Feeding Issues in Young Children

By Joel Manwill, Occupational Therapist

Frequently, babies and children with a history of reflux or GERD or other gastro-intestinal issues begin to have food and/or feeding aversions. The severity of these aversions can range from being a little picky sometimes to downright refusing all foods and requiring nourishment via feeding tubes. The following information is provided to help give you a general idea of what is considered normal eating habits and normal feeding development.

The most common time for a child to develop a food or texture aversion is at the transition from single texture purees to more complex or mixed texture foods.  This often occurs at the introduction of Stage 3 foods.  Many normally developing children can make this transition without difficulty.  Children with feeding issues get stuck.  There are several “missing steps” included in the following list, which come in between purees and mixed texture foods.  This begins at 8 months with the hard munchable foods and progresses until the child is able to tolerate an appropriate variety of food textures.

Developmental Food Continuum

Copyright 2002, Kay A. Toomey, PhD

This is a progression of foods according to the food’s texture and complexity.  If a child is struggling with mixed texture foods, it may be appropriate to go back to the last stage that was tolerated on the food continuum and then move forward with an appropriate challenge of moving to the next stage according to the food continuum.

0-13 monthsbreast/bottle

5 monthsthin baby food cereals

6 monthsthin baby food puree/stage 1

7 monthsthicker baby food cereals and thicker baby food smooth purees/stage 2

8 monthsSoft mashed table foods and table food smooth puree

8 monthsHard Munchables (raw carrot sticks, celery sticks, pretzel rods, dried fruit, bagel strips, etc) These foods are meant to provide oral stimulation rather than nutritional value.  They can be used at the first of a mealtime for the child to explore orally, move back a prominent gag reflex, and “wake up” a mouth to prepare it for better eating.

9 monthsMeltable Hard Solids – foods that dissolve easily when in the mouth and do not require chewing.  When swallowed they are handled as a puree. (towne crackers, biter biscuits, graham crackers, Gerber’s cereal squares, fruit loops, captain crunch, baby cookies)

10 monthsSoft Cubes – soft foods that hold a form but do not require chewing and can be mashed inside the mouth (avocado, overcooked squash, kiwi, vegetable soup ingredients without the broth, Gerber Graduates fruits, boiled potatoes, peas, bananas)

11 monthsSoft Mechanical single texture (fruit breads, muffins, soft small pastas, cubed lunch meat, thin deli meats in small rectangles, soft pasta or soft meat soups without the broth, soft pretzels, barley, scrambled eggs)

12 monthsMixed texture, soft mechanicals/stage 3 (mac and cheese, microwavable children’s meals, soft chicken nuggets (not fast food), French fries, spaghetti, lasagna)

12-14 monthssoft table foods in appropriate sizes and shapes

16-18 monthshard mechanicals (cheerios, thin pretzel sticks, ritz crackers, saltine crackers, pop tarts, most other chips, fritos

Children also benefit from structured meal and snack times. This encompasses a designated place to eat, a routine to meal and snacks – notification of meal time; sitting at a table; serving; eat; clean up; presenting foods in manageable bites and a pattern of presenting foods according to the Developmental Food Continuum for a time frame of 15 – 30 minutes. Allowing the child to graze at food, eating sooner than every 2 – 2.5 hours results in the child consuming just enough food to take the edge off the hunger and then move off to do another task. The child then has little motivation to explore more difficult foods and may consume up to 50 % fewer calories in a day, in comparison to eating to a schedule.  It is often appropriate to offer a hard munchable food at the beginning of a mealtime to prepare the child for better eating.

These methods are usually performed while under the care of a qualified feeding therapist, which may be either an occupational therapist or a speech therapist with experience in children’s feeding issues.

Note: Joel Manwill is an Occupational Therapist who has a private practice and also works with the Early Intervention Program.  He is happy to field questions from any of our readers.  Here is his contact information:

Phone: (801)390-4947

email: childrensabilityservices@gmail.com

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