Red Flags in Feeding children Behaviors

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.” That 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 it 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 new born 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

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.