Childhood Feeding Disorders

At Expressable, we’ve helped many children with pediatric feeding disorders improve their ability to eat the least restrictive diet possible. Our feeding therapy program teaches evidence-based strategies for improving feeding skills, with caregiver support and home exercises so your child can make faster progress.

Pediatric feeding disorders (PFDs), also called childhood feeding disorders, can be defined as “impaired oral intake that is not age-appropriate, and is associated with medical, nutritional, feeding skill, and/or psychosocial dysfunction.” 

Signs of a feeding disorder in children may include: 

• Eating less food than they should for their age

• Eating fewer types of foods than they should for their age

• Disruptive or inappropriate behaviors during mealtime 

• Difficulty feeding themselves or using utensils or cups by the appropriate age 

• Reddened or teary eyes while eating or drinking

• Gurgly or wet-sounding voice during or after eating or drinking 

• Gagging, coughing, or choking while eating or drinking 

• Slow physical growth and/or slow weight gain

This article explains Expressable’s clinical approach to treating children with feeding and swallowing difficulties. You can also view our expert guide to feeding disorders to learn about feeding milestones for babies and toddlers, the causes and signs of feeding disorders, and how parents can support their child at home.

1Why is therapy for childhood feeding disorders important? 2How Expressable treats childhood feeding disorders 3Practice feeding strategies at home with the Expressable portal 4The benefits of online feeding therapy 5See what families are saying about pediatric feeding therapy at Expressable 6Get matched with a feeding therapist today

Why is therapy for childhood feeding disorders important?

Safely eating enough food, and an adequate variety of food, is a huge part of a child’s overall health. It’s important for children who have a pediatric feeding disorder to receive support so they can eat as well as possible. 

There are different types of feeding disorders. For children who don’t eat enough food or enough types of foods, feeding therapy focuses on increasing the volume and variety of food. These children often have sensory issues or behavioral responses that limit what they eat. This is feeding therapy for sensory food aversions.

Some children need feeding therapy for concerns with feeding skill and safety, also called pediatric dysphagia. If safety is an issue, that will be the top priority of feeding therapy. Feeding safety has to do with airway protection. If food goes down the airway instead of the esophagus, this can lead to choking or aspiration. Aspiration is when small amounts of food or liquid enter the airway, which can cause health problems such as pneumonia.

Feeding therapy is a necessity for children with feeding disorders. The earlier feeding therapy begins, the faster the child can start eating as safely and nutritionally as possible. While each child’s treatment plan will be tailored to their needs and goals, the Expressable feeding disorders program generally focuses on:

• Improving your child’s quality of life by increasing their ability to eat as safely as possible

• Using evidence-based techniques to expand your child’s diet

• Helping your child create a positive association with food for more enjoyable, less stressful mealtimes

• Educating parents and caregivers so they understand their child's reactions to non-preferred foods, the signs of aspiration, and any changes needed for their child's diet

How Expressable treats childhood feeding disorders

Feeding therapy is provided by a speech-language pathologist, also known as a speech therapist. Feeding therapy falls within the scope of practice of speech therapy. Your therapist may be referred to as a speech therapist or a feeding therapist.

It’s important to know that some types of feeding therapy can be done through online therapy, but not all. Because of potential safety concerns, children who can’t safely eat by mouth may need in-person feeding therapy. The speech therapist may need to be physically present to observe the child’s oral-motor and swallowing abilities. This decision should be made by your child’s pediatrician and speech therapist. 

It’s more common that children who do not have known airway safety concerns can receive online feeding therapy. However, this should still be discussed with your child’s pediatrician and speech therapist.

Here at Expressable, we match families with a licensed speech therapist trained to evaluate and treat childhood feeding disorders. All therapy is delivered online via face-to-face video conferencing on Zoom. 

Many children respond well to feeding therapy that takes place in the familiarity of home, rather than at a clinic.

Research has shown that online feeding therapy works just as well as in-person therapy. Online feeding therapy is convenient, offers wider access to speech therapists, and makes it easier for parents and caregivers to be involved with their child’s care. Many children respond well to feeding therapy that takes place in the familiarity of home, rather than at a clinic. Educating parents and caregivers is one of the most important parts of pediatric feeding therapy. At Expressable, parent coaching is a key part of our feeding disorders program. We provide comprehensive guidance on safety precautions, recognizing signs of feeding distress, and how to support your child during meals.

You’re the one who feeds and eats with your child most often, so it’s important to understand the techniques used in therapy.

You’re the one who feeds and eats with your child most often, so it’s important to understand the techniques and approaches used in therapy. Online sessions make it easy to attend alongside your child, so you can learn these strategies directly from the therapist and confidently practice with your child at home. 

Expressable’s clinical approach to evaluating childhood feeding disorders

Pediatric feeding therapy will begin with an evaluation. Your speech therapist will choose from a variety of questionnaires and checklists, such as the Morris and Klein Developmental Pre-Feeding Checklist and the Feeding Impact Scale. Before the evaluation, you may be asked to keep a 3-day feeding log or journal, noting what your child eats and how they act at mealtimes. The therapist will review this log with you during the evaluation.

Your feeding therapist will also use functional measures, like clinical observation, to holistically assess your child’s current feeding abilities. If online feeding therapy is determined to be safe and appropriate for your child, the therapist will likely want to watch your child eat and drink.

Your speech therapist will likely do the following during the evaluation:

• Review your child’s medical history

• Examine the anatomy of their mouth, as well as their oral-motor skills and mouth movements

• Observe their physical and emotional response to food

• Determine whether your child’s feeding and oral-motor development is on track or if concerns are present

• Provide a professional opinion on whether feeding therapy is needed

If the therapist thinks a swallow study is necessary, a request for a referral will be made. A videofluoroscopic swallow study (VFSS), also called a modified barium swallow, is done in person. An X-ray is used to determine if a child is aspirating on food or liquid and what kind of diet is safest for them. Not all children will need a swallow study, but when one is necessary, it will help guide the speech therapist’s therapeutic recommendations.

After the evaluation, if feeding therapy is recommended, your therapist will develop a personalized care plan. Treatment for feeding problems typically includes two therapy sessions per week.

Evidence-based strategies to treat sensory feeding disorders

If your child has a sensory feeding disorder, your therapist will help your child decrease sensory aversions, or negative responses to foods. This can help them eat more food, as well as a greater variety of foods.

At Expressable, we believe it’s most important to establish a trusting therapist-client relationship and a positive experience with food. This is at the core of sensory feeding therapy.

Your speech therapist will determine what aspects of food your child is aversive to: texture, taste, temperature, or touch. Treatment will differ depending on the aversion type. The ultimate goal of sensory-based therapy is to expand the child’s preferred food repertoire. Your family’s lifestyle, routines, and culture will be part of setting goals for your child.

Some sensory feeding therapy techniques include:

• Building rapport and trust

• Allowing the child to lead in their interactions with food (called child-led therapy)

• Playing with and exploring non-preferred foods

• Slowly trying new foods that are similar to foods the child likes, called food chaining

• Expanding the child’s diet with a focus on different textures, colors, shapes, and flavors, depending on their needs

• Keeping a food journal to identify patterns, challenges, and successes

• Learning how to identify signs of feeding distress and strategies for more positive mealtimes

You can find more details about what to expect in sensory feeding therapy in this article.

Evidence-based strategies to treat issues with pediatric dysphagia

If your child has problems with feeding skill and safety and has been approved to start online feeding therapy, therapy will focus on finding foods and liquids they can safely eat and drink in order to minimize their risk of choking or aspiration. Your speech therapist will also assess whether your child is safely able to eat and drink by mouth. If not, an alternative means of nutrition may be considered, such as a g-tube. 

Your feeding therapist may teach your child oral-motor exercises to increase their strength and coordination to improve their ability to eat. As an example, some children have poor tongue movement or control, which makes it hard to move food around safely in their mouth. Increasing tongue strength and movement can help them then eat more safely.

Feeding therapy techniques for childhood dysphagia may include: 

• Oral-motor activities to build your child’s oral strength, such as using recommended tools that help with chewing or tongue movement 

• Exercises to increase oral awareness and control

• Exercises for safer swallowing

• A modified diet with textures that are safest for your child to consume, such as thicker or thinner liquids

• Using therapist-recommended feeders, cups, and utensils that make feeding safer

• Learning how to identify signs of feeding distress and strategies for more positive mealtimes

Practice feeding strategies at home with the Expressable portal

At Expressable, feeding therapy doesn’t stop when your session ends. You’ll have ongoing text messaging support so you can ask questions or get tips from your speech therapist between sessions. You’ll also have access to our client portal, which makes it easier to practice feeding skills with your child throughout the week. The more often you practice, the faster your child will make progress!

In the portal, you’ll find Learning Paths that explain and reinforce the strategies you’re using in sessions, such as making mealtimes positive and knowing the signs of feeding distress:

You can watch videos that show real feeding techniques, such as improving chewing skills:

Your speech therapist will assign personalized practice activities you can do at home, such as being mindful of bite size at dinnertime: 

The benefits of online feeding therapy 

Multiple studies over several years have shown the effectiveness of online speech therapy for children. Not only does it work as well as in-person speech therapy, there are lots of reasons people prefer it:

1 Wider access to qualified feeding therapists

With online speech therapy, it’s not hard to find a speech therapist who’s experienced in treating feeding disorders. You have access to an entire network of feeding therapists who are licensed to treat in your state. This is especially beneficial for people who live in rural areas, or in areas with long waitlists for feeding therapy.

2 Convenience and flexibility

Between school, work, errands, and everyday life, it can be hard to regularly attend in-person therapy sessions. Not only is there the commute time, but most speech therapy clinics are only open during normal business hours. With work schedules and after-school activities, for many people, that just doesn’t work.

Online feeding therapy removes this problem. At Expressable, you can schedule sessions on the days that work best, at the times that are most convenient, including evenings and weekends. 

3 The comfort of home

If your child feels shy or nervous when it comes to feeding therapy, they’re not alone. Many children feel unsure in new situations, and eating can be especially stressful for kids with feeding disorders. Doing feeding therapy sessions from the comfort of your own home can put your child at ease. You can be right beside them the whole time. And when your child feels comfortable, their therapy will be more effective.

Another benefit of online feeding therapy is that the therapist gets to see how the child interacts with food in their home environment–perhaps even during actual meals! 

4 Affordability

In-person speech therapy clinics have many expenses that aren’t directly related to your care, such as rent, utilities, and other operational costs. As with any business, these costs are often passed down to the consumer. The cost of speech therapy will vary by provider, but generally, the cost of online feeding therapy will be less than an in-person practice—even though you receive the same quality of treatment.

See what families are saying about pediatric feeding therapy at Expressable 

We’ve treated many children with feeding disorders around the country. This personal story from a family we’ve served is just one example.

Our speech therapists consistently earn ratings of 4.9 out of 5 stars from their clients. Here’s a sampling:

“She helped my son improve a lot with his eating habits” “The speech therapist Olivia was great, patient and very helpful. She helped my son improve a lot with his eating habits. I would definitely recommend her.”

“Mealtimes are no longer a terrifying experience for him, and a lot less stressful for me” “Maddie's ability to connect with my son is unmatched! We are seeing so much progress in such a short period. Mealtimes are no longer a terrifying experience for him, and a lot less stressful for me. Being able to consult with the SLP has been life-changing for us. My only regret is that I didn't find Expressable sooner so we could've begun intervention earlier.”

“She is eating so much more on her own now” “Both therapists were absolutely amazing and patient with assisting in my daughter learning how to eat. She is eating so much on her own now. I truly appreciate everyone.” 

Get matched with a feeding therapist today

Feeding therapy can help your child safely consume a greater variety of foods, while making mealtimes less stressful for the whole family. We’re here to support you and your child. Get matched with a feeding therapist here.