INFANTS WITH FEEDING DIFFICULTIES

Prevalence: What can an EI provider do for your child?

Feeding problems occur in 25-35% of • Improve oral motor skills to safely
and effectively suck, swallow,
typically developing children and within 80-
propel, and chew food
90% of children with developmental • Improve food tolerance &
delays.5 acceptance/expand diet
• Establish feeding skills: holding
bottle, grasp of utensil, scoop food
into mouth4

Types of Interventions
Common eating challenges:
• Behavioral- evidence for improving food acceptance,
• Food refusal/spitting out food
variety of food intake, mealtime behaviors, caloric intake
• Food selectivity- limited variety, limited or restricted
and self feeding skills. 4
textures and types; high frequency single food
• Positive reinforcement-rewarding desired behavior
intake
• Differential attention-giving positive attention to
• Emotional dysregulation or aggressive behaviors-
desired behaviors and ignoring inappropriate
tantrums
behaviors
• Rumination and pocketing- involuntary
• Extinction: place the spoon non-forcefully on the
regurgitation of food or storing food in cheeks
child’s lips and hold until acceptance (ideally) as
• Poor appetite
removing immediately after refusal enforces the
• Reflux
behavior.
• Ritualistic behaviors
• Parent-Directed educational- Moderate to strong evidence
• Eating too quickly 5
for improving development, growth, feeding competency
Tips! and parent-child interactions.4
• Mealtime PREP(promoting routines of exploration
• Make mealtimes fun, the more coercive or and play) with fruits and veggies for toddlers with
structured/rigid mealtimes are, the more likely sensory food aversions can increase intake by an
food refusal occurs.1 avg. of 2 after OT instructive sessions and parent
• If a child begins a pattern of refusal and food directed sessions using positive reinforcement
is pushed harder, this can create a e cycle of during family meals.2
perpetuating stress for all involved.1 • Physiological-
• Oral stimulation can promote onset of oral feeding
• 10-15 tastes of a novel food are optimal to
• Strong to Moderate evidence for positioning
increase acceptance and enjoyment.3
strategies ,adaptive equipment (bottles, eating
• Increasing food familiarity through picture utensils.) and feeding schedules. 4
books and social stories can enhance positive
attitudes about the foods w/o repeated taste
exposure.3
Sources

1. Bookser, B. A. (2014). Food for thought: Early childhood food refusal, maternal caregiving, and child sensory processing (Doctoral dissertation, Mills
College).

2. Caldwell, A., Bendixen, R., Danford, C., Terhorst, L., & Skidmore, E. (2017). Examining the Effects of the Mealtime PREP Intervention for Toddlers With
Sensory Food Aversions. American Journal of Occupational Therapy, 71(4_Supplement_1), 7111515208p1-7111515208p1.

3. Heath, P., Houston-Price,

1
C., & Kennedy, O. B. (2011). Increasing food familiarity without the tears. A role for visual exposure? Appetite, 57(3), 832-
838.

4. Howe, T.-H., & Wang, T.-N. (2013). Systematic review of interventions used in or relevant to occupational therapy for children with feeding difficulties
ages birth–5 years. American Journal of Occupational Therapy, 67, 405–412. http://dx.doi.org/10.5014/ajot.2013.004564

5.Vissoker, R. E., Latzer, Y., & Gal, E. (2015). Eating and feeding problems and gastrointestinal dysfunction in Autism Spectrum Disorders. Research in
Autism Spectrum Disorders, 12, 10-21.