Got a Child Who Fights Eating? Feeding Therapy Might Be the Answer

It happened: You killed it at work today and got out of there right on time. So on time that your commute was a breeze, you made it to the grocery store ahead of the crowds and now you finally have the hour you need to whip up that honey-mustard chicken bake you’ve had your eye on for weeks. You’re feeling pretty darn Super Mom about your day until your child makes that face you’re way too familiar with and—plop—dinner is on the floor. Fantastic.

Normal? Probably. But if your kid is doing this and having trouble eating almost daily, or if she’s regularly vomiting up her meals or averse to very specific textures, she might be a candidate for what’s known as “feeding therapy,” a form of physical therapy that encourages kids to broaden their food consumption in the name of health and happiness. We asked occupational therapist Chaye Lamm Warburg, founder of the New Jersey-based practice Pediatric Occupational Therapy Services, to break it all down.

Feeding therapy is the work that children and occupational or physical therapists do together in order for kids to eat more broadly. Feeding therapy includes all the seeing, smelling, touching, tasting and eating that a child needs in order to become used to different foods.

There are different approaches, but Warburg likes what’s known as the sequential oral sensory method because it makes a point of helping kids learn about their food and why they should give it a try. “This approach to feeding enables children to interact with and learn about foods in a playful, non-stressful way,” she says. “Children are encouraged to progress up a series of eating steps by using ‘play with purpose’ activities,” like smushing their hands into their mashed potatoes, shooting grapes out of their mouths or creating stick figures with asparagus and cherry tomatoes. In other words, pretty typical kid behavior.

Warburg says the goal here is to get kids to eat a wider variety of foods by taking the pressure off them. And, by extension, you. 

Some kids are actually just “picky eaters” who maybe cannot stand the taste of grapefruit or kale (same, kid, same). That doesn’t necessarily mean they need a professional to step in. But here are some signs that feeding therapy could work:

1. When your child is completely put off by the particular textures of new foods (say, a toddler who refuses to eat anything beyond softer pureed peas)

2. When she can’t physically swallow a number of different foods and it’s affecting her growth

3. When eating regularly makes her gag, cry or vomit

“For a child who eats fewer than 20 different foods, has a history of reflux, gags or vomits when trying to eat, can’t make those transitions to new foods at 10 to 12 months old, is losing or not gaining weight and makes mealtime and your dinner table a battleground, feeding therapy can help,” Warburg says.

Feeding therapy is generally recommended for children between 10 months and 5 years old, since those are the years when they’re experiencing different types of food for the first time. For babies younger than 12 months, a feeding therapist might focus on moving them away from breastfeeding and toward foods like cereals and bananas. For older children, it’s about learning to enjoy a variety of foods. Warburg says a child must exhibit eating without issue for at least ten straight appointments before she “graduates,” and while there are no hard and fast rules, this could take anywhere from three to 12 months.

Feeding therapy typically takes place in a physical therapist’s office and is covered by most major insurance companies. Once or twice a week during an hour-long session, the therapist will first get to know your child in order to figure out what approach will work best for them. 

This is also when you’ll decide together if it’s best for you to stay in the room during the therapy sesh or head out.

A feeding therapy session is broken down into three steps: prep, play and peace out (our term, not Warburg's). These steps work, she says, because “having a clear beginning, middle and end reduces mealtime stress by making the session and act of eating predictable.” 

Prep: Warburg says that therapists will create a pre-eating routine around the senses (similar to the idea of a bedtime routine) to help the child get into the mindset that they’re about to chow down. This might mean washing their hands (touch) when they arrive for therapy, helping to set the table (sight) and blowing air through their lips to make horse noises (sounds). This last move is also a fun way of desensitizing their lips and relaxing their mouth for eating.

Play: The senses get really revved up here, as kids are given permission and encouragement to play with their food. Kids sit down at the table they just prepared with all the foods they’re about to play with laid out in front of them. Here, they can make a chicken-strip log cabin with a broccoli-tree yard (sight, touch) or go “bowling” with oranges and eggplants (sound), Warburg says. A taste test or color-matching game involving cards and different hued fruits and vegetables (taste, sight) gets them to think of eating as something they can win, while introducing them to new tastes and textures helps take the pressure and attention off the fact that eating used to be so hard for them to do on their own.

Peace Out: At the end of the “therapeutic meal,” as Warburg likes to call it, kids wind down just like they would at bedtime by leaving the table to brush their teeth in order to cleanse their mouth—especially if they tasted something they identified as gross. They’ll go through some deep breathing exercises to help them relax and associate meals with peacefulness and to signify the end of the meal.

Not really! The only way feeding therapy could go off the rails is if you met a therapist who didn’t jive with your child. 

If this sounds like something you think your family needs, find a referral, set up a meeting and see if it’s a good fit. Warburg maintains she’s seen kids gain 13 pounds and grow two inches in only five months thanks to feeding therapy. That’s something we can definitely stomach.