Feeding Therapy

The goal of feeding therapy is to help patients develop normal, effective feeding patterns and behaviors.

What is feeding therapy?

Feeding therapy is more than just “teaching a child to eat.” Therapists work closely with patients and their families to determine the source of the child’s difficulties and develop very specific therapies to make the entire process of eating easier and more enjoyable.

When should a child be referred for feeding therapy?

Mealtimes are a great time for bonding and enjoying new experiences. Unfortunately, for some children, it can be a stressful and challenging time. If any of the behaviors below are affecting a child’s ability to safely eat, meet nutritional needs or enjoy the mealtime experience, the child may benefit from receiving a feeding evaluation.

• Difficulty chewing foods, typically swallowing food in whole pieces.
• Difficulty swallowing foods or refuses to swallow certain types of food consistencies.
• Refuses to eat certain food textures or has difficulty transitioning from one texture to another texture (ex: from bottle feedings to purees, from purees to soft solids or mixed textured foods).
• Gags on, avoids or is very sensitive to certain food textures, food temperatures and/or flavors.
• Struggles to control and coordinate moving food around in mouth, chewing and preparing to swallow food.
• Fussy or irritable with feeding.
• The child seems congestion during feedings or after.
• Frequently coughs when eating.
• Gags and chokes when eating.
• Frequently vomits during or immediately after eating or drinking.
• Refuses or rarely tries new foods.
• Pushes food away.
• Has difficulty transitioning from gastric tube (G tube) feedings to oral feedings.
• Negative mealtime behaviors (infant cries, arches, pulls away from food; child refuses to eat, tantrums at mealtimes or “shuts-down” and does not engage in mealtime).
• Infant demonstrating signs of difficulty with coordinating the suck/swallow/breath pattern during bottle or breastfeeding.
• Feeding time taking longer than 30 minutes for infants, and 30 to 40 minutes for toddlers or young children.
• Known to be a “picky eater” who eats a limited variety of foods or consistencies.

Learn more about feeding disorders.

What skills are taught in feeding therapy?

During feeding therapy, therapists work with children to provide them with the skills they need to make meal time more enjoyable and nutritious. The skills taught to each child are determined based on the patient’s needs and may differ from those below. The most common skills taught include:

• Oral skills Some children may lack the skills needed to eat and/or drink due to developmental delays, illness, allergies and a variety of other factors. When this is the case, therapists work with patients to teach them how to control and coordinate chewing, sipping, sucking swallowing and the like while eating and drinking. Therapists also work with patients to increase each child’s oral strength and range of motion.
• Food orientation Due to illness, allergies, sensory aversion or developmental delays, some children may need assistance broadening the amount and type of foods they eat. This is very important and will allow the child to better enjoy meals and eat a more balanced, healthy diet. Therapists work with patients and their families to increase the amount and types of foods the child is willing to eat. Many patients, especially those with sensory aversion or those who have had limited exposure to a variety of foods, may be taught skills on how to reduce their sensitivities to foods and their textures.
• Improve the overall eating experience Whether a child has struggled to eat because of illness or allergies, a sensory aversion food, and/or reduced oral skills, he or she may have developed negative feelings toward eating and mealtime in the process. As a result many children, and their families, benefit from learning how to create positive eating and drinking experiences. Therapists work with patients and their families to improve the child’s overall mealtime routine and create positive associations with food. Therapists also work with patients to help them gain the self-feeding independence that many of them crave by teaching skills like drinking from a cup, eating with a spoon or fork or drinking from a straw. By teaching the child how to enjoy meal time and retraining the child’s caregiver on how to create a positive mealtime experience, meals and snacks may become easier for the entire family.

What roles do caregivers play in feeding therapy?

Caregivers play an important role in feeding therapy. As a vital member of the child’s care team, therapists stay in close contact with the child’s family in between appointments to that the therapy and strategies used can be changed as needed. While the child is learning skills in order to become a better eater, caregivers must learn the skills and strategies they can use at home in order to help the child progress and become a better eater and/or drinker. The child’s caregivers and therapist are a team, working together to make sure the child receives the therapeutic, physical, social and emotional support to improve his or her feeding skills and habits. In order to provide patients what they need at home, therapists teach the child’s caregivers:

• Feeding strategies and general advice for eating at home.
• Tactics for addressing negative mealtime behaviors.
• How to continue encouraging the child to eat the new foods introduced during therapy at home.
• To keep a food log of what the child eats and how he or she acts at mealtime and reacts to foods.

Working as a team, the caregivers and therapist decide which foods to introduce or target during the therapy. This decision includes many factors including the child’s oral skill level (what he or she is able to chew, sip or swallow), the family’s culture and lifestyle choices, the child’s specific nutritional needs and any sensory or food texture experiences the overall therapy is addressing. After sharing a meal with the child and caregiver or observing a meal between the child and caregiver, the therapist may provide feedback and advice on ways to incorporate things being learned in feeding therapy and make the meal more enjoyable.

How long does feeding therapy take?

The length and frequency of therapy depends upon each child’s needs. The child’s therapy team will work with the child and his or her caregivers to make sure the child gets the right amount of therapy so that he or she can progress without feeling too overwhelmed. Children who do not show adequate progress in feeding therapy may qualify to participate in CHOC’s inpatient feeding program. Learn more about the renowned inpatient feeding program at CHOC.