|WHY EVALUATE AND TREAT
MILD FEEDNG DELAYS AND LIMITATIONS
Children with mild sensorimotor problems may show
delays or difficulties with feeding that do not limit
their ability to eat in clearly observable ways. Thus, if
a child is able to chew, eats a wide variety of foods,
and does not choke on food, many parents and
professionals think that there are no feeding problems.
This is not always true. Why might we still evaluate
feeding skills and include feeding goals in an
educational or therapy program? In order to answer these
questions, it is helpful to look at the connection
between feeding and other areas of development.
- Feeding movements are closely related to
the oral movements that children use in early
speech development. Many believe that
feeding movements provide the actual patterns
which children learn and refine for speech
- Feeding skills require a high level of
sensory organization and integration.
When children have difficulties with sensory
processing skills, feeding may become impaired in
very subtle ways. This may be expressed in
dislike of certain food textures or tastes and a
reluctance to try new foods.
- Feeding skills are used in social
situations. A child who drools during
meals or in the classroom is often shunned by
classmates or adults. Children who are messy
eaters call attention to their disability in
restaurants and in social situations with
typically developing children. Thus, even a mild
feeding problem can have consequences in daily
Children with sensorimotor difficulties tend to fall
into two major categories of oral sensorimotor problems
that will be identified during feeding.
- Sensorimotor Control. Some children
have delays in feeding development (i.e. retained
suckle, unstabilized up-down jaw movement
exclusively during drinking, lack of cleaning the
lips with the teeth or tongue), or
deviant/limiting patterns during feeding (i.e.
low tone in the cheeks which prevents active
asymmetrical pull-in of the cheek on the side of
the food, lip retraction, lack of central groove
in the tongue). These children have difficulty
controlling the movements used for feeding.
- Sensorimotor Planning. Other
children have appropriate feeding movements but
cannot make the same movements at a volitional
level (i.e. the child is observed to use the
tongue to clean pudding from the corner of the
mouth but cannot lateralize the tongue in
imitation). These children have difficulty with
motor planning or apraxia.
It is important to constantly ask ourselves why we are
interested in feeding evaluation and intervention with
these mildly involved children. When we ask that
question, two further questions with answers emerge.
- Could the movement and coordination patterns
observed in the mouth during feeding help us
understand the movement and coordination patterns
observed in the mouth during speech?
- Do the sensorimotor patterns observed with food
reflect in any way the more general sensorimotor
organization used by the child?
Both of these questions influence treatment decisions.
For example, if we see low tone in the cheeks and/or in
the tongue and the child has a "sloppy" /s/
sound, it lets us know that work to improve cheek and
tongue function in feeding would assist getting better
phonological production of these fricative sounds. Or, if
we see a child who has many picky dislikes of food
texture or taste, or stuffs and gulps everything, we may
see this same type of sensory processing in the child's
whole learning style. Thus, work on the underlying
sensory issues and focus of attention and slowing of
feeding patterns may very well become a way of working on
an underlying basic skill which will also generalize into
the child's ability to use language and learn more
Work to improve feeding skills can be incorporated
into both the individual therapy session and in the
classroom. Feeding skills are sensorimotor skills, and
like other sensorimotor skills such as sitting, and
walking, and hopping, children may require special
therapy assistance to learn a new or unfamiliar movement.
Often new patterns of chewing or swallowing will be
taught initially by a therapist or teacher with special
skill or training in the learning of feeding skills.
As new skills develop, children need lots of
opportunity to practice the new patterns. The classroom
provides many opportunities for continued learning and
change. Snack time occurs in every classroom. Often it is
considered a time to physically refresh the children with
food or an opportunity to work on language and social
skills. When food is carefully selected, snack time can
provide major opportunities to develop sensorimotor
skills for feeding.
Food can be selected to meet specific goals for
individual children and to provide opportunities for all
children in the group to increase their experience with
different kinds of food. Several types of food and
utensils provide excellent opportunities for children
with sensorimotor difficulties:
- Foods with multiple textures. Foods
which consist of more than one texture are very
challenging to children. Some foods have two or
more textures which can be visibly observed;
others tend to produce extra juice or saliva when
they are chewed. The child must swallow the
liquid and extra saliva produced by the food
while continuing to chew the more solid parts.
Often children with mild difficulties in
oral-motor skill will drool or loose liquid when
they eat combination foods. Foods which could be
given at snack time include: unpeeled apple
wedges; orange wedges; raisins; jello with fruit
chunks, non-mushy dry cereal such as Cheerios or
small shredded wheat squares with milk; salad
with pieces of different raw vegetables.
- Foods which require extended chewing.
Foods which require extended chewing are often
resisted by children with mild feeding problems.
At home they are often given softer meats or no
meats or raw vegetables at all because they
refuse them. Foods which could be given at snack
time to increase chewing skill include: raw
carrots, raw celery, beef jerky, strips of rare
roast beef, steak, or other firm meat. Although
candy and other sweet foods should be discouraged
as a regular snack, liquorice twists and
sugar-free bubble gum are wonderful for
encouraging extended chewing, and chewing without
- Foods which can be served in many sensory
variations. Foods which can be served in
many different taste and texture combinations
lend themselves beautifully to work on sensory
discrimination and language. They also provide
ways of making smaller, more gradual changes for
children who are resistant to eating new foods.
Foods which could be given at snack time to focus
on sensory changes in taste and texture include:
crackers + peanut butter; crackers + Swiss
cheese; crackers + cheddar cheese; crackers +
cream cheese; crackers + cream cheese + jelly. Or
one could take a theme of "cheese" and
vary the type of cracker used (i.e. Ritz cracker,
soda cracker, rice cake, rye krisp).
- Foods which encourage playful exploration.
Exploration with food is a common activity with
young children in the 18-36 month age range.
Children enjoy hiding pieces of food in different
parts of the mouth, feeling the mouth stuffed
with food, playing with differing amounts of food
in the mouth etc. Foods which encourage
exploration include: raisins, cereal pieces such
as Cheerios and Grape Nuts. Chewing sugar-free
bubble gum also develops playful exploration.
Suzanne Evans Morris, Ph.D.
1124 Roberts Mountain Road
Faber, Virginia 22938
This paper is a
working draft and multiple copies may not be
without prior written permission of the author
© Suzanne Evans Morris, 1997 All Rights Reserved