Feeding Red Flags: When to Seek Help for Your Child
Parents frequently ask “When should I be concerned about my child’s feeding and swallowing skills?” or “How do I know when to seek help and when do I wait and see.” The fact that you even ask the question is an indicator that there is a problem or concern. That is the time to seek help. Problems addressed earlier tend to be resolved sooner. This FAQ is written to help parents understand what is typical feeding issues and when to seek help.
Feeding and mealtime should never be stressful for you or your child. If feeding is stressful, get help now. The earlier you identify feeding problems and seek help, the easier they are to resolve because there is less time for associated behaviors, behavioral problems, and/or inappropriate feeding patterns to develop which will have to be “undone.” Younger children are also often more willing to participate in oral sensori motor feeding activities and make faster progress than older children.
You should be concerned and seek help if your child is exhibiting any of the following
Coughing, choking, gagging, congestion
Delays in or refusal to feed or self-feed
Refusal to accept new or non-favored foods on the plate
Unable/refusal to eat variety of appropriate foods and food textures
Mealtime tantrums or refusal to sit at mealtime
Unable/refusal to eat appropriate volumes of food
Requires distraction, bribes, or forcing to eat
Multiple food dislikes and strong food selectivity
Other at risk behaviors, that are commonly indicative of oral sensori-motor feeding and/or swallowing difficulties and should be formally evaluated. These are:
Current or history of gagging, choking, vomiting, or congestion associated with eating
Gagging or vomiting at the sight/smell of any foods
Unable to advance to age appropriate foods
Elimination of a class of textures or foods (e.g., only eats smooth purees, white foods, or crunchy foods)
Aversive feeding behaviors including tantrums, batting arms, turning head away, refusals and locking lips
No desire to eat. Some children will not eat when they are hungry because they may never be hungry.
Risk factors for feeding/swallowing disorders include
Reflux/other GI problems/allergies/intolerance
Down Syndrome and other syndromes
Neurologic problems
Oral sensory and oral motor problems
Premature
Autism and SI dysfunction
Newborn feeding red flags
Feeding your newborn should be a pleasurable bonding experience for you and your baby. If you are worried about feeding your child or how your child feeds, seek help now. Problems in the newborn period can be exacerbated as your child gets older. Sucking problems can impact spoon feeding skills which impact chewing skills. The following are red flags that need assistance:
Sleep feeding/dream feeding
Congestion/choking/coughing during feeding
Breast feeding failure
Hard swallows, noisy feeding, stridor
Uncoordinated suck/swallow/breathe patterns
Very shallow latch or gags with touch in mouth
Lengthy feeding/ fatigue
Toddler red flags: Concern if your child has/does not
Transitioned to puree by 7 months
Chew crunchy dissolvable solids by 8 months
Chew mixed textures by 9 months
Consume more calories in solids than liquids by 12 months
Transitioned off baby foods by 12 months
Chew table food by 12 months
Weaned off bottle by 12 months
Eat more than 20 different foods (12 months) 30 foods (2 years)
Healthy eating behaviors that you should see in your toddler
Enjoys eating and sits at the table throughout the entire meal
Will eat in a variety of settings without discomfort
Appetite and food preferences may vary from meal to meal
Accepts less than favorite foods
Pays attention to their body’s feelings of hunger and fullness to know what, when, and how much to eat
Is interested in trying a variety of new and different foods
Does not become upset when presented with new or unusual foods
Is able to eat the family meal without requiring short order cooking
Is able to refuse undesirable foods politely without tantrums
Concerned About Your Child’s Feeding?
Typical toddler intake will fluctuate. As your child is learning to read his or her own indicators of hunger and satiety, his or her intake will fluctuate. Look at the “big picture” of what your child has eaten for the day or the week. Don’t just focus on one meal. It is very important that you offer nutritious age and skill appropriate choices that allow your child to eat enough over the course of a day or week to support growth and development. If you are concerned because your child is not eating an adequate volume or variety of food, you should seek help immediately. Parents’ “gut” feelings are often correct. If you feel like something is wrong, or if feeding feels stressful, discuss your concerns with your pediatrician and ask for a referral.