As the famous American restaurateur Guy Fieri once said ”Food is maybe the only universal thing that really has the power to bring everyone together. No matter what culture, everywhere around the world, people eat together.” However, for some of us, and in particular for some of our children, the process of eating is not so simple.

So, let’s think about what we do when we eat [or drink] – put it in a simplistic way, we usually see the food and “eat it” with our eyes first (not only another chef’s quote but also an interesting research¹). We then have to take the food to our mouths- we may use a spoon, a fork, our hands… we need to open our mouths to take the food in and close our lips right after to keep the food inside. We will chew this food, use our tongue to collect the pieces scattered across the mouth, and move the food around to get it ready to be swallowed.

You learn to eat

Like any other motor process, children have to learn to eat. They first begin by sucking. Fast forward and they move to eating solid foods and drinking from a cup. They will have some trouble as they try new foods and drinks – liquids will spill from their mouths. Some new food will cause a gag response or will be pushed back. They may take a little longer to eat. But the truth is practically all infants and kids can learn to eat, since learning to eat is a genetically programmed intrinsic part of human development and a crucial condition for ensuring growth on a nutritional and social level.

However, many children of determination, due to disorders such as cerebral palsy, genetic disorders, or ASD, can have affected muscles, senses, and/or cognitive development impacting on their oral feeding abilities, self-feeding skills, and sensory system functioning. These children will, therefore, suffer from what we call a feeding disorder or dysphagia. The degrees of severity of such disorders vary from child to child (some children will even need enteral nutritional support, i.e., to be fed through a tube), but they can all benefit from the support of a Speech and Language Therapist specialized in feeding disorders, integrated in a supportive team, which may include an Occupational Therapist, a Dietician, a Pediatrician, and more elements of a medical team.

In the case of complex medical conditions

If it is true that some children are often labelled as picky eaters^2,3, it is also true that some of our children present with more complex medical conditions that will impact in their feeding abilities. As soon as your child is medically stable, you can start with feeding therapy. Even if your child is still being tube fed ⁴, you can search for the support of therapy.

The Feeding Therapist will support the child by working on an array of components that might be impaired. Delayed oral motor skills are very often the main reason we work with children with complex needs – quite frequently, these children continue to use the bottle or to consume pureed food beyond the appropriate age as they do not have the proper oral motor skills to accept new foods, such as an effective chewing pattern or correct tongue movement to propel the food to the back of the throat to be swallowed. For the lack of practice, they become “untrained” in learning the motor program of chewing, for example. Another big component is the regulation of the child’s sensory system, that can sometimes be hypersensitive (e.g., when the child avoids a certain texture) or, on the contrary, hyposensitive (e.g., when the child doesn’t detect that’s there’s food on his/her mouth). The Feeding Therapist will also support the family in correctly positioning the child during mealtimes and guide the family through every step from oral motor therapy to introduction of food to food exploration.

If you feel that mealtimes are becoming a problem and sense that your child is experiencing any difficulty, please do not hesitate to contact our Speech and Language Therapy Department who will be able to support you and your child in the great food adventure.

Sources:

1. Delwich, J. (2012). You eat with your eyes first. Physiology & Behavior. 107, 502-504
2. Picky eaters usually show refusal to eat, are selective in what they eat (eating a limited number of foods or only certain colors/flavors/textures – which is often linked to their sensory systems), have tantrums during meal times, are too slow to eat, and sometimes regurgitate, vomit, or spit out food during eating time.
3. Children with picky eating habits also need specialized support. If you feel that you are fearing mealtimes, please consult with a Speech and language Therapist specialized in feeding disorders
4. Tubes help children receive adequate nutrition in cases when it is not safe for them to swallow due to risk of aspiration or when they get tired easily while eating. In these cases, it is difficult for children to consume orally the calories they need to grow.

• Delwich, J. (2012). You eat with your eyes first. Physiology & Behavior. 107, 502-504
• Eating difficulties in children and young people with disabilities, West London Mental Health, 2014
• Uher, R., & Rutter, M. (2012). Classification of feeding and eating disorders: review of evidence and proposals for ICD-11. World Psychiatry, 11(2), 80–92.
• Manikam, R., & Perman, J.A. (2000). Pediatric feeding disorders. J Clin Gastroenterol, 30(1):34-46.