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Parenting, Therapy Tips

Mealtimes: Five Challenges and Solutions for Feeding Your Child with Special Needs

Mealtime for families without special needs kids can be difficult, but for those with kids with sensory processing difficulties it can really be an adventure. While there isn’t an easy way around these challenges, there are a few helpful hints that may keep a child’s feeding issues from turning into significant problems. Here are the five main components that affect a child’s ability to eat.

1. Sensory issues

The Challenge: Sensory-based feeding issues are the underlying factor to most feeding difficulties in children. The combination of food texture, temperature, and taste can be off-putting to kids, and cause frustration. Children usually tend to stick to foods they are familiar with, and soon these foods are the only ones that they will eat. The Solution: To help create a broader diet, begin to slowly alter the child’s favorite foods. For example, if they enjoy elbow macaroni and cheese, and will only eat that shape, toss in four or five pieces of different shaped macaroni (wheels, characters, etc.). Next time, add food coloring to the elbow-shaped macaroni. The changes in texture, temperature, color or taste should be slight but noticeable. Another way to help children with feeding difficulties is to allow them to help choose foods at the grocery store and to let them help prepare the meal, exposing them to different textures, smells and tastes along the way.

2. Oral-motor issues

The Challenge: Oral motor-based feeding problems can be caused by tone and strength issues. Kids need to achieve good gross-motor coordination and movement in their body before they will achieve sufficient oral-motor skills. However, oral-motor difficulties must be dealt with only after sensory issues have been attended to. In the end, good sensory input will result in good oral motor output. The Solution: There are many oral-motor exercises that can help strengthen the jaw, tongue and lips, and parents with concerns should contact their pediatrician, occupational therapist or speech therapist for guidance.

3. Behavior issues

The Challenge:  There are many different behaviors that can affect feeding: the child gets Mom’s and Dad’s attention when they don’t eat, or eating is one of only a few things they have control of. The Solution:  Positive reinforcement (“If you eat this piece of lettuce, then you’ll be able to play 10 minutes of video games”), and extinction/planned ignoring (“Daddy doesn’t hear whining, he only hears big girl words,”) work the best with behavior-based feeding issues. Gradually work through the steps of eating. Start by having the child touch and play with the non-preferred food, then increase the difficulty: take a bite; take a bite and don’t spit it out for 2/3/4 seconds; swallow it; take bigger bites; eat larger portions; decrease gagging. Progress until the child is eating more or less on their own. Keep in mind that behavior-based feeding issues can look a lot like sensory-motor feeding issues, so it is important to treat both aspects of feeding. The best outcomes result from the child’s engagement in a voluntary, purposeful activity in a positive environment.

4. Medical issues

The ChallengeGastrointestinal, cardiopulmonary and pharmaceutical issues can affect feeding, along with prematurity of birth and visual impairment, when the child simply can’t see what they’re eating. The biggest culprit of medical-based feeding issues continues to be GERD. GERD in its simplest form is spitting up or vomiting, causing children to refuse food. The Solution:  If there appears to be medical issues interfering with feeding, it is important to consult your pediatrician for more options.

5. Family issues

The ChallengeFamily dynamics are one of the hardest feeding difficulties to deal with. Parents and caregivers are the most important and pivotal components in implementing feeding strategies. Many parents tend to feed their kids foods that the parents enjoy. The Solution: It is important to give the child many options, including foods that the parents don’t regularly eat. It’s also important to clearly define roles: the parents or caregivers are responsible to provide the foods, while the child is responsible to eat and choose how much to eat. Most importantly, the child should feel as comfortable as possible when they are eating. Feeding is social, and feeling uncomfortable in the social situation can cause problems. Parents and families should be open and adapt when necessary. Go slow with the child and make the them feel as comfortable as possible. Parents should try to avoid forcing children to eat. Present children with both preferred and non-preferred foods and let the child choose. When children feel like they have control over the situation, it’s easier for them to try new foods. Here are a few general tips and tricks to try for children with feeding difficulties.
  • If the picky eating seems to be sensory-based, encourage the child to play with foods to get used to them. Getting messy is OK!
  • Encourage the child to get more involved with food preparation. Kids are more likely to try things if they help prepare the meal.
  • Encourage the child to eat with other kids. In some circumstances, peer pressure is a good thing!
  • Provide the child with small amounts of the foods mom and dad are eating along with a food the child usually eats. This way, the child gets used to the foods being there and when they are ready to try them, they will.
  • Have a consistent routine at mealtime so the child knows what to expect.
  • Experiment with small, subtle changes in difficult foods. Sometimes just a change in temperature makes it easier to handle.
  • Make a schedule for the meal, and write a list of the food items that need to be eaten before going to the next activity.

WRITTEN ON November 15, 2013 BY:


Chris Purgatori, MOT, OTRL is an occupational therapist at the Kaufman Children’s Center for Speech, Language, Sensory-Motor & Social Connections, West Bloomfield, Michigan. He holds a Bachelor’s degree in Kinesiology from Michigan State University and a B.A. in Health Science from Wayne State University. He went on to earn his Master’s degree in Occupational Therapy from WSU. When he’s not coaching young kids in the OT gym at the KCC, Chris coaches high school varsity boys on the soccer fields at Rochester High School.