Does the thought of mealtimes or feeding your child make you stressed or nervous? Do you feel like you’re the only parent dealing with a ‘fussy feeder’ or a ‘difficult eater’? You’re not alone. About 20% to 50% of children have difficulties feeding or swallowing, and 70% to 90% of children with developmental disabilities or complex medical conditions experience feeding and/or swallowing difficulties (also known as dysphagia).
Feeding and swallowing difficulties can occur at any time stage of life. They can be very stressful for families, and it can often be difficult to know when to seek help.
That said, mealtimes should always be a positive and stress-free experience for both you and your child. You should seek advice from a speech pathologist if your child:
- Regularly coughs, chokes or gags during mealtimes;
- Has trouble breathing or changes colour during or after feeding or changes;
- Is exhausted during or after breast/bottle feeds;
- Takes longer than 30 minutes to finish their meal;
- Won’t sit at the table or in their highchair for meals;
- Will only eat with distractions such as an iPad, TV or toys;
- Is not accepting purees by 10 months of age;
- Is not accepting any table foods or finger foods by 12 months of age;
- Refuses to drink from a cup or sipper cup by 16 months of age;
- Avoids or refuses specific textures (e.g. purees, chewy foods) or food groups (e.g. meat, vegetables);
- Eats less than 20 types of food.
Speech pathologists can help by teaching you and your child some strategies to make eating and drinking safer.
Why is safe swallowing so important?
Safe swallowing is important because it means that children can eat and drink without coughing, choking or being at risk of food or drink going down ‘the wrong way’ (aspiration). Swallowing is one of the most complex things our body does. When we swallow, we close off our ‘windpipe’ to make sure that food, drink, medication and saliva go down the right way into our stomach. Children who have difficulties swallowing might cough, choke, turn blue, have a wet or gurgly voice after eating or drinking and/or may get recurrent chest infections (aspiration pneumonia).
What are the common causes of feeding and/or swallowing difficulties?
Feeding is a very complex process with many muscles and body systems involved, so there could be a number of reasons your child has feeding or swallowing difficulties. These can include:
- Pain. When your child is in pain, the last thing they feel like doing is eating. They might be in pain from reflux, vomiting, gagging, gastrointestinal issues, breathing difficulties or if they have had lots of medical procedures.
- Discomfort. If your child is uncomfortable they might have difficulties eating. Your child’s discomfort might be related to nausea, allergies, heart conditions, constipation, renal conditions or fatigue.
- Delayed oral motor skills. Oral motor skills are the skills your child needs to eat and drink. This includes tasks such as being able to use your tongue to move food to the side of your mouth. Or being able to chew a food into small pieces quickly. If your child has difficulties with their oral motor skills they might find it difficult to eat particular foods.
- Sensory processing difficulties. This may mean that your child avoids certain textures or tastes because they are overwhelming. Alternatively, they may seek out big flavours and textures to help wake up their mouth. If you think that your child has sensory processing difficulties, you should seek help from an Occupational Therapist.
How do children learn to eat and drink?
Children generally learn to eat and drink in a particular order and the way your child feeds, or what you offer them to eat and drink will change as they grow:
- 0-4 months: baby feeds from breast and/or bottle in supported position.
- 4-6 months: baby offered smooth puree in a highchair, as well as breast and/or bottle. Babies should be positioned in a highchair and be able to hold their head up by themselves before introducing pureed foods.
- 7-10 months: baby offered mashed and lumpy purees, soft finger foods and fluids from a cup or sipper cup.
- 18 months: toddler drinks most fluids from a sipper cup and able to sit at small table and chairs or in a booster seat.
- 2 years+: child able to eat most family foods.
Some tips for dealing with the most common mealtime complaints from parents
My child refuses every new food I give them.
Did you know that it can take up to 20 tries of a new food to decide if we like it or not? If your child does not eat a food the first time you offer it to them, keep offering it. If your child says, “Yuck! I don’t like that food”, tell them they are still learning about that food.
Learning about foods involves looking, touching, smelling and tasting. You could even try a ‘learning plate’ where each person at the table can put foods they are still learning about (even adults have learning foods). It is important to talk about and explore learning foods.
My child takes forever to finish their meal
If you find that your child takes a long time to finish their meal try setting a timer (there are some good apps with visuals for children). Set the timer to 30 minutes so that your child has a clear end point, knows how long they have to eat and know what is expected at mealtimes.
My child seems to have difficulty chewing their food
If your child has difficulty chewing their food, you might have show them how to chew. Talk to them about using their ‘side’ or ‘dinosaur’ teeth to do some big crunching! Make sure you sit with your child and over emphasise your biting and chewing so that they can see what you do.
My child plays with their food more than they eat it
Touching and getting messy with food is a normal part of learning to eat it! Children learn lots about a new food before it touches their mouth. Think of it as ‘play with a purpose’.
Where can I get help?
- Talk to your general practitioner, child health nurse or medical specialist if you have any concerns about your child’s feeding/swallowing and ask for a referral to a speech pathologist or feeding clinic.
Useful websites
Some information adapted from resources prepared by Dr Kay A Toomey (2010)