and introduce them to a wider range of foods.
Most of the time, feeding therapy is helpful for children who aren't gaining weight and growing as they should for their age because they aren't eating enough. No matter why you're considering feeding therapy, it's important to work with a therapist both you and your child trust.
The content and advice provided in this article is for informational purposes only and is not a substitute for medical diagnosis, treatment, advice for specific medical conditions. Always consult a pediatrician to understand the individual needs of your child.