Pediatric Feeding Therapy

 

Our feeding therapy is provided in a collaborative team approach, made up of occupational therapist, speech therapists, myofunctional therapists, and a dietitian. We utilize a team approach to provide the most comprehensive and complete care to treat the underlying causes and support optimal function and independence. In addition to our in-house team, we collaborate with local providers to make sure all necessary structural and functional aspects of eating and swallowing are appropriately addressed. This collaborative team approach supports the best outcomes for our clients and their families.

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Let our feeding therapy team support your child by helping to discover underlying causes of their feeding behaviors, develop a professional multidisciplinary team, and provide intervention to help them reach their maximum function and independence. 

Picky Eating

Feeding therapy can be very beneficial for children with and without a diagnosis or condition. Though many children with diagnoses show signs and symptoms of feeding disorders, many neurotypical children also demonstrate feeding disorders and picky eating which interfere with their ability to participate in age-appropriate mealtime routines and get adequate nutrition from whole foods. Picky eating is one of the most common conditions reported to pediatricians, with up to 50% of children being reported as picky eaters with vegetables being the most commonly omitted food group (Mascola, Bryson, & Agras, 2010).

Nutrition plays a pivotal role in brain development and cognition, specifically in the early years of life as brain development is faster during this period which makes dietary deficiencies more impactful (Nyaradi, et al, 2013). Studies show that picky eating in children is associated with constipation, poor physical activity, fear of unfamiliar places, and high occurrence of medical illness compared to same aged typical eaters (Chao, 2018). Additionally, a child that is a picky eater can impact the whole family, causing increased stress and anxiety around mealtimes and leaving parents and caregivers frustrated, confused, and upset. Picky eating in early childhood and adolescent years is shown to have significant negative impacts on growth, development, nutritional status, physical activity, and health status overall (Chao, 2018).

Common conditions/diagnoses/disorders that we help in feeding therapy:

  • AFRID

  • Picky Eating

  • Food Aversion/Texture Aversion

  • Dysphagia

  • Pediatric Feeding Disorder

  • Oral Motor Dysfunction

  • Tube Dependence

  • Choking, gagging, vomiting during eating

  • Aspiration

  • Bottle Feeding

  • Low Muscle Tone

  • Sensory Dysfunction

  • Gastroesophageal Reflux Disease (GERD)

  • Behavioral management/modification during mealtime

  • Difficulties and deficits related to ASD, Cerebral Palsy, Down Syndrome

Do you think your child might be a picky eater?

Wondering if feeding therapy could help? Download our parent screening tool here.

Screening Tool

Feeding Therapy Groups

  • In addition to one-on-one treatment options, we offer feeding peer groups. Research supports the positive impact of feeding therapy in group settings with similar aged peers. Using evidence-based interventions, our highly skilled therapy team creates meaningful and functional group activities to facilitate generalization of skills from individual treatment to a wide variety of settings (home, school, community). Group sessions are typically recommended following some individual treatment and provide good opportunities for children to practice their new skills in a social setting. This also can present additional challenges of mealtimes and allows our therapy team to be present to support the child in mastering all areas of mealtime. Parent training and education is always a part of feeding therapy and greatly supports the success of the child.

    Feeding Groups are a great example of one of our specialty services that supports our choice for remaining as out of network providers. Unfortunately, most insurance companies will not approve co-treatment provided by multiple therapy disciplines or group therapy sessions, which would limit our ability to provide the most comprehensive care to our clients.

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Developmental Milestones

 

0-3 months

  • reacts to loud sounds

  • cry differs based on needs

  • smiles at parent/caregiver

  • turns head towards sounds

  • makes eye contact

  • coos and smiles

  • pushes up on arms while on tummy

  • opens fists

  • tolerates tummy time for short periods

  • brings hands to mouth

  • visually tracks toys side to side while lying on back

  • able to keep head at midline/centered while lying on back

  • enjoys different types of movement

  • can be calmed with rocking, soothing noises, and touching

  • happy if not hungry or sleepy

  • latches during feeding on nipple or bottle

  • sucks and swallows well with minimal loss from side of mouth

10- 12 months:

  • Claps hands

  • Purposeful release of objects

  • Able to hold/self-feed with bottle in upright position

  • Walks with one handheld assist

  • Pulls to stand and cruises

  • Stands without support

  • Takes multiple steps independently

  • Moves in and out of different positions to explore

  • Crawls towards desired toy

  • Self feeds with fingers

  • Able to drink from open cup

  • Starting to explore using utensils

  • Increased variety of smells and tastes that are preferred

  • Enjoys games like pat-a-cake, peek-a-boo

  • Uses “mama” and “dada” meaningfully

  • Turns to sounds

  • Points to objects of interest

  • Responds to simple command ("come here")

  • Uses gestures (waving, reaching out with arms)

  • Uses one- two simple words

  • Responds to “no”

  • Turns head to name

2- 3 years old 

  • Snips with scissors

  • Able to imitate lines or circles

  • Balance on one foot for 5-10 seconds

  • Catch a medium ball

  • Walks with heel toe pattern, does not toe walk

  • Coordinates hands and fingers

  • Appropriate strength and endurance to play with peers

  • Able to use hands together for play (swinging a bat, opening a container)

  • By 3 able to snip with scissors, while moving forward across paper

  • Enjoys bath time

  • Tolerates diaper changes without crying

  • Tolerates schedule/routine changes

  • Able to self soothe when upset

  • Acknowledges and responds to injury/pain

  • Able to maintain eye contact with others and demonstrate interest and awareness during interactions

  • Has a word for almost everything

  • Talks and requests with 2-3 word phrases

  • Uses plurals

  • Uses “in” and “on”

  • Understands “yours” and “mine”

  • Understands “why” questions

  • Most speech is understood by family and friends (36 months)

  • Able to eat the same foods as their family (by 36 months)

  • Self feeds with utensils well

  • Able to wipe face/mouth during mealtime

  • Tolerates mealtime at table with family/peers for appropriate duration

4-6 months 

  • Opens mouth to spoon

  • Shows interest in food

  • Begins eating smooth, pureed foods

  • notices toys with sounds

  • babbles (ex: da,da,da)

  • laughs

  • reacts to sudden noises

  • maintains eye contact with familiar person during play

  • supports self with hands in sitting

  • rolls tummy to back, back to tummy

  • accepts all weight in legs when supported in standing

  • plays with feet with both hands while lying on back 

  • transfers toys one hand to the other when lying on back 

  • explores toys with both hands

  • raises hands to be picked up

  • isn’t upset by common everyday sounds

  • can be calmed 

  • able to prop on elbows and pick up head during tummy time 

13- 18 months:

  • Pointing with index finger

  • Able to put objects into containers

  • Able to kick a ball

  • Walks independently with minimal falls

  • Stacks two blocks

  • Able to squat to pick up a toy or object

  • Helps with dressing

  • Sleep schedule is regular

  • Uses 5-10 words

  • Puts gestures and sounds together

  • Follows simple directions regularly

  • Interest in pictures

  • Able to identify 1-2 body parts if named

  • Understand 50 words

  • Points to familiar objects and people in picutres

  • Responds to yes/no questions with head shake

  • Holds and drinks from an open cup

  • Increased variety of foods eaten

  • Increased variety of food textures eaten

  • Able to eat coarsely chopped foods

4- 6 years old

  • Answers who? what? why? where? questions

  • Able to talk about activities from their day

  • Uses 4+ word sentences

  • Enjoys a variety of age appropriate toys

  • Able to locate items that are pointed at

  • Doesn’t put non food items in mouth

  • Demonstrates safety awareness

  • Uses appropriate force during play with pets and peers and when using and holding objects

  • Maintains balance on uneven surfaces

  • Able to maintain attention and play with one toy or theme for 15 minutes

  • Able to cut paper in half, cut circle within ½” of boundary line, cut square within ¼ of boundary line (5 years)

  • Able to imitate/draw cross, square (4 years), diagonal lines, and triangle (5 years)

7- 9 months:

  • Independent sitting

  • Reaches for toys in sitting without falling

  • Turns head to track while sitting

  • Uses finger and thumb to pick up small objects

  • Imitates others in simple play

  • Crawls on hands and knees with alternating movement

  • Turns several pages in board book

  • Enjoys musical toys

  • Moves to explore surroundings when on the ground

  • Maintains head forward when being pulled from lying to sitting

  • Investigates toys and surrounds (shape, size, textures)

  • Able to drink from straw

  • Holds and drinks bottle when seated in highchair

  • Is full for longer periods after eating

  • Demonstrates strong reactions to smells and tastes that are new

  • Begins to progress through more textures (lumpy, mashed)

  • Variety of sounds and syllables used in babbling increases

  • Recognizes sound of name

  • Interested in play with others

  • Uses simple gestures (shaking head for “no”)

  • Imitates sounds

  • Able to follow a few simple routine commands when paired with a gesture

19-24 months:

  • Self feeds with spoon

  • Completes simple shape sorter toy

  • Walks and runs well

  • Explores variety of environments

  • Enjoys swinging and movement play

  • Minimal mouthing of toys

  • Can participate in small group with peers

  • Enjoys playing with new toys

  • Likes to sit and listen or look at a book

  • Maintains balance to throw and catch ball

  • Minimal loss of food during chewing and swallowing

  • Scoops with spoon, Stabs with fork, (not efficient until after 24 months)

  • Eats a wide variety of foods

  • Uses at least 50 words

  • Identifies 3-5 body parts

  • Imitates new words regularly

  • Uses simple pronouns

  • Begins to use two word phrases and questions ("where dog?" "go bed")

  • Follows 2-step direction for familiar task (“Pick up book and bring it to me”)

*Folio & Fewell (2000). Peabody Developmental Motor Scales

*Parham,D. et al (2007). Sensory Processing Measure

*Pathways.org (2021) Milestones & Abilities