Rehabilitation :: Knowing When It’s Time to Get Help with Difficult Feeders
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For children who struggle with feeding, the speech therapists and occupational therapists at CHOC Children’s work to evaluate and create a treatment plan for each child that takes into consideration the child’s specific oral-motor, sensory, behavioral and developmental needs.  
There are three main goals of feeding therapy:
  • Improve the child’s feeding skills.
  • Increase the amount of nutritional foods the child eats.
  • Make mealtimes enjoyable for both parent and child.
Caregivers should contact the child's pediatrician if the child has:
  • Difficulty accepting new foods and/or textures.
  • Wet sounding vocal quality while eating. (If the child’s speech is “gurgly” it could be a sign of aspiration or "going down the wrong pipe.")
  • Poor weight gain.
  • Coughing, choking or gagging during feeding.
  • Feeding periods longer than 30 to 40 minutes.
  • Lack of coordination when sucking and swallowing.
  • Food refusal or fear.
  • Negative behaviors during mealtimes.
  • Unusual/low muscle tone in mouth or face.
Many parents are surprised to know that there are many things our specialists can do to help a child who is struggling with eating:
  • Individualized feeding and/or swallowing therapy. 
    A trained therapist works with each child one-on-one to follow a treatment plan based on an initial evaluation and the therapist’s recommendations. The therapist works closely with the patient’s family to encourage caregivers to do many of the same things taught by the therapists at home. As the child makes progress, he or she may be transitioned to a small feeding group to add the challenge of eating with peer interaction.
  • Increasing acceptance of new foods or textures. 
    The therapist presents the child with preferred and non-preferred foods based on their sensory properties (i.e. look, smell, taste).
  • Modifications to position and posture for eating. 
    The therapist will work with the child to ensure he or she is positioned properly in a chair for all meal times. Proper positioning will improve attention and concentration during meals.
  • Behavior modifications and management. 
    The therapist educates each child’s family on how to increase desirable behaviors during meal times by ensuring that interactions between the caregiver and child are appropriate and understood by the child.
  • Referral to other professionals, such as a psychologist or dentist. 
    A multidisciplinary approach is important to make sure that all the child’s needs are being addressed. If the child has an underlying condition contributing to their feeding difficulties that is not being addressed, progress with feeding will be limited. 

Want to make an appointment for feeding or swallowing therapy?

Caregivers should request an authorization for a swallowing or feeding evaluation at CHOC Children's from the child’s primary care physician, allergist or gastroenterology doctor or nurse practitioner. Once the Rehabilitation Department obtains the authorization, they will schedule the child for an evaluation based on their triage process-which looks at the medical acuity of the child.   

For more information, please call (714) 509-4220.

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chocChildren's Hospital of Orange County | UCI University of California, Irvine

Children's Hospital of Orange County is affiliated with UC Irvine Healthcare and UC Irvine School of Medicine

CHOC Children's - 1201 W La Veta Ave, Orange, CA. Phone: 714-997-3000. .