Red Flags for Feeding Difficulties

by Amanda Zito Griffin, M.S., CCC-SLP

Amanda is a speech-language pathologist and feeding therapist, addressing the needs of clients with oral-motor, sensory, and/or behavior-based feeding difficulties. Her use of Sequential Oral Sensory (SOS) approach incorporating behavior modification and desensitization helps to facilitates positive interactions with food for her clients and their families. We are pleased that she is sharing some of the red flags that parents need to watch for.--Dr. Stan

Since meals are such a prominent part of raising children, parents are constantly questioning, “What is normal?” and “Am I doing this right?” When determining if a child has a “feeding difficulty,” a number of red flags may indicate the need to involve a specialist in feeding issues (a gastroenterologist, feeding therapist, and/or nutritionist). These include:

  • Poor weight gain or consistent weight loss: Fortunately, length and weight are regularly tracked during the first years of life at doctor’s visits. If a child loses weight or has difficulty gaining, the carefully plotted growth curve can suggest testing or a referral may be needed.
  • Coughing, gagging, choking, and/or vomiting: These behaviors can cause concern, especially if they are ongoing and seen during or after feedings. Difficulty managing the size of a bite, tolerating the texture of a food, or manipulating foods can be evidence of a potential problem--or they may be behaviors the child learned to avoid certain foods, to gain attention, or to escape from a meal.
  • A history of GI or Reflux issues: When children have continued GI issues, they may begin to associate eating/drinking with pain and discomfort. This can lead to avoidance and escape behaviors, as well as a decrease in overall intake.
  • Difficulty transitioning to new food textures or tastes: Many children need to try a new food a number of times before they will eat or drink it readily. However, if a child consistently rejects most new foods presented, this may be cause for concern.
  • Difficulty transitioning from liquids to solids: Children should transition to baby food purees by 10 months, table food purees/solids by 12 months, and be weaned from baby foods by 16 months of age. Those who don't may need evaluation, particularly if they have some of these other problems as well.
  • Negative behaviors during meals: When every meal is a “battle,” parents often try negotiating, bribing, distracting, and doing almost anything to get their child to eat, sometimes with little success.
  • Aversion or avoidance of all foods of specific textures or nutritional groups: Most children have a preference for specific textures and tastes. However, if they avoid an entire group of food textures (e.g. purees, chopped foods, soft foods, chewy foods) or an entire nutrition group (e.g. proteins, fruits, vegetables, dairy), this may indicate a problem.
  • History of eating/breathing coordination: If your child has a history of, or difficulty with ongoing respiratory issues, they may tire easily during meals and/or have decreased intake.
  • A range of less than 20 foods eaten: A child should gradually increase their food repertoire to, at minimum, 20 foods. This would allow for three to five meals per day without repeating a food. Many kids with potential feeding issues will “food jag” – eating the same foods every day or for every meal. When a “food jag” takes places, a child will typically tire of the food and quickly eliminate it from their diet.

These "red flags" are present in lots of infants and toddlers for short periods of time, but when they continue, your primary physician help you sort through the issues, look for some of the problems that can cause these symptoms and direct you to someone who can delve into these concerns further in order to assist your child in some of the ways that we will discuss in another of my posts on Nutrition4Kids.

Amanda Zito Griffin, M.S., CCC-SLP 16 July 2014

Amanda is a pediatric Speech-Language Pathologist and owner of A to Z Pediatric Therapy, LLC in Atlanta, GA.  She has worked as a therapist for Cobb Pediatric Therapy Services, serving both Atlanta Public Schools and Fulton County Schools.  For Read More

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