Q & A Feeding Children with Special Needs
- What is a feeding specialist and how do they get my child to eat?
- Due to complications at birth, my son had a g-tube put in. We are now beginning to wean him off the g-tube and allowing him to try eating by mouth. Do you have any suggestions on food to start with?
- My child will only eat yellow food – french fries, yellow pasta (with a butter sauce) and chips are her staple. What can I do to expand her diet?
- My child has huge challenges with eating. Someone suggested “Food Chaining”, what is that?
- My 2 year old can only eat pureed foods that are sweet or he will vomit. Our doctor did a swallowing test and confirmed it was not physical. I am trying to slowly introduce foods with a little more texture into his diet, any suggestions on how to do this would be helpful.
- My child was recently diagnosed with severe oral/feeding aversion. How can I begin to desensitize her mouth so she can eat?
- My 2 year old will not eat anything – whatever I put in front of him is always greeted with “I’m afraid that will hurt me to eat”. What should I do?
- My doctor has said my child is underweight and that I need to increase her weight. How can I do this?
- My child has hypotonia and often doesn’t want to eat when she is constipated. What do you recommend?
Feeding specialists evaluate your child’s current oral-motor skills, sensory involvement, and behaviors to develop a program to address your child’s needs with feeding and swallowing. They can be occupational therapists (OTs), speech and language pathologists (SLPs) or psychologists and they often work with gastroenterologists (GI) as part of a feeding team. Occupational therapists may receive a special credential by meeting the National Board’s standards for a “feeding and swallowing specialist”.
2. Due to complications at birth, my son had a g-tube put in. We are now beginning to wean him off the g-tube and allowing him to try eating by mouth. Do you have any suggestions on food to start with?
First of all it is important to know that this is a long process often requiring enormous patience from the caregivers and small steps at a time for your son. Before starting any program to wean a child from his G-tube, you should have the full clearance (including a barium swallow study if aspiration is a potential concern) from his GI. You should work with his doctor to slowly change these feedings to daytime only and eventually to3-4 regular bolus feedings a day. Many feeding teams start with liquids such as a regular infant formula or a thickened liquid such as a smoothie. You can start to desensitize any of your son’s oral aversions through oral play with textured toys. Eventually food selection will depend on his age, developmental stage and oral-motor abilities
Involve her in choosing what she will try eating and have her help with preparations. Try combining a food she likes with a new one of a different color. Many children will at least try an item that they have spent time choosing and preparing themselves. For example, ask her if she would prefer to make a black bean dip or a tomato salsa dip for her white chips and then have her help you prepare her choice. Begin by requesting that she just try the new item and slowly work on it from there. At the same time, you can also expand on the flavors of the foods she already eats by mixing yellow fries with sweet potato fries, yellow pasta with spinach pasta and her regular chips with blue corn chips. All of these items will have similar tastes to the original item she likes but will have a different color to get used to.
The idea of food chaining is to start with foods that your child already likes and introduce similar items into mealtimes. For instance if your child likes chicken nuggets, try breading nuggets of fish or mozzarella cheese. If your child likes spaghetti with tomato sauce, try putting tomato sauce on chicken. Some children love to dip their foods and you can present a new food such as raw carrots with a familiar dip such as guacamole.
5. My 2 year old can only eat pureed foods that are sweet or he will vomit. Our doctor did a swallowing test and confirmed it was not physical. I am trying to slowly introduce foods with a little more texture into his diet, any suggestions on how to do this would be helpful.
Take a taste your child likes and slowly increase the texture of that taste; if your child prefers sweet tastes, you could add finely crushed graham crackers to his current pureed foods. Gradually you increase the amount of texture he will tolerate by adding more graham crackers and eventually graham crackers with more texture (not so finely crushed). For more information, see my article “How To Help Your Child Eat Textured Foods” http://www.abilitypath.org/articles/article/child-development/daily-routines/feeding–mealtimes/toolkit-how-to-help-your-child-eat-textured-foods.html
It is helpful to know if there is any medical reason for this aversion such as GERD (reflux) so that you can begin addressing any underlying medical problems. At the same time help your child get ready to eat by concentrating on oral play with textured toys, vibrating toys, and teething toys that can be made cold or warm to help your child get used to different temperatures that she will be experiencing with foods. Have fun doing messy activities with foods where you have no expectation that your child try to eat anything. For example, play with whipping cream on the bath tub walls, finger paint with pudding or pancake syrup, and let your child help you with baking or food preparations.
Again it is important to know if there is any medical reason for this aversion such as GERD (reflux), or a hernia so that you can address any underlying medical problem that could be causing pain. If no problem is found, work with a feeding specialist to develop a program using some distraction methods while working on his eating. While it is not always appropriate to encourage play at the table, many children can become better eaters when they are distracted by reading a book together or playing a board game (that requires taking a bite for each turn) during the mealtime.
Doctors recommend increasing weight when an infant stops following the same pattern on their growth curve. A good way to increase caloric intake look is adding more fat and protein into your child’s diet. Cream can be substituted for recipes requiring milk and butter can be added to lower calorie vegetables. Avocado is an excellent source of good fat and can be offered as cubes or smashed and offered as a dip. Add whole-milk cheese to other foods that your child enjoys. Morning smoothies of whole milk yogurt, protein powders and fruits for flavoring are another good way to increase calories.
9. My child has hypotonia and often doesn’t want to eat when she is constipated. What do you recommend?
Hypotonia affects muscle strength, this includes the muscles of the digestive system which can lead to slow intestinal motility. Children with hypotonia also tend to get less exercise which also contributes to constipation. Make sure to offer your child plenty of water on a regular basis. Try mixing a small amount (start with one and increase until your child is having normal, regular bowel movements but no diarrhea) of prune juice with water or milk that your child is already drinking. Lastly, spend some time each day doing abdominal massage (circular motion about 1 inch around the child’s belly button ) or ‘bicycling’ your child’s legs while she is lying on her back.