by Jennifer McCullough M.S. CCC-SLP
As a pediatric feeding therapist I get asked this question often. Many toddlers ranging in age from 10 months to 24 months come in to see me because they refuse to transition from their bottle/breast feeding and purees to chunky and chewable solids. They refuse by turning their heads, pushing the food away, gagging, crying and sometimes if parents persist hard enough, by vomiting. Eating is a such a ‘normal ‘ and social activity in our culture that this refusal is hard to understand by most parents and caregivers.
To know when your child has a problem, it is good to know when should most babies be able to eat table food? By about 8 months babies are starting to transition from pureed baby foods to ground and mashed table foods and by 12 months should be sufficiently taking coarsely chopped table foods including easily chewed meats. So what happens when this doesn’t happen so easily?
There are many reasons why a child is having trouble eating solid foods but it usually boils down to two underlying processes: Sensory and/or Oral Motor difficulty. Sensory processing refers to the way the nervous system receives messages and turns them into appropriate motor and behavioral responses. A sensory processing disorder (SPD) exists when sensory signals are not detected or misinterpreted and therefore do not get organized into appropriate responses. Most feeding-based, sensory processing disorders become either ‘hyper-sensitive’ or ‘hypo-sensitive’. Hyper-sensitivity indicates too much oral awareness and therefore tastes and textures become overwhelming and scary. Hypo-sensitivity refers to not enough oral awareness and so the kids are seeking more input. Hypo-sensitive kids tend to over stuff their mouths and mouth different objects throughout the day. These kids may also drool more often.
We have found that the hyper-sensitive kids tend to be the ones that are referred more often for feeding concerns. These children will most likely have developed a negative behavioral reaction to eating and will gag, cry and turn their heads when new foods are introduced. Depending on how long this process has been occurring will determine how many negative behaviors have developed. We have had clients that when a non-preferred food item is placed on the table they vomit. Although that is a bit extreme, it shows how far the body will go to stay away from a scary taste/texture.
In order to properly take a bite, chew and swallow food your mouth goes through a complicated motor plan. Your lips and front teeth bite into the food, your tongue then moves it to your molars that use a diagonal-rotary chew pattern to break it down. Your tongue jumps back into action and retrieves this food from your molars, puts it into a pretty, little ‘bowl’ of food and then the back of the tongue activates your larynx to be protected, or shut off, so your esophagus can take the food down to your stomach. Muscles from your lips, cheeks, tongue and jaw are all needing to be strong enough and have perfect timing to do this process successfully. Some kids have trouble with these precise motor movements and may send food down the esophagus before it is ready, which can cause choking, and in extreme cases parts of the food may get into the larynx and down to their lungs. This food left untreated could get infected and cause aspiration pneumonia. Most of the time, however, these children realize it is not a safe way to eat so they refuse, gag or do other negative behaviors to avoid eating.
When we see kids at our office we evaluate both the sensory and the oral-motor aspect of their eating. Many times these children have difficulties with both areas and we wonder which one came first? Did they have a sensory difficulty and therefore did not experience eating different foods and so their muscles are not strong enough to have appropriate oral motor skills? Or did they have difficulty with strength and range of motion with their oral muscles and therefore were not able to experience the variety of textures of food. Either way both of these areas need to be examined and addressed in order for the kids to be comfortable eating different foods.
Our team of feeding therapists work in partnership with the parents to make eating feel like a safe and sociable activity for the children. We use a variety of programs that we have been trained on over the years including S.O.S (https://www.pediaspeech.com/treatment-specialties/speech-programs/) and Beckman Protocol (https://www.pediaspeech.com/treatment-specialties/speech-programs/) . However, ultimately we use a program that is tailored to the specific needs of each child. For more information on our feeding programs please contact our office and let us know how we can help your child!