When Should I See a Feeding Therapist for My Child? 10 Signs Your Child May Need Specialist Support
If you're worried about your child's eating, you may find yourself wondering: “Is this just picky eating, or does my child actually need help?”
It's completely normal for children to go through phases of eating less variety, refusing unfamiliar foods or suddenly deciding that foods they previously loved are no longer acceptable. But sometimes feeding difficulties become more persistent, more restrictive or more stressful for the whole family.
This is where a paediatric feeding therapist can help.
Feeding therapists work with children who have difficulties with eating, drinking and mealtimes. Depending on the child, this might involve looking at sensory sensitivities, chewing and swallowing skills, food anxiety, mealtime behaviours, developmental history or the impact that feeding difficulties are having on family life.
Here are 10 signs that it may be worth seeking specialist feeding support.
What Does a Feeding Therapist Do?
A feeding therapist helps identify why a child is struggling with eating, rather than simply focusing on getting them to eat more foods.
Paediatric feeding difficulties can have many different causes. A child may have sensory sensitivities, difficulties with chewing or swallowing, a history of reflux or painful eating, anxiety around food, developmental differences or a combination of factors.
Speech and language therapists have an important role in assessing and supporting children's eating, drinking and swallowing, particularly where there are concerns about feeding skills or swallowing safety.
A feeding assessment should therefore look at the whole picture: what your child eats, how they eat, what happens at mealtimes and what might be making eating difficult for them.
10 Signs Your Child May Need a Feeding Therapist
1. Your Child Eats a Very Limited Range of Foods
One of the most obvious signs of a feeding difficulty is a very restricted diet.
Perhaps your child eats only a handful of foods, relies on the same meals every day or has a very specific set of brands, shapes, colours or presentations that they will accept.
Having favourite foods is completely normal. However, if your child's diet is becoming increasingly limited, or you are finding it difficult to identify enough foods that they will reliably eat, it may be worth seeking support.
2. Their List of Accepted Foods Is Getting Smaller
Sometimes the problem isn't simply that a child has always been a picky eater. Instead, you may notice that foods are gradually disappearing from their diet.
A child might stop eating a particular brand, reject a food because it looks slightly different or suddenly decide that a previously accepted food is “yucky”.
Over time, this can lead to a very small range of accepted foods.
If your child's diet is becoming progressively more restricted, it's a good idea to understand what's driving the changes rather than simply hoping they'll grow out of it.
3. They Refuse Entire Food Groups or Textures
Does your child refuse all meat? All fruit? Anything crunchy? Anything wet? Anything mixed together?
Strong preferences for particular textures can be associated with sensory sensitivities or difficulties managing certain food textures.
Some children also struggle when they're expected to progress from one texture to another. For example, they may remain reliant on purées or very soft foods long after you would expect them to be managing a wider range of textures.
A feeding therapist can help identify whether there are sensory, oral-motor or other factors contributing to these difficulties.
4. Mealtimes Cause Significant Stress or Anxiety
If every meal feels like a battle, that's important.
You may find yourself negotiating, bribing, encouraging, distracting or worrying throughout every meal. Your child may cry, become distressed, leave the table or become extremely anxious when unfamiliar food is presented.
When feeding becomes stressful for both the child and their parents, getting support can help you understand what is happening and develop a more positive approach to mealtimes.
Importantly, feeding therapy shouldn't be about forcing a child to eat.
A pressure-free, child-centred approach can help children gradually become more comfortable around food and build positive experiences at mealtimes.
5. Your Child Gags, Coughs or Chokes When Eating
Gagging can be a normal part of learning to eat, particularly during early weaning. However, frequent coughing, choking or other signs of difficulty during eating and drinking should be assessed.
Other signs that may warrant assessment include wet or gurgly breathing or voice after eating, changes in breathing, tiring during meals or recurrent chest infections.
These symptoms can sometimes indicate an eating, drinking or swallowing difficulty, so it's important not to assume that they are simply behavioural.
If you have concerns about swallowing safety, speak to your GP, health visitor or an appropriate healthcare professional for advice and referral.
6. Your Child Struggles With Chewing
Some children find chewing surprisingly difficult.
You might notice that your child holds food in their mouth, takes a very long time to finish meals, avoids foods that require more chewing or prefers foods that are soft and easy to manage.
They may also struggle to move food around their mouth effectively.
Feeding difficulties can involve oral-motor and feeding skills as well as sensory or behavioural factors, and these are areas that a suitably qualified feeding therapist can assess.
7. Your Child Hasn't Progressed With Textures
Children typically develop their feeding skills gradually, moving from early tastes and textures towards a wider range of foods.
If your child seems “stuck” at a particular stage, this may be worth investigating.
For example, perhaps they will only accept smooth purées, very soft foods or foods that dissolve easily in the mouth, and attempts to introduce more complex textures consistently result in refusal, distress or gagging.
Rather than repeatedly presenting foods and hoping that your child will eventually accept them, it can be helpful to understand why the transition is difficult.
8. Your Child Has Very Strong Sensory Reactions to Food
For some children, food isn't simply something they dislike. Its smell, appearance, texture, temperature or even the way it feels in their mouth can be overwhelming.
You might notice your child becoming distressed when certain foods are nearby, refusing foods because of their appearance, becoming upset if foods touch each other or having very specific requirements around how food is presented.
Sensory differences can play an important role in paediatric feeding difficulties, and understanding your child's individual sensory profile can help you work out what support they need.
9. You're Worried About Their Nutrition or Growth
A restricted diet can sometimes make it difficult for a child to get everything they need nutritionally.
You may be concerned that your child isn't eating enough, is missing whole food groups or isn't getting enough variety.
If you're worried about your child's growth, weight or nutritional intake, it's important to involve the appropriate healthcare professionals. A paediatric dietitian can assess nutritional intake and provide specialist nutritional advice alongside feeding therapy where appropriate.
You don't need to wait until your child's diet becomes extremely restricted before asking for help.
10. Feeding Difficulties Are Affecting Family Life
This is one of the most important signs of all.
Perhaps you're planning every day around what your child will eat. You can't go to restaurants or visit friends because your child won't eat food outside the home. Family meals have become stressful. You are making several different meals every night. Or you're constantly worrying about whether your child has eaten enough.
Even if your child's growth appears to be fine, the impact of feeding difficulties on your child's wellbeing and your family's quality of life matters.
You don't have to wait until things reach crisis point before seeking support.
Is My Child Just a Picky Eater?
This is one of the most common questions parents ask.
There is a huge difference between a child who has a few strong food preferences and a child whose eating is significantly restricted.
A typically picky eater might refuse certain foods but still eat a reasonable range of foods across different food groups. They may be reluctant to try new things but can usually eat enough variety to support their nutritional needs.
A child with more significant feeding difficulties may have a much smaller range of accepted foods, experience significant distress around eating, struggle with particular textures or feeding skills, or have eating difficulties that are affecting their nutrition, development or everyday life.
There isn't one magic number of foods that tells you whether your child needs feeding therapy. The bigger question is whether your child's eating is causing difficulty for them or for your family.
What Happens During a Paediatric Feeding Assessment?
A feeding assessment is about understanding your child's individual difficulties rather than simply giving you a list of foods to try.
I'll usually want to understand:
What your child currently eats and drinks
Which foods they accept and which they refuse
How their diet has changed over time
What happens during mealtimes
Their history of weaning and feeding development
Any difficulties with chewing, swallowing or managing textures
Sensory preferences and sensitivities
Their medical and developmental history
How feeding difficulties are affecting your family
Depending on your child's needs, we may also look at their feeding skills and observe them eating and drinking.
The aim is to work out what might be getting in the way of eating and what practical strategies are most appropriate for your child.
Can Feeding Therapy Be Done Online?
Yes. For many children with restricted eating, picky eating and sensory feeding difficulties, feeding therapy can be provided effectively online.
Online sessions can also have the advantage of allowing me to see your child eating in their normal environment, using their usual foods and equipment.
Of course, online therapy isn't appropriate for every feeding difficulty. If there are concerns about swallowing safety, significant medical issues or other factors requiring face-to-face assessment, a different type of assessment or a multidisciplinary approach may be more appropriate.
How Do I Find a Feeding Therapist in the UK?
If you're looking for a feeding therapist in the UK, it's worth checking that they have appropriate qualifications and experience with the specific difficulties your child is experiencing.
Speech and language therapists can have a key role in children's feeding and swallowing difficulties, and may work alongside other professionals such as paediatric dietitians, occupational therapists, paediatricians and psychologists.
Look for someone who takes time to understand the underlying reasons for your child's eating difficulties rather than simply focusing on increasing the number of foods they eat.
It can also be useful to ask what happens during an assessment, what their approach to feeding therapy is and whether they work collaboratively with other professionals when needed.
When Should I Get Help for My Child's Feeding Difficulties?
You don't need to wait until your child stops eating altogether or their diet becomes extremely restricted before asking for help.
If you're worried about your child's eating, your concerns are enough reason to seek advice.
In particular, it's important to seek professional advice if your child is losing weight, struggling to maintain growth, has signs of swallowing difficulty such as coughing or choking, has recurrent chest infections, is becoming increasingly restricted in what they eat, or is experiencing significant distress around food.
The earlier you understand what is contributing to your child's feeding difficulties, the easier it can be to put appropriate support in place.
How I Can Help
I'm Emma, a Speech and Language Therapist specialising in paediatric feeding difficulties.
I support children and families with a range of feeding challenges, including restricted eating, picky eating, sensory feeding difficulties, difficulties progressing with textures and other feeding concerns.
My approach is child-centred and focused on understanding why your child is struggling to eat. Rather than forcing children to eat foods they aren't ready for, I work with families to develop practical strategies that can be used in everyday life.
I offer feeding support online for families across the UK and Ireland, as well as face-to-face appointments in the East Midlands.
If you're wondering whether your child's eating is something they will simply grow out of, or whether they could benefit from specialist feeding support, you don't have to work it out on your own.
Get in touch to talk through your child's feeding difficulties and find out whether I can help.