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May 22, 2018

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Feeding Difficulty



There are many reasons a child may have difficulty feeding, in fact many children go through phases of “picky eating” as a part of normal feeding development causing confusion and frustration to their parents who last week had a “perfect eater”.

Although picky eating can be a normal part of development it is important to know when to seek help to protect your child’s health, development and to save unnecessary stress for both them and yourself. One of the health professionals that can help with feeding is a Speech Pathologist. Speech Pathologists are trained to help people of all ages with the feeding skills.

Have a look at the list below, if your child ticks any of these signs or symptoms it’s time to book an appointment with a Speech Pathologist or Dietician to make sure you and your child get the help and support you need.

Red Flags for Feeding Difficulties:

  • Long or ineffective feeding sessions (>30mins)

  • Hypersensitive gag reflex

  • Structural abnormalities to the oral cavity: (i.e. Tongue Tie or Cleft Lip/Palate)

  • Coughing, choking or gagging during feeding or frequently during the day

  • Signs of distress during or after feeding: a

  • Not gaining weight

  • Lacking energy (i.e. sleeping for more than 2-3hrs during the day, irritability, etc)

  • Excessive drooling or food/fluid lost during feeding

  • Refusal of food or fluid

  • Refusal of a certain type of food only (i.e. only crunchy foods or only salty foods)

  • Difficulty transitioning through food consistencies

  • Difficulty chewing effectively

  • Complaints of pain during or after eating

  • Limited list of foods your child will eat (i.e. less than 30 different foods)

  • Difficulty with cups or straws

Red Flags for Feeding Difficulties with Infants:

  • Painful feeding, sore or cracked nipples

  • Attachment difficulties

  • Poor weight gain

  • Poor breast drainage or reduced milk supply

Case Study


Annie and her 12 month old son Max visited the clinic because mealtimes were getting more and more difficult. Max was not eating solids and would get agitated during mealtimes. Max was drinking 5 bottles of formula a day and would sleep for around 2 hours for both naps each day. Max was quite pale when he came into the clinic and was also quite petite.

When talking to the Speech Pathologist, Annie reported that Max would only eat:

  • Puree fruit

  • Yoplait vanilla yoghurt

  • Pauls Custard

  • Formula

The Speech Pathologist watched Max eat his favourite foods and also watched Annie try to give him new foods. The Speech Pathologist observed that Max:

  • Did not play with his food

  • Did not tolerate food left on his face

  • Did not cough on any fluids or foods

  • Did not eat any of the more solid foods he was offered.

The Speech Pathologist noticed that Max had a preference for smooth soft foods and avoided messy play. The Speech Pathologist and Annie worked together to devise goals and strategies to gently introduce new textures and flavours into Max’s diet, reduce his distress around eating and to help him engage in messy play at home. Their goal was for Max to have age appropriate feeding skills. The Speech Pathologist also recommended that they see a dietician to talk about nutritional and caloric supplements while they built up Max’s food list.

Annie and Max came to the Speech Pathologist for weekly sessions to discuss therapy tasks. Therapy involved mealtime strategies, oral desensitisation activities, oral movement activities and messy play games. After four weeks Annie and Max were less anxious about mealtimes. Max was more open to experiencing variety in his sensory environment, he had started taking more textures in his foods and was putting on weight. After eight weeks of therapy the dietician started to reduce the supplements they were taking, and Annie and Max started seeing the Speech Pathologist monthly for reviews instead of weekly therapy.

After a few more months they stopped seeing the Speech Pathologist all together because they had achieved their goal of age appropriate feeding skills. Annie continued to use the skills she had learned in therapy to introduce more textures and flavours and she kept her eye on Max’s height and weight charts as he continued to grow. Annie would occasionally call the Speech Pathologist or Dietician when she wanted new ideas, clarification or information but they were now independent in their feeding journey.


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