Additional Feeding Questions & Knowledge

What is the body’s number one priority?

1. Breathing

2. Eating

3. Sleeping

Breathing is the body’s number one priority. Must be able to coordinate breathing with swallow. Children with respiratory complications can easily tire out from eating and become frustrated and eventually refuse to eat.

A child will eat when he/she is hungry enough

1. True

2. False

False. This is a dangerous recommendation because some children have been known to go days without eating.

A child who will not eat has either a behavioral OR an organic problem

1. True

2. False

False. A behavioral problem can turn into a physiological problem and learned avoidance behaviors can and most often do develop on top of medical/physiological complications.

Eating is only considered Instinctive through ____

1. the first year of life

2. the first month of life

3. the first 6 months of life

Eating is instinctive only during the first month of life. It is reflexive from 1 to 6 months of age. Eating after 6 months of age is a completely learned behavior. If your child is eating while sleeping, then he/she is eating reflexively. Does your child require distractions in order to eat? Eating while watching television is also a reflexive behavior.

Here are some common examples describing adaptive feeding behavior:

• A baby becomes fussy whenever he is having his face wiped clean. During meals your child is eating in his high chair and becomes messy. You instinctively scrape food off of his face with the spoon and wipe food off of hands and face during and after the meal while your child is sitting in the chair. You notice that your child begins fussing and crying at the very sight of the chair and the spoon, making meal time extremely stressful for everyone involved.

We are all guilty of this! We are creating an undesirable consequence for eating, leading to refusal of eating. The first question to investigate is: Why is your child reacting negatively to touch? It is very important to rule out any underlying medical complications such as gastroesophageal reflux, food allergies, other gastrointestinal complications, respiratory complications, sensory processing disorders, etc. These questions can be further investigated with the help of your therapist and other professionals. Refer to our FAQ entitled ‘Introduction to Positive Feeding Experience’ for more information on this subject.

• Your child enjoys munching on crackers and other crunchy foods, she will accept smooth baby foods without any hesitation, but if you place a spoonful of chunky stage 3 food in her mouth you witness gagging and coughing and even vomiting. Why is this happening when she is eating crackers without any problem?

Research shows that ~1/3 of kids who are typically developing do not handle 3rd foods. Many picky eaters may have mild sensory issues in addition to oral motor delays. Higher sensory foods, such as crunchy crackers, are easier to manage from an oral motor standpoint. These foods give more input in the mouth and therefore are more easily recognized. Textured table foods can be difficult to process when lateralization of the tongue has not fully emerged.

Chewing involves a relationship between the lateral molars and lateral movements of the tongue simultaneously. The lateral movement of the tongue is necessary for keeping food on the side for consecutive munching. When a spoonful of chunkier food is placed in the mouth you may notice that the smooth stuff is swallowed without difficulty but the chunks remain in the mouth. You may also notice that gagging occurs almost immediately. The key to success involves appropriate manipulation of dissolvable crunchy solids such as graham crackers…this needs to happen first. Teeth or no teeth…babies should be chewing on the side with an open mouth and not in the front of the mouth. If your baby is not chewing in this manner, please consult with a therapist for additional information.

My child grazes with eating throughout the day, should I be concerned?

Yes. The definition of grazing is eating more frequently than every 2 hours. Some children eat Just enough to take the edge off of hunger. In children 20-50% fewer calories are consumed when grazing. It is best to set a schedule for meals and snacks. As a parent you should provide the structure and boundaries for your child. This includes deciding the choices of food and the time and place for meals and snacks. Your child will decide what he will eat of those choices and how much will be consumed. Please refer to Dealing with Challenging Feeding Behaviors FAQ for further information regarding division of responsibility between parent and child.

Why does my child refuse milk unless it is presented in a bottle?

Some children get stuck on certain cups for certain drinks. They know that the ‘white stuff’ is supposed to come from a bottle. Make sure you put ALL fluids in a cup on a regular basis. You may need to use a completely different cup for milk for a while as well as change the flavor in order to increase acceptance.

Why does my child try certain foods during feeding therapy and completely refuse them at home?

If you are noticing that your child is not transferring skills into a new environment then more efforts will need to be made toward generalization. Using the same paper plates, napkins, and Dixie cups at home, day care/school, and therapy may help transfer the skills into other environments. Keep a journal of your child’s feeding behaviors to help identify contributing factors. This may include any changes that have occurred in daily routines, changes in health status (recent sickness, abnormal bowel movements, changes in respiratory status).