As parents, we know that there is a lot of learning for our children to do. We don’t expect that our child can do everything perfectly, but sometimes we can wonder if our child is showing a normal amount of difficulty with a skill. A feeding disorder refers to “impaired oral intake that is not age-appropriate, and is associated with medical, nutritional, feeding skill, and/or psychosocial dysfunction.” There are many reasons why a baby or child may struggle to eat, all of which can be eased with the help of a knowledgeable professional. Here are some red flags for feeding disorder (developed by Kay Toomey, founder of the SOS Approach to Feeding) to watch for to determine if your child’s difficulties with food may require a little extra support.
Earliest feeding red flags
Trouble with feeding can start at the very beginning of life. Here are some signs of difficulty that can be recognized with your infant, and can continue through the lifespan if not addressed.
- have ongoing poor weight gain (dropping percentiles on the growth curve) or weight loss?
- reported that your infant cries and/or arches at most meals?
- have ongoing choking, gagging, or coughing during meals?
- have ongoing problems with vomiting?
- more than one incident of nasal reflux (vomiting or spitting up out their nose)?
- a history of eating and breathing coordination problems, with ongoing respiratory issues?
- difficult for everyone to feed (very specific in how they will take a feeding)
feeding red flags in transition to solids
Skills required for feeding change as food textures, shapes, and consistencies become more variable. Purees and solids require more manipulation in the mouth to prepare for a comfortable and safe swallow. If your child is struggling, you may notice some of the following.
- unable to transition to baby food purees by 10 months of age?
- doesn’t accept any table food solids by 12 months of age?
- unable to transition from the breast/bottle to a cup by 16 months of age?
- unable to wean off of baby foods by 16 months of age?
- avoids all foods in a specific texture (wet, squishy, crunchy, etc.) or nutrition (meat, vegetables, starches, fruits, etc.) group?
- has less than 20 foods that they are able to consistently eat? Especially if foods are being dropped over time with no new foods replacing those that were lost.
feeding red flags related to the experience of eating
Like so much of being a human, sometimes the root of difficulty comes from the head. That doesn’t make these difficulties less real, and arguably they can be less obvious and there by more complex. Humans need to feel at ease to eat and digest. Sometimes feeding issues are regarded as “behavioral,” which is code for “choosing not to.” This is never the case for children. When working with children, in any area and on anything, we have to consider behaviors as a communication of a bigger issue, whether that is discomfort, fear, unease, or other negative emotion or experience surrounding eating.
- reported the child as being “picky” at 2 or more well child checks?
- felt like mealtimes are a battle, and that you are always fighting about food with your child?
- a traumatic choking incident, where the child choked on something and then subsequently stopped eating certain foods?
- had a history of an eating disorder, in addition to having a child who is not meeting weight gain goals? (Please note – parents are not viewed as causing the feeding problem in their child, however, they may be more stressed around meals and need extra supports.)
Now what?
If you answered yes to any of these questions, there could be an underlying reason for your child’s difficulty with feeding. Feeding therapy can help. Contact Square One OT via the contact form, call/text 479-407-4523, or email Katelyn at katelyn@squareoneot.com to discuss your child’s issues further and make a plan to put feeding challenges behind you.
Additional Resource:
Use this questionnaire (https://questionnaire.feedingmatters.org/questionnaire) from Feeding Matters to get more information about your child’s feeding based on their age. You can share with Katelyn at the end of the questionnaire to give a full picture of your child’s difficulty before evaluation, Katelyn@squareoneot.com, or you can keep your results to yourself for your own education.