Pediatric Rehabilitation: Everything You Need To Know About Feeding Therapy

A child’s refusal to eat can be distressing for a parent. Some fussiness around mealtime is normal for any infant or toddler, but it should disappear over time. When fussiness or eating difficulties last months or years, there may be a medical or behavioral problem at the root of their symptoms.

What is pediatric feeding therapy?

Pediatric feeding therapy is used to treat infants and young children who have impaired oral intake that is not appropriate for their age. The disorder, known as PFD, may be caused by medical, nutritional, feeding skill or psychosocial dysfunction.[1] Therapists work with children and their families to determine why a child has difficulty eating and develop specific therapies to make eating easier and more enjoyable.

How do I know if my child needs feeding therapy?

Children should enjoy mealtimes, which should be a pleasurable experience for the whole family. Naturally, there will be some exceptions to this, such as when they’re suffering from a short-term illness or they’ve had a particularly stressful day. After an illness or a stress resolves, eating should return to normal.

“As feeding therapists, we love when children are messy eaters,” said Rebecca Gormley, MS, CCC-SLP, a speech-language pathologist at Good Shepherd Rehabilitation. “That is how they learn about new foods and the textures of foods. As toddlers, being messy and exploring foods with their hands is crucial to help with learning to eat. It will also help reduce the risk of picky eating in the future if children are comfortable with being messy around mealtimes.”

What are examples of feeding disorders?

There are many potential reasons for your child’s feeding difficulty: nervous system disorders, acid reflux (GERD), heart disease, cleft palate, low birth weight, muscle weakness in the face and neck, sensory issues, behavior problems and more. [2]

If your child consistently shows any of these symptoms, they may have a feeding disorder:

• Difficulty chewing or swallowing (dysphagia)
• Arches their back or stiffens when feeding
• Swallows food in whole pieces
• Gags on foods with certain textures, flavors, temperatures or consistencies
• Drools a lot or has liquid coming out of their nose
• Difficulty transitioning between food textures (such as from purees to soft solids)
• Difficulty moving food in their mouth
• Is constantly fussy about eating or feeding
• Becomes congested while feeding or immediately after
• Coughs, gags or chokes frequently when eating
• Has trouble breathing when eating
• Vomits or spits up frequently during or immediately after feeding
• Will rarely try or refuses new foods
• Falls asleep when feeding
• Frequently cries, pushes food away, refuses to eat, pulls away or throws tantrums
• Is not gaining weight or growing
• Becomes hoarse after eating

Why would a baby need feeding therapy?

Every child has a natural inclination to eat; it’s human nature. But eating is a learned skill, and some babies may have difficulty learning this skill for a variety of reasons. They may have trouble coordinating the suck-swallow-breath pattern of bottle feeding or breastfeeding or may be an extremely picky eater as you introduce solid foods.

Pushing food away may not be a matter of taste but a sign that your infant is having trouble coordinating the muscles responsible for swallowing or chewing.

Does feeding therapy work for picky eaters?

At some point, most parents believe their toddler is a picky eater. And this may be true, as “picky eating” can be a part of their normal development, especially between the ages of two and four. But if it’s extreme (for instance, if a child refuses entire categories of food groups or only eats one texture of food), it may be time to call a feeding therapist.

“It is normal for children to refuse some of their favorite foods at some point”, says Gormley. “They may be tired of them or have had too much of their favorite foods and need a break. We call this food jagging. However, if we see children who already are labeled as picky eaters start to refuse their favorite foods, and then do not return to those foods even after a break, intervention may be required. That is when a referral for feeding evaluation would be appropriate.”

What specialists will my child see for their eating disorder?

As the root problems of feeding difficulties vary, your feeding therapy team may include:

• Speech and language therapist
• Pediatric physiatrist
• Occupational therapist
• Recreational therapist
• Physical therapist
• Physician or nurse
• Developmental specialist
• Neuropsychologist
• Counselor
• Lactation consultant
• Nutritionist

The feeding therapy team at Good Shepherd Rehabilitation customizes plans to meet your child’s unique. To learn more, visit our Pediatric Feeding Program Services page or call 1-888-44-REHAB (73422).

[1] Pediatric Feeding Disorder Consensus Definition and Conceptual Framework, Journal of Pediatric Gastroenterology & Nutrition

[2] Feeding and Swallowing Disorders in Children, American Speech-Language-Hearing Association