Abby Barnes, M.S., CCC-SLP
Some children have problems that affect how they eat and drink. A childhood feeding disorder can impact a child’s nutritional intake, health, and safety, and make mealtimes stressful for both the child and their family. The good news is that feeding therapy can help children with sensory food aversion, swallowing problems, and other feeding disorders. Many parents wonder what to do when their toddler refuses to eat anything. When should you worry if your child doesn’t want to eat? In this guide, our feeding therapists answer common questions about feeding and swallowing disorders in children. Learn the signs and symptoms to watch for, how to know if your child needs feeding therapy, and how to help your child with “picky eating” at home.
What is a pediatric feeding disorder?
From learning how to suck, swallow, and breathe as infants, to learning to chew a variety of textures and types of foods as toddlers, lots of exciting feeding milestones happen during early childhood. This time is a period of rapid growth and brain development. So it’s important to pay attention to any problems your child has with eating and drinking.
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.” Pediatric feeding disorders often occur in children who are neurodivergent, autistic, or bound by routine. That means they're only comfortable with things that are known/routine, which can lead to a limited food diet.
Pediatric feeding disorders can also occur in children who have:
Developmental disabilities
Oral-motor deficiencies (such as childhood apraxia of speech)
Muscle tone issues
Cerebral palsy
Sensory differences
Challenges related to a head injury
Expert feeding support for kids
Feeding therapy helps make mealtimes safer and more positive. Our feeding program supports your family from the comfort of your home.
Get startedSigns and symptoms of a childhood feeding disorder
How do you know if your child needs feeding therapy? You may see the following signs or symptoms in toddlers and children with feeding disorders:
Eating less food than they should for their age
Eating fewer varieties of foods than they should for their age
Disruptive or inappropriate behaviors during mealtime
Difficulty feeding themselves by the appropriate age
Difficulty using utensils and devices, such as a cup or spoon, appropriately and by themselves during meals
Slow physical growth and/or slow weight gain
Learn more about what’s expected for different ages. Check out our feeding milestones for babies up to 12 months old and toddlers ages 1 to 3 years old.
Some kids with feeding problems are at risk for choking or aspiration, which is when food or liquid falls into the airway. This is a sign that feeding therapy is necessary.
The following are symptoms of aspiration to watch for:
Coughing while eating or drinking
Reddening of the eyes while eating or drinking
Teary eyes while eating or drinking
Gurgly or wet-sounding voice during or after eating/drinking
Gagging
Choking while eating or drinking
Children who have any of these symptoms, either as babies or later in childhood, may have a feeding or swallowing disorder. They should be evaluated by a speech therapist who specializes in feeding disorders.
What is a sensory feeding disorder?
Some feeding disorders are due to sensory issues. One type of childhood feeding disorder is called a sensory feeding disorder, also known as sensory food aversion. It means a child has difficulty eating because of sensitivities to the smell, look, texture, taste, and/or sound of foods.
For example, some children may respond negatively to the sensation of mixed food textures, like a soup with vegetables in it. Others may not like crunchy textures like crackers. These sensory sensitivities lead to big challenges with feeding, and they often limit the foods a child will eat. This can affect the child’s nutritional intake and growth.
Sensory aversion isn’t just being a "picky eater." Picky eating can be considered developmentally appropriate between the ages of 2 and 4. But picky eating becomes a problem when a child has a “fight or flight” response when they're exposed to new or non-preferred foods. Examples of this response include running away, hiding, panicking, or shutting down. If your child does these things, they may have a sensory feeding issue, which can be treated with sensory feeding therapy.
Signs of a sensory feeding disorder
How do you know if your child has a sensory aversion to food or is simply a picky eater? There are some symptoms of sensory aversion to look for. Kids with sensory feeding disorder may show the following behaviors:
Seem grossed out by looking at a new food on their plate
Feel uneasy from the smell of new food
Refuse to try or eat much of certain kinds of flavors, like savory, spicy, etc.
Dislike certain textures, such as the texture of meat or anything juicy or stringy, like fruit or vegetables
Frequent gagging
Covering the mouth or nose and refusing food
Spitting out food
Negative reactions or anxiety around eating and mealtimes
Sensory aversions can look different in different kids. Some children may have many types of sensory aversions, and some may have just a few. Some children may show big reactions to foods they don’t like, while others may be more quiet when refusing food.
We want kids to be able to eat a wide variety of foods, as well as an adequate amount of food. It’s important to watch your child and note anything you see. Chances are, if your child has a sensory aversion, you’ll catch on to it.
Connor's story
At age 2, this adventurous eater suddenly started refusing most foods. Feeding therapy helped him and his family get back to stress-free meals.
Read Connor's storyWhat is childhood feeding therapy?
Pediatric feeding therapy helps children who have difficulty with the physical act of eating or swallowing. The goal of therapy is to improve a child’s ability to safely eat as many foods and liquids as possible. Feeding therapy can help your child get the nutrition they need, while making mealtimes easier and more enjoyable.
Childhood feeding therapy is provided by a speech-language pathologist, also known as a speech or feeding therapist, who specializes in this area. The speech therapist helps the child safely eat the least restrictive diet possible, which means as many foods and liquids as possible. Feeding therapy can make a big difference in your child’s experience with food.
Therapy for feeding skill and safety
If feeding safety is a concern, that will be a top priority of feeding therapy. Feeding safety has to do with airway protection. The esophagus and the airway are very close together. If food goes down the airway instead of the esophagus, this can lead to choking or aspiration.
Some children may have muscle weakness, oral-motor weakness, or poor coordination of their mouth. This can raise their risk for problems with feeding safety and complications.
For children with these difficulties, therapy will focus on finding foods and liquids they can safely eat and drink. Some children are unable to eat safely by mouth at all. They may need alternative means of nutrition, such as a g-tube.
Feeding therapy may include oral-motor exercises to increase a child’s strength and coordination. This also supports safe eating. As an example, some children have poor jaw strength and need to increase their strength in order to chew adequately.
Therapy for sensory food aversions
For children who don’t eat enough food or enough different types of foods, feeding therapy will focus on increasing the volume and variety of food. These children have sensory issues or behavioral responses that limit what they eat.
The speech therapist will help the child decrease sensory aversions, or negative responses to foods. Some ways to do this include:
Playing with non-preferred foods
Food chaining, which means trying new foods that are similar to foods the child likes
Child-led interactions with food
For example, playing with food can help the child get used to interacting with the food before eating it. The speech therapist may walk the child through steps working up to taking a bite, such as smelling, touching, kissing, and then licking the item. The speech therapist will observe the child’s reactions in order to determine when they’re ready to try eating the food.
The speech therapist may also help the child eat a larger volume of food. To do this, a structured meal may be offered. The child is prompted to take bites while playing a game or eating a highly preferred food.
For more details and examples of what happens in sensory feeding therapy, check out this article.
How do I know if my child needs feeding therapy?
There are a few ways to know if your child may need feeding therapy:
They show any signs of aspiration, choking at meals, or physical struggles at meals.
Your child seems stressed at mealtimes or has big, negative reactions to foods.
Your child doesn’t eat enough food or a wide variety of foods.
They consistently refuse many foods.
If your child shows any of these signs, talk with their pediatrician or a speech therapist. This is especially important if your child is losing weight or you’re concerned about malnutrition. Listen to your gut! If something doesn’t seem quite right, contact a professional.
What does online feeding therapy look like?
Some types of feeding therapy can be done through online therapy, but not all. This decision should be made by your child’s pediatrician and speech therapist. The speech therapist may need to be physically present to observe the child’s oral motor and swallowing abilities.
It’s more likely that children who don’t have known airway safety concerns may be seen via teletherapy. Online feeding therapy takes some planning and communication by the speech therapist and the parent or caregiver. The speech therapist will ask for certain foods to be brought to the session. They will then guide you and your child through different exercises to do with each food.
No matter what goals are being targeted in therapy, and whether it’s online or in person, the parent or caregiver should be involved.
No matter what goals are being targeted in therapy, and whether it’s online or in person, it’s extremely important for the parent or caregiver to be involved. This way, you can learn how to support your child during meals at home.
Expressable matches 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. Online feeding therapy makes it easier for parents and caregivers to attend sessions with their child, and parent coaching is a key part of our treatment approach.
Support beyond sessions: The Expressable portal
Your feeding therapy doesn’t stop when the session ends. At Expressable, you’ll have access to our client portal, which makes practicing feeding strategies easier and more effective. Here’s what you’ll find:
Learning Paths that explain and reinforce feeding strategies
Demo videos that show real feeding techniques in action
Home practice activities you can do during everyday meals
Text messaging support so you can ask questions, get reminders, or receive tips from your therapist between sessions.
By using the tools in the portal and practicing regularly, your child can make faster progress and build more independence in their feeding abilities.
Quick demo: Try this with your picky eater
Watch hereTips for helping your toddler or child with picky eating
If you have a toddler who’s refusing to eat, or a child who seems to be a “picky eater,” here are some ways to support them and encourage them to try new foods:
Create a food-positive environment. Use positive, calm, and supportive language to reduce the pressure to try new foods. For example, instead of saying, “Try it, you’ll like it,” say, “This is a food we’re learning about.”
Serve new or non-preferred foods in small portions. This helps to avoid a potential fight-or-flight response.
Encourage your child to learn about the food(s) in new ways. Talk about the food using descriptive, child-friendly language. What does it look like? What does it smell like? What does it feel like?
Get your child involved. Have them help you create a grocery list, and take them shopping.
See this article for other ways to help your picky eater.
Get started with Expressable today
If your child needs support with eating or drinking, reach out to Expressable today. We’re here to listen to your concerns and guide you on next steps. If online feeding therapy is appropriate, we’ll match you with a licensed speech therapist who can perform an evaluation and develop a treatment plan. Get in touch with us here!
