Addressing Eating Challenges with Therapy

A child with physical disabilities may face eating challenges that include trouble swallowing liquids, safely chewing or swallowing foods with certain textures, and feeding himself independently.

An occupational or speech therapist may develop a program to improve your child’s eating and oral-motor skills. Overall therapy goals for eating include:

  • Improving oral-motor tone and sensitivity and increasing the strength of the oral-facial muscles
  • Teaching safe positioning and techniques to avoid aspiration
  • Encouraging adequate food intake for growth and development
  • Promoting a child’s participation in eating through a variety of therapeutic techniques (for example a therapist may encourage you to let the child decide between two foods to prepare for a meal or the therapist may suggest certain children start by simply tasting a food that they normally won’t eat before they are offered a food they prefer)

A therapist gradually advances a child to more complicated textures and may also advise the use of modified cups, utensils, and tableware. At times, he or she may have a child start with teething toys and mouth play to help develop the necessary skills for eating and drinking. Other children may have the physical skills they need to eat, but be very sensitive or even aversive to new food textures, flavors, and temperatures. These children need help to gradually master eating most table foods (link to textures for feeding toolkit).

To encourage safe eating and decrease problems with reflux, a child must be seated in an upright posture, positioned with his hips at a 90-degree angle to his knees, his ankles at a 90-degree angle to his feet, and his feet stabilized. Children in wheelchairs may benefit further from having a tray or table on their chair and from head support. Special utensils and bowls can assist with stability. Examples include weighted utensils for children with tremors, or bowls that suction to the table and have special rims. A wide variety of bottles, training cups, and cups are available to address children’s eating issues, from cleft palates to low muscle tone. You can consult an occupational therapist about this.

Most infants and young children can participate in family mealtimes for twenty to thirty minutes. Encourage your child to stay at the table for this length of time. In most cases, it is important to limit distractions, such as TV or toys. Focus on mealtime as an important daily routine and a great time to promote further development. For children with sensory issues, mealtimes can also include time to touch and feel new textures, helping your child to become more comfortable with new foods.

Toddlers often love to help prepare a snack or meal. With adult supervision, they can practice their fine motor skills for dipping, pouring, stirring, or using utensils to spread or cut foods. This is also a good time to encourage communication by offering choices and letting your child select between two snack items. Encouraging a child to point, sign, or use words to ask for more of a food is a fun way to foster further communication.

Eating Challenges » Links & Resources

Equipment Flaghouse information about equipment for eating Children’s Medical Ventures, provider of developmentally supportive products, including feeding equipment for preemies and children with cleft palates

Wolf, L S & Glass, R P (1992). Feeding and Swallowing Disorders in Infancy: Assessment and Management. Therapy Skill Builders, USA.

Dunn Klein, M & Delaney, T (1994). Feeding and Nutrition for the Child with Special Needs: Handouts for Parents. Therapy Skill Builders.

Morris, S E & Dunn Klein, M (1987). Pre-Feeding Skills. Therapy Skill Builders .
Satter, E. (1987). How to Get Your Kid to Eat…But Not Too Much. Bull Publishing.