Underlying medical conditions: It is critical to explore possible underlying medical conditions that may be contributing to problem feeding. Undiagnosed gastrointestinal conditions may be causing GI track inflammation, discomfort, and motility issues. These internal symptoms are difficult for young children to verbalize to adults and can significantly impact the child’s feeding behavior. Children may resort to maladaptive behaviors to express their gastrointestinal discomfort. If there is a suspected underlying medical condition, your therapist will refer you to a gastroenterologist for further evaluation.
Oral Motor: Conducting an oral structural or muscular mechanism examination assesses the coordination, timing, and function of the mouth and related structures. This portion of the assessment rules out physiological issues which could be hindering the mechanics of chewing and swallowing while protecting the airway. Some examples of contributing factors to oral motor feeding issues are facial muscle weakness, nervous system disorders (such as cerebral palsy), cleft lip and/or palate, and prematurity. Children with structural or muscular feeding issues may have the following symptoms:
Sensory Integration: Parent report is a critical component of assessing sensory-based feeding behaviors. We ask parents to complete a comprehensive food log, which is a record of all foods and beverages consumed by the child within a period of time. Observed trends can be concluded from the child’s diet, revealing what food-based sensory attributes (taste, texture, temperature, color, appearance) the child prefers and avoids. The clinician can also draw conclusions about the child’s general nutrition to determine if a referred to a nutritionist is needed. Children with sensory feeding issues demonstrate highly rigid behaviors related to mealtime routines and food choices. They are at risk of poor nutrition and difficulty maintaining a healthy body mass index. It is also common for these children to experience anxiety and social isolation related to eating in social situations and settings.
Behavioral Feeding Challenges: Behavioral feeding issues can coexist with any of the previously described feeding issues. For this reason, it is essential to consider all possible factors contributing to your child’s feeding problem. Prior to treating problem behaviors, oral-motor and possible underlying medical condition must be ruled out or addressed. Furthermore, sensory-based and behavioral-based feeding issues will need to be distinguished from each other to determine the best course of treatment. Children with behavioral feeding issues may being exhibiting some of the following behaviors: refusal to sit at table, refusal to eat, crying/screaming during meals, throwing foods, or vomiting to get out of eating.
Poor weight gain or weight loss
Eating and breathing coordination issues (repeated episodes of pneumonia or aspiration)
Trouble transitioning to puree foods by 10 months
Trouble accepting tables foods by 12 months
Not weaned off baby foods by 16 months
Refused to eat entire food groups
Fewer than 20 foods in their diet
Pattern of refusing to eat previously preferred foods without adding new foods
Refused to eat family meals
Extremely rigid feeding behaviors
Behavioral Feeding Challenges: