Early Childhood Intervention
This website is a place for families who are facing
challenges pertaining to their child's development and
growth.
It is a place to find answers and practical
suggestions. That's what Early Intervention Support is all
about.
Whether a family has a child with a challenging behavior,
a disability or developmental issue, childhood is short - it
should be savored and enjoyed.
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Ask a Therapist
We understand developmental milestones and the challenges
of Special Needs children. We spend a great deal of time
with families understanding the inner workings of childhood
routines and interactions. Ask us about your child today!
Ask a Therapist
Food and Eating Concerns with Children
Listed below are a few previous questions from our
Ask The Therapist
form relating to speech and language. You may also want to review:
I have a three year old little boy that has severe eating issues.
For the most part, he does not seem developmentally delayed, although,
we have had suspicions that he may have Asperger's Syndrome. We have
been
to our family doctor, a nutritionist, a feeding therapist, an
occupational
therapist and had a swallow study done, not the barium one, but they
just
watched him eat. We have come across the problem of people not really
taking us seriously when we say that he doesn't eat, and we are
struggling
daily with getting actual food into him. He lives off of chocolate milk.
We use
Carnation Instant Breakfast because it has some nutrition in it. We
offer him
three meals every day including a snack. His diet is limited to less
than ten
food items. We've followed the nutritionist's advice and postponed
giving him
the milk until after mealtime; this hasn't helped. I found on the
website
information regarding the difference between picky eaters and problem
feeders
and he fits the problem feeders category completely. We need help, and
we are
running out of ideas on who to turn to. I am worried about my son's
health; he
is extremely thin, although not so thin that the doctor says he's
underweight,
and his skin is very dry. Please if you have any resources or ideas on
where
we could find help, let us know.
We at Early Intervention Support certainly are familiar with the
frustration and
helplessness that families feel when their child is not eating enough,
having difficulty
with food textures or only eating a limited diet of select foods. It
sounds like that if
you have already read our information regarding Picky Eaters vs Problem
Feeders and
determined your son fits the "problem" category that you indeed do need
help from a
specialist to address his concerns. I am sorry you could not find help
locally through
the various specialists you mentioned, since these would be the type of
referrals we
would recommend for help as well. The best I can do is to give you the
web address and
contact information for our own family centered, holistic feeding center
(specifically
geared to children ages 0-6 with feeding/sensory concerns) called
Thrive Place.
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You may wish to call the specialists at Thrive Place for a phone
consultation and tell
them you were referred via "Ask A Therapist" at Early Intervention
Support and that you are
calling from out of the state. From there you can determine if traveling
to see these
specialists would be appropriate for your son and your family. All
contact info for
Thrive Place is Thrive
Place, 4070 Beechwood Blvd, Unit 1, Pittsburgh PA 15217, 412-521-1067
I have a 2 year old that is still eating #2 baby foods which she
eats without a problem, some #3 baby foods which has gotten better but
will gag some of the time, and is still drinking formula because she
will not swallow table food. She will chew the food some of the time but
will spit it back out. The doctor recommended taking her to a Food
Therapist which she has been seeing once a week for the past 6 months.
We still are not having much luck. She walks, talks and learns very
well. There does not seem to be a problem with her learning abilities.
Do you have any suggestions? Is this an unheard of situation?
Thanks for your question. I see many toddlers "stuck" at stage 2 baby
foods. There is a texture progression baby and toddlers work through
that begins liquids>smooth puree (stage 1)>lumpy puree (stage 2,
applesauce, yogurt, etc.)>mushy (hot cereals, mashed potatoes, etc.)>
melt able crunchy (Ritz crackers, short bread cookies, many boxed
cereals) >soft (fruits, cooked veggies)> firm (meats, apples, etc)>
crunchy (foods that "snap" uncooked carrots, celery ,etc.) > mixed
textures (spaghetti, stews, creamed corn, lasagna, etc). Many feeding
experts advise families and therapists to avoid stage 3 food since mixed
textures are one of the most difficult textures to accept.
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Since your child is eating purees try using table foods -cooked
veggies, puree pasta dishes, potatoes (sweet and white) in mini food
processor which will provide more flavor, more calories, and more
nutrition. Stage 1 and 2 foods are made for children 1 year old and
under and therefore won't meet the nutritional and caloric needs a busy
toddler needs. Also begin to introduce yogurt, applesauce, oatmeal,
instant mashed potatoes and cream of wheat cereal to phase away from
baby foods. At snack and meal time, offer one melt able crunchy on plate
such as crackers, cheese curls, hulless popcorn, vanilla wafers to offer
opportunity to bite and chew foods and to give opportunity to self feed.
Try to stay calm during meals even when it has not been successful. Two
year olds are very observant and will sense your frustration and/or
anxiety. When possible eat with your child. Kids love to imitate their
parents. Eating together doesn't always have to be at the table. Try
having a picnic lunch outside or inside. Use an old sheet or blanket and
small bowls of food to be shared.
My son is 18 months old and still to this day all he will eat is fruit (mainly bananas, apples, grapes, mixed fruit). He
will eat carrots and cucumbers and French fries and junk like
cookies, crackers and chips. Anytime we try to give him anything he pushes it away or throws it on the floor. He has seen his doctor
regarding this and she states that he has anger problems, which I don't
agree with.
He also has pebble like stools or thick stools. Hardly ever are his stools loose. He also drools all the time and has had
recurrent ear infections just in the last 6 months. He has an appointment
made to see an ENT. I just need some help or more advise to keep my little one healthy.
Sorry that we took a bit longer than usual to respond, but I wanted to consult with a few of our other therapists to see
if they had any suggestions for you. We feel that without knowing
you or your son the best we can recommend is to certainly follow
through with your upcoming ENT appointment, but perhaps seek the advice
of a Developmental pediatrician so he can look at all the
factors you've mentioned.
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You know your son best, so if you know something is wrong and you
are not satisfied with your current pediatrician's advice,
I would
seek a second opinion since sometimes a developmental
pediatrician
can be of more help. We would also recommend perhaps an
allergist,
dietician and a gastroenterologist see your son to rule out
that any
medical issues are connected to his food refusal and
limited diet, as
well as his irregular stools. You may want to seek an early
intervention evaluation if your local EI providers have
occupational
therapists or speech language pathologists who specialize
in feeding
disorders. An OT or SLP may also be able to help with the
drooling &
feeding concerns, by implementing an oral motor program for
your son.
If you are concerned about behaviors or "anger issues" as
your
pediatrician stated, a developmentalist can also help by
implementing
a behavior plan.
I was unable to locate any specific resources for feeding or
feeding clinics in your area, but here is some contact
information
for your local early intervention provider: SoonerStart -
Pottawatomie County Health Dept. 1904 Gordon Cooper Dr.
Shawnee, OK
74801-8698 405-273-2157 Voice 405-275-5167 Fax
I will ask at my child's next doctor's appointment but why do you
list the following as developmental delays? What kind of
delays/issues could this be a sign of? Excessive fluid intake and
minimal food. Pushing away food. My child is 22 months. He would
definitely prefer to drink milk and juice for his meal. He
does eat throughout the day but not a lot. We try not to give him
too much milk and we still, usually, dilute juice with water.
We as therapists are used to hearing parents describe their
toddlers as "picky eaters", but it is our job to determine
if the child is just going through a typical toddler stage or if
there is something more contributing to the child's pickiness or
food refusal.
We treat many children who were described as just "picky"
but were
later found through an evaluation by an occupational
therapist to
have an underlying sensory or oral motor issue that was
impacting the
child's ability to maintain a healthy diet.
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According to the American Academy of Pediatrics guidelines, only
low-fat milk should be served to children older than age
two and
children ages 1 to 3 years old should just be drinking
about 2 cups
of milk each day, so no more than 16 ounces. Too much milk,
especially whole milk, is not a good thing. Keep in mind
that many
toddler "sipper" cups today are in large 7-12 oz sizes. The
American
Academy of Pediatrics also recommends that children ages 1
to 6 drink
only 4 to 6 ounces of juice each day, so far less than a
cup. A
healthier alternative to fruit juices is fresh fruit which
contains
more fiber and nutrients.
Children will learn to drink water if it�s the beverage of choice
that is offered at meals. If you always serve milk or juice
at meals,
young children will always associate mealtimes with those
beverages.
If water is the only choice offered, children will
eventually drink
it. Children who fill up on liquids, are just that-full, so
why would
they want to eat when they are not hungry? The best way to
help
toddlers establish healthy mealtime habits is to have a set
mealtime
schedule and offer a few healthy snacks throughout the day.
It may
help to keep a list of the different foods your child likes
and that
will give you a better idea for how to prepare a balanced
diet for
them. Breakfast, lunch and dinner should take place at
fairly
consistent times and be a pleasant, distraction free time
(no toys or
watching tv). As long as your child is gaining weight and
healthy,
they are probably getting enough to eat. As toddlers they
may eat
less at one meal, but make up for it at another meal by
eating more.
They also may go through phases of preferring only certain foods
and resisting trying new foods. Keep in mind it typically
takes a
child 17 tastes or tries before they may begin to eat a new
food, so
don't stop offering new food choices if they are initially
pushed
away. For toddlers, do not offer a snack if a main meal
will be
served within the hour since you want the child to come to
the table
hungry. Set a good example by having others at the table
eat a
variety of foods. Avoid bribing your child to eat or
scolding them
for not eating, try to keep mealtimes pleasant. If your
child is
healthy and growing properly and your pediatrician is
pleased at your
visit you should have nothing to worry about, just try to
build in
some of the above tips for reducing fluids and increasing
healthy
fruit and nutritional food alternatives. Lastly, there is a
condition
called "polydipsia" which literally means excessive fluid
intake,
that combined with other factors such as excessive
urination, dry
mouth & tiredness can be signs of diabetes. If you feel
your child's
limited diet is affecting his nutrition and/or weight gain,
or if you
feel your child has difficulty with chewing or swallowing
foods or
you see an aversion to certain textures of food you may
want to seek
an early intervention evaluation by contacting your local
provider.
This link is a provider in your area:
http://www.lookatmegrow.org/intervention.asp
My husband and I adopted a little boy from China. He had cleft lip
and cleft palate; both have been repaired. He just turned. It was a real
struggle getting him to eat from a spoon, but we finally achieved that
goal. He still will only accept slightly chunky pureed food.
If we give him anything with more form or texture, he gags on it and
will spit it out, and he doesn't seem to know how to chew. We know he
has sensory disorders and some developmental delays due to orphanage
living. He only says about four words. Any advice you can give on how to
transition him away from pureed food would be so appreciated.
Your question, though brief, provided many possible factors that are
contributing to your child's resistance to transitioning from pureed
foods. When evaluating a child for feeding treatment, I will look at
several elements that impact "normal eating." These are environmental,
sensory, motor skills, and developmental. Based on your summary, your
child has many factors weighing into feeding problems.
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It sounds as though transition from bottle to spoon occurred late due
to cleft palate and lip, orphanage feeding practices, and surgeries, not
to mention cultural and environmental changes. Some thoughts to keep in
mind: if quality is good over time, quantity will follow; if quantity is
pushed too early, children will shut down and become averse to eating.
Since your son is over 3 years old, offer pureed foods your entire
family is eating to increase flavor and nutrition. Use ice cube trays to
freeze leftovers and pop into freezer bags for other meals. Typically,
each cube equals 2 oz. This is great if you are monitoring calorie
intake and volume. Heat makes foods more flavorful. If he is
refusing/spitting foods out, you may want to present foods at room
temperature or cold.
Steps leading to chewing begin: thin creamy, no chewing; then thicker
creamy; then on to thicker with small, discreet lumps. Chewing starts
with dry, meltable, crunchy foods placed on molars for munching. Use
foods such as shortbread cookies, graham crackers, cheese curls,
hull-less popcorn, and vanilla wafers during snack time. Offer foods he
likes/prefers, then begin to offer similar foods. For example, if he
will eat applesauce, puree canned pears and peaches. This practice is
called "food chaining. If he will eat smooth strawberry yogurt, offer a
variety of flavors (peach, blueberry, raspberry, etc.) but continue with
smooth texture. There is a great book on the subject, titled Food
Chaining, by Cheri Fraker. It can be found at most bookstores in the
child development section. You can also find it in the Parents Books
section of our online store
Finally, seek out an outpatient feeding program in your area that
offers occupational, speech, and nutrition services where oral motor
skills, sensory processing disorder, and growth/nutritional needs can be
addressed due to the complexity of his feeding.
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