The great air debate: How different swallowing patterns impact breastfeeding and reflux
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The great air debate: How different swallowing patterns impact breastfeeding and reflux

ByLondon Speech and Feeding

The great air debate

As a Speech and Language Therapist specialising in infant feeding, I often hear from worried mums describing their breastfed baby’s fussiness. ‘My baby is so burpy and gassy,’ ‘might it be reflux?’ or ‘she just seems uncomfortable after every feed’. While these concerns are incredibly valid and distressing for both baby and mum (and dads!), the underlying cause isn’t always what you might think. Often, the culprit isn’t primarily a digestive issue, but rather a mechanical one: how effectively your baby is managing air during feeding.

Many parents are told their baby has ‘colic’ or ‘reflux’ and are offered solutions that don’t quite hit the mark because they overlook a fundamental aspect of feeding: the suck-swallow-breathe sequence. Understanding this intricate dance can be the key to unlocking a calmer, happier feeding experience for your baby and you.

Understanding the suck-swallow-breathe sequence

Your baby’s mouth, tongue, jaw, and throat muscles work together in a precise rhythm like a beautifully orchestrated symphony. First your baby draws milk, then swallows it, and then takes a breath, all without interruption. This is the ideal suck-swallow-breathe (SSB) sequence.

When the SSB sequence functions optimally, a baby latches deeply, creates good suction, draws milk, swallows efficiently, and then pauses just long enough to take a gentle breath before the next suck. This smooth, coordinated process minimises the amount of air swallowed.

However, for various reasons (it could be a shallow latch, oral motor challenges, an uncoordinated suck, or even an overly fast milk flow) this sequence can get a bit out of sync. Instead of a smooth rhythm, you might see:

  • Suck-suck-swallow-gasp!: Too much air pulled in with the swallow.
  • Rapid, shallow sucking followed by gulping: Inefficient milk transfer and air intake.
  • Clicking noises during feeding: Loss of suction, indicating air entry.
  • Frequent detaching and re-latching: Often to ‘catch a breath’ or because of discomfort.

Each of these patterns can lead to increased air intake.

The root cause: Air trapping leading to a gassy breastfed baby

When a baby swallows too much air during a feed, that air must go somewhere. It builds up in the stomach, causing bloating, discomfort, and often leads to the familiar reflux-like symptoms parents describe: arching, spitting up, burping excessively, or simply appearing distressed.

It’s a common misconception that all gassiness or reflux symptoms in a breastfed baby are due to something in the mother’s diet or a genuine digestive disorder. While these can be factors, as an SLT, we first look at the mechanics of the feed. If a baby is constantly struggling to maintain a seal, sucking inefficiently, or having to gulp to keep up with flow, he or she is inevitably swallowing air. This air then creates pressure, which can push milk back up (silent reflux) or out (visible reflux).

Think of it like trying to drink through a straw with a hole in it. You’re sucking, but you’re also pulling in air, making it harder to get the liquid and leaving you with more bubbles in your stomach.

Why mechanical speech therapy assessment is key

This is where the distinction between a medical diagnosis (true gastro oesophageal reflux disease or GORD) and a functional feeding challenge becomes critical. A paediatrician will assess for medical causes and may prescribe medication to reduce stomach acid. This can be appropriate for severe cases of GORD.

However, if the primary issue is air being trapped due to a suboptimal suck-swallow pattern, medication only treats the symptom (acid burning) and not the root cause (air intake). This is precisely where a Speech and Language Therapist specialising in infant feeding comes in.

My role is to meticulously observe and assess your baby’s oral motor skills, latch, tongue function, and the efficiency of their SSB sequence. I look for subtle signs of inefficiency that contribute to excessive air swallowing.

  • Is the tongue elevating correctly to create suction?
  • Is the jaw stable, or is it excessively moving?
  • Is the latch deep enough to prevent air leaks?
  • Can the baby coordinate suck, swallow, and breathe without gasping?

By identifying these mechanical challenges, I can then implement targeted strategies to improve feeding efficiency and reduce air intake, often leading to a significant reduction in reflux-like symptoms and overall discomfort.

Strategies to optimise air management during breastfeeding

The good news is that many babies can learn to feed more efficiently with the right support. Here are some general strategies we might explore:

  1. Optimise latch and position: A deep, asymmetric latch is crucial. Experiment with different positions that allow for a deeper latch and better head/neck alignment, such as laid-back feeding or upright positions.
  2. Paced feeding (even at the breast): If your milk flow is very fast, consider removing your baby from the breast briefly if you hear excessive gulping or see him or her struggling to breathe. This allows him or her to catch up and manage the flow.
  3. Support the jaw and cheeks: Sometimes, gentle support to the baby’s jaw or cheeks can help them maintain a more stable, efficient suck. I can demonstrate specific techniques for this.
  4. Burping effectively: While burping won’t get rid of all swallowed air, upright burping positions and gentle back rubs can help release some of it.
  5. Pre-feed oral preparation: Gentle oral massage or stretches before a feed can sometimes ‘wake up’ the oral muscles and improve coordination.

Addressing the ‘Great Air Debate’ isn’t about blaming anyone; it’s about empowering parents with a deeper understanding of their baby’s feeding mechanics. By focusing on the how, not just the what, we can often resolve persistent feeding challenges, reduce discomfort, and make breastfeeding a more joyful, peaceful experience for both you and your little one.

If you suspect your baby’s gassiness or reflux symptoms are related to how they are managing air during feeds, don’t hesitate to reach out for a specialist assessment.

Sonja McGeachie

Highly Specialist Speech and Language Therapist

Owner of The London Speech and Feeding Practice.

Health Professions Council registered
Royal College of Speech & Language Therapists Member
Member of ASLTIP

Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

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Dynamic assessment – Let’s look beyond the checklist
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Dynamic assessment – Let’s look beyond the checklist

ByLondon Speech and Feeding
Dynamic assessment – Let’s look beyond the checklist

As a parent, you’re always observing your child, celebrating his or her milestones, and sometimes, wondering if he or she is quite on track. When it comes to speech, language, play, attention, and listening, these early years are a whirlwind of development! It’s natural to seek guidance if you have concerns, and that’s where a truly comprehensive assessment comes in.

But what exactly does ‘comprehensive’ mean, especially when it goes beyond a typical checklist? You can find any number of check lists online these days but whilst they can give you an overall idea of what a child is typically expected to do at any given age, it can also start leading you into a rabbit hole of anxiety of ‘what-iffery’.

At The London Speech and Feeding Practice I believe in something far more insightful than a static evaluation: Dynamic Assessment. Think of it as an in-depth, interactive investigation into your child’s unique communication landscape, exploring not just what he or she can do, but how he or she learns and why he or she might be facing challenges. This is so important.

What makes an assessment ‘dynamic’?

Imagine trying to understand a child’s personality by just looking at a single photograph. It gives you a glimpse, but it hardly tells the whole story. Traditional, formal assessments, while valuable, can sometimes be like that photograph – a snapshot of skills at one specific moment.

Dynamic assessment, on the other hand, is a living, breathing process. It’s called ‘dynamic’ because:

  • It’s interactive and responsive: It adapts to your child’s needs in real-time. It’s not about sticking rigidly to a pre-set schedule of tests. Instead, it’s about observing, gently prompting, and providing support to see how your child responds and learns. This allows me to understand his or her learning potential, not just his or her current performance.
  • It’s holistic and multi-faceted: I look at the whole child. We delve deep into not just speech and language, but also his or her play skills (a crucial window into cognitive and social development), attention and listening abilities, and his or her social engagement. These areas are intricately linked, and a delay in one can often impact others.
  • It integrates multiple perspectives: Your insights as a parent are invaluable! Before we even meet, my comprehensive onboarding questionnaire gathers essential background. During the assessment, your feedback, observations, and comments are woven into the fabric of our session. You are the expert on your child, and your voice is central to forming a complete picture.
Dynamic assessment – Let’s look beyond the checklist

More than just ‘speech’: A deep dive into development

You might initially be concerned about your child’s speech sounds, or perhaps his or her ability to form sentences. These are vital areas, but my approach goes much further. I’m keen to understand:

  • The ‘why’ behind the ‘what’: Is a child struggling with language because of difficulties with understanding instructions (receptive language), or with expressing themselves (expressive language)? Are his or her attention skills impacting his or her ability to follow a conversation? Is his or her play demonstrating imaginative thought, or does he or she prefer more structured, repetitive activities? These nuances are critical.
  • Differential diagnosis: This is where the skill of an experienced clinician truly comes into its own. Through dynamic assessment, I can differentiate between a developmental delay (where a child is following a typical progression but at a slower pace) and a disorder (where his or her development is following an atypical pattern). This distinction is vital because it guides the type of support and intervention that will be most effective. Understanding the cause of the delay or disorder is paramount to creating a targeted, impactful therapy plan.

The art of observation

While I draw upon evidence-based practice as well as a formal, standardised assessment as well as my extensive clinical knowledge, I also rely heavily on the art of observation. From the moment your child walks into the room, I’m establishing rapport, engaging them in play, and creating a safe, fun environment. It’s through this genuine interaction – often without them even realising they’re being ‘assessed’ – that the most authentic insights emerge.

This is where the magic happens:

  • Building rapport: A child who feels comfortable and connected will show you so much more of his or her true abilities and personality. I pride myself on creating an atmosphere where children can relax and simply be themselves.
  • Play as a window: Play isn’t just fun; it’s a child’s natural language. It reveals his or her understanding of the world, his or her problem-solving skills, his or her social engagement, and his or her ability to use symbols and language.
  • Skilled interpretation: My years of experience allow me to see beyond surface-level behaviours and interpret the subtle cues that might indicate underlying strengths or challenges. This goes far beyond what any standardised test alone can capture.

Why choose a clinician who offers dynamic assessment?

In essence, a dynamic assessment provides a rich, nuanced, and truly personalised understanding of your child. It’s an investment in:

  • Accuracy: Leading to a more precise diagnosis and understanding of his or her unique profile.
  • Tailored support: Enabling the creation of highly individualised therapy goals that truly meet your child where he or she is and gently guide him or her forward.
  • Empowerment: You’ll leave with not just answers, but also practical strategies and a clear path forward, feeling confident and informed.

If you’re seeking a thorough, empathetic, and truly insightful assessment for your child’s communication development in London, I invite you to get in touch. Let’s work together to unlock your child’s full potential.

Sonja McGeachie

Highly Specialist Speech and Language Therapist

Owner of The London Speech and Feeding Practice.

Health Professions Council registered
Royal College of Speech & Language Therapists Member
Member of ASLTIP

Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

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Hard munchables: Chewing through the weaning journey
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Hard munchables: Chewing through the weaning journey

ByLondon Speech and Feeding

As a Speech and Language Therapist with a specialism in paediatric feeding, I’m constantly looking for ways to support families in developing their little ones’ oral motor skills and fostering a positive relationship with food. While Baby-Led Weaning (BLW) has revolutionised how many families introduce solids, (see my previous blog in July 25) a concept that often sparks discussion and curiosity is the use of ‘hard munchables.’

Image by Freepik

What are hard munchables?

The term ‘hard munchables’ refers to specific types of firm non-digestible food items that are offered to babies for oral exploration and skill development, not for nutrition. These are typically foods that babies cannot bite off or swallow in large pieces due to their texture, but which provide resistance for chewing practice.

The phrase was coined by Marsha Dunn Klein, M.Ed., OTR/L, Occupational Therapist and feeding therapist. Well known for her work in paediatric feeding she introduced and advocated for the concept of hard munchables as part of a therapeutic feeding approach, particularly for infants learning to manage textures and develop crucial oral motor skills.

Common examples of hard munchables include:

  • Large, raw carrot sticks: Too hard to bite through, but great for gnawing.
  • Celery sticks: Like carrots, offering firm resistance.
  • Large, raw apple slices (peeled chunks): A firm, slightly sweet option.
  • A firm, uncut pear core: With the seeds removed.
  • Dried mango cheeks (hard, unsweetened varieties): These offer a fibrous texture.
  • A large, fully cooked but firm piece of meat (like a steak bone with some meat attached): The meat provides flavour and a bit of shreddable texture, while the bone is for gnawing.
  • Hard crusts of bread or breadsticks (very firm, without soft inner crumb): These can soften slightly with saliva but offer significant resistance.
Image by Freepik

It’s crucial to emphasise that hard munchables are not for consumption or nutrition. They are tools for oral motor development and should always be offered under strict, active supervision.

How do hard munchables fit into weaning?

While weaning (traditional or Baby-Led Weaning) introduces solid foods that a baby can eventually bite and swallow, hard munchables are complementary to the weaning phase. They enhance that phase by helping a child to develop hand dexterity, hand to mouth movement, and oral development.

It’s important to differentiate: Weaning provides the digestible food for eating, while hard munchables provide the tool for skill practice. They are not substitutes for each other but can be used together under careful guidance.

Pros and cons from a speech therapy perspective

As an SLT, I see both the potential benefits and the necessary precautions when incorporating hard munchables.

Pros:

  • Enhanced oral motor development: Hard munchables provide excellent resistance training for the jaw, helping to develop the strength, endurance, and coordination needed for efficient chewing. This is foundational for moving beyond purées and very soft textures.
  • Promotes lateralisation of the tongue: The act of moving the hard item from side to side in the mouth encourages the tongue to move independently of the jaw, a crucial skill for managing food and for speech sound production.
  • Preparation for more complex textures: By strengthening the oral musculature and refining chewing patterns, hard munchables can help babies transition more smoothly to lumpy and mixed textures.
  • Sensory exploration: They offer rich sensory input (tactile, proprioceptive) that can be beneficial for oral mapping and awareness, especially for babies who might be orally sensitive.

Cons:

  • Choking risk: While the intention is for the baby not to bite off pieces, there is always a risk. Small pieces can break off, or a baby might accidentally bite off a larger chunk than he or she can manage. Active, vigilant supervision is non-negotiable.
  • Not a replacement for digestible solids: It’s vital to remember that hard munchables are for practice, not nutrition. They should complement, not replace, the introduction of varied, digestible solid foods.
  • Not suitable for all babies: Babies with certain developmental delays, oral motor deficits, or medical conditions might not be appropriate candidates for hard munchables without highly specialised guidance. For instance, babies with an exaggerated gag reflex might find them overwhelming.

Key Considerations for Parents

Here are my top recommendations:

  1. Consult with a professional: Always discuss this with your Paediatric Feeding SLT first before you introduce hard munchables. We can assess your baby’s individual readiness and guide you on safe practices.
  2. Strict supervision: Never leave your baby unsupervised with a hard munchable, even for a second. Your full attention is required.
  3. Appropriate size: Ensure the item is large enough that the baby cannot fit the whole thing in their mouth. It should extend well beyond their fist.
  4. No biting off: The goal is gnawing and scraping, not biting off pieces. If your baby is consistently breaking off chunks, stop using them.
  5. Focus on skill, not consumption: Reiterate to yourself that this is for practice, not for eating.

In conclusion, hard munchables, when used appropriately and under guidance, can be a very valuable tool to support oral motor development during the weaning journey. However, always be safe and consult with a specialist to ensure your little one develops his or her feeding skills effectively and joyfully.

Sonja McGeachie

Highly Specialist Speech and Language Therapist

Owner of The London Speech and Feeding Practice.

Health Professions Council registered
Royal College of Speech & Language Therapists Member
Member of ASLTIP

Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

References:

Rapley, G., & Murkett, T. (2008). Baby-Led Weaning: The Essential Guide to Introducing Solid Foods. Vermilion.

Morris, S. E., & Klein, M. D. (2000). Pre-feeding skills: A comprehensive resource for feeding development. Pro-Ed.

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Baby-led weaning: Empowering little eaters from the start
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Baby-led weaning: Empowering little eaters from the start

ByLondon Speech and Feeding

I had a mum ask me about Baby Led Weaning the other day. So I thought I would write a blog on all the useful questions she had and what we discussed as it may help lots of mums and dads out there.

Image by Freepik

As a Paediatric Feeding SLT, one of the exciting developments in recent years is the growing interest in baby-led weaning (BLW). This approach to introducing solids has gained significant traction, and for good reason. It empowers infants to take the lead in their feeding journey, fostering a positive relationship with food and supporting important developmental milestones.

What exactly is baby-led weaning?

At its core, baby-led weaning is about offering your baby appropriately sized and textured solid foods from the very beginning, allowing him or her to self-feed. Instead of spoon-feeding purées, you present whole, soft foods that your baby can grasp, bring to his or her mouth, and explore at his or her own pace. This means no mashing, no blending, and no forcing spoons into reluctant mouths. It’s a fun, messy, and intuitive process that is led by your baby’s natural instincts.

The genesis of baby-led weaning

‘Baby-led weaning’ was popularised by British health visitor Gill Rapley. In the early 2000s, Rapley observed that babies naturally develop the skills needed to self-feed and that traditional spoon-feeding might actually hinder this development. Her work, particularly her book Baby-Led Weaning: The Essential Guide to Introducing Solid Foods (co-authored with Tracey Murkett), published in 2008, brought BLW into the mainstream and provided a structured framework for parents. Her research and observations highlighted the benefits of trusting a baby’s innate ability to regulate his or her intake and explore different textures.

What’s the deal?

Implementing BLW is simpler than you might think, though it does require a shift in mindset. Here’s a breakdown of what it typically involves:

  • Readiness is key: The golden rule of BLW is to wait until your baby shows clear signs of readiness. This isn’t about age alone, but rather developmental milestones. Your baby should be at least six months old, able to sit unassisted, have good head and neck control, show an interest in food (e.g., reaching for yours), and have lost his or her tongue-thrust reflex (which pushes solids out of his or her mouth).
  • Offer finger foods: Start with soft, easily graspable foods cut into finger-sized sticks or spears. Think cooked sweet potato fries, steamed broccoli florets (soft enough to mash with gentle pressure), banana sticks, or avocado slices. The goal is for babies to be able to pick it up and get some into their mouth.
  • Embrace the mess: BLW is inherently messy, especially in the beginning. Food will be squished, dropped, and smeared. This is a crucial part of the learning process as babies explore textures, smells, and the properties of food. A wipeable mat under the highchair and a good bib are your best friends!
  • Observe, don’t interfere: Allow your baby to lead. He or she will decide what to eat, how much, and how quickly. Avoid putting food into his or her mouth or pressuring him or her to eat more. This respects his or her hunger and fullness cues, laying the foundation for healthy eating habits.
  • Continue breastmilk or formula: Until your baby is well-established on solids, breastmilk or formula remains his or her primary source of nutrition. Solids are for exploration, taste, and developing skills, gradually increasing in quantity over time.

The benefits of baby-led weaning

The advantages of BLW extend far beyond simply getting food into your baby. From a speech and feeding perspective, the benefits are compelling:

  • Develops oral motor skills: Chewing, gnawing, and manipulating various food textures are crucial for developing the muscles in the mouth, jaw, and tongue. This strengthens the oral motor skills necessary for speech development.
  • Enhances fine motor skills and hand-eye coordination: The act of grasping food, bringing it to the mouth, and coordinating these movements significantly refines fine motor skills and hand-eye coordination.
  • Promotes self-regulation and intuitive eating: By allowing babies to control their intake, BLW helps them tune into their own hunger and fullness cues, fostering a healthy relationship with food and reducing the likelihood of overeating.
  • Encourages adventurous eating: Exposure to a wide variety of tastes and textures from the outset can lead to less picky eating later. Babies are more likely to accept new foods when they have been in control of their exploration.
  • Facilitates family mealtimes: BLW integrates babies into family mealtimes from an early age, promoting social interaction and making mealtime a shared, enjoyable experience.

When is baby-led weaning appropriate, and when not?

While BLW offers numerous benefits, it’s not a one-size-fits-all approach.

When BLW is appropriate:

  • When your baby meets all the developmental readiness signs: This is paramount for safety and success.
  • When you are comfortable with the mess and the learning curve: It requires patience and a relaxed attitude.
  • When you are committed to offering a variety of safe, appropriate foods.
  • When you are willing to learn about and practise safe food preparation to minimise choking hazards.

When BLW might not be appropriate (or requires extra caution and professional guidance):

  • If your baby has a history of prematurity or significant developmental delays: His or her oral motor skills might not be sufficiently developed.
  • If your baby has certain medical conditions or anatomical differences (e.g., cleft palate, severe reflux, swallowing difficulties): These may necessitate a modified approach to feeding.
  • If there are significant feeding difficulties, aversion, or a history of choking incidents.
  • If you feel overly anxious about choking: While BLW, when done correctly, is not associated with a higher choking risk than traditional weaning, parental anxiety can impact the feeding experience. Education and consultation with a professional can help alleviate these concerns.

A note on safety: Choking hazards

It’s crucial to understand the difference between gagging and choking. Gagging is a natural reflex that helps prevent choking and is very common in BLW as babies learn to manage food in their mouths. Choking is silent and serious. To minimise choking risks:

  • Always supervise your baby closely during mealtimes.
  • Offer appropriately sized and textured foods. Avoid small, round, hard foods like whole grapes, nuts, popcorn, and large chunks of meat.
  • Ensure your baby is sitting upright and calm.
  • Educate yourself on infant CPR.

Final thoughts

Baby-led weaning is a wonderfully empowering approach that celebrates a baby’s natural abilities and fosters a positive and independent relationship with food. As Speech and Language Therapists we often see the positive impact it has on oral motor development, self-regulation, and overall feeding confidence. By understanding what it entails, when it’s appropriate, and prioritising safety, you can embark on this exciting journey with your little one, helping him or her become a confident and capable eater from the very first bite.

If you would like help and support with weaning your baby whilst continuing to breastfeed then please get in touch!

Sonja McGeachie

Highly Specialist Speech and Language Therapist

Owner of The London Speech and Feeding Practice.

Health Professions Council registered
Royal College of Speech & Language Therapists Member
Member of ASLTIP

Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

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The picky eater's plate: Introducing solids to toddlers with ARFID
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The picky eater’s plate: Introducing solids to toddlers with ARFID

ByLondon Speech and Feeding
Designed by Freepik

Mealtimes can be a battleground for parents of picky eaters, especially toddlers with Avoidant/Restrictive Food Intake Disorder (ARFID). I see a great number of toddlers with Autism traits and many of my clients are picky eaters from mild to severe. Take a look at my blog for an outline of what the issues are and how to try and help.

ARFID goes beyond typical ‘picky eating’ and can significantly impact a child’s growth, nutrition, and social-emotional well-being. If your toddler is resistant to trying new foods or has a very limited diet, here are some strategies to navigate the introduction of solids:

1. Understand ARFID:

ARFID is a diagnosable eating disorder characterised by:

  • Limited food variety: Eating only a small range of foods, often with specific textures or colours.
  • Fear of new foods: Intense anxiety or aversion to trying unfamiliar foods.
  • Sensory sensitivities: Heightened sensitivity to taste, smell, texture, or appearance of food.
  • Lack of interest in eating: May show little interest in food or mealtimes.

2. Seek professional guidance:

  • Paediatrician and/or gastroenterologist: Rule out any underlying medical conditions.
  • Registered dietitian: Assess nutritional needs and create a balanced meal plan.
  • Speech and language therapist (SLT): If oral-motor skills or sensory sensitivities are contributing to feeding difficulties.
  • Occupational therapist (OT): If sensory processing challenges are affecting mealtime behaviours.
  • Child psychologist: If anxiety or emotional factors are contributing to ARFID.

3. Strategies for introducing solids:

  • Start small: Introduce one new food at a time, in small amounts, alongside familiar favourites.
  • Patience is key: It can take multiple exposures (up to 10–15 times!) for a child to accept a new food. Don’t give up!
  • Positive reinforcement: Praise and encouragement for any interaction with the new food, even just touching or smelling it.
  • No pressure: Avoid forcing or pressuring the child to eat. This can create negative associations with food.
  • Make it fun: Present food in playful ways, use cookie cutters for fun shapes, or involve the child in food preparation.
  • Sensory exploration: Encourage exploration of food through touch, smell, and sight before tasting.
  • Role modelling: Show the child that you enjoy eating a variety of foods.
  • Use fun utensils: your child might like characters from ‘Frozen’ or ‘Dinosaurs’ or ‘Diggers’ there are a host of character-based cutlery and cups/plates to be had. Also, I really rate these two items very highly they are so good so I want to share these with you. Both are available online. But warning: the cup is outrageously expensive as it comes from the United States and is sold by a small scale company. But I feel this is cup very worth trying, I have had good results with this.
NumNum Baby Spoons Set
TalkTools Recessed Lid Cup with Handles
  • Gradual desensitisation: Start with foods that are similar in texture or taste to accepted foods, then gradually introduce more challenging options.
  • Food chaining: Introduce new foods that are similar in taste, texture, or appearance to accepted foods.

4. Mealtime Environment:

  • Positive and relaxed: Create a calm and enjoyable mealtime atmosphere.
  • No distractions: Minimise distractions like TV or toys.
  • Consistent schedule: Offer meals and snacks at regular times.
  • Child-sized portions: Offer small, manageable portions to avoid overwhelming the child.
  • Involve the child: Let the child choose their utensils, plate, or cup.

5. Remember:

  • Every child is different: What works for one child may not work for another.
  • Progress takes time: Be patient and celebrate small victories.
  • Focus on the positive: Praise any positive interaction with food.
  • Seek support: Connect with other parents or support groups.

Introducing solids to toddlers with ARFID can be challenging, but with patience, persistence, and professional guidance, you can help your child develop a healthier relationship with food.

Get in touch with me via my contact form if you need support

Sonja McGeachie

Early Intervention Speech and Language Therapist

Feeding and Dysphagia (Swallowing) Specialist The London Speech and Feeding Practice

The London Speech and Feeding Practice

Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

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Feeding Therapy – What can a Speech Therapist help with and how does it work?
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Feeding Therapy – What can a Speech Therapist help with and how does it work?

ByLondon Speech and Feeding

Feeding our child can be the most satisfying time of the day or it can be the worst, stressful and hardest thing to do. Parents usually contact a Feeding Therapist once things have become totally stressful and unmanageable as often parents feel that ‘it will get better’ and ‘let’s wait and see’. Whilst this is generally a good, relaxed way of thinking, when it comes to feeding, eating and drinking, it does not take much to completely put a child off a particular food or texture. Once refusal has set in and not been responded to in quite the right way then feeding rarely gets better without intervention and support.

What can have started as a physical, concrete problem can quickly develop or acquire a psychological and sensory aversion aspect as well. A child may have started out with an allergy to cow milk protein or gastro-oesophageal reflux for example or perhaps our child has an oral motor difficulty such as the tongue not rotating well, or lips not closing tightly enough around a bottle teat. Because those difficulties were not understood we now have a combination of both physical discomfort, oral weakness and sensory aversion making it a heady cocktail of feeding difficulty and refusal, which needs careful unpicking before each issue can be addressed sensitively and effectively.

A dyad

We call the relationship between the feeder and the child a dyad: both individuals play their part and both need ‘to work together’ to ensure meal times are happy events. The parent/feeder is responsible for offering and providing the meal and the child is ‘responsible’ for taking the food, spoon or drink and swallowing it.

Formation

For the past few years Speech and Language Therapist Students in the UK have received basic feeding/swallowing training as part of their undergraduate degree courses. However, relatively few SLTs in the UK end up specialising in this area and take further professional courses to develop this area of specialist knowledge and input. To be sure that an SLT is able to work in the complex field of eating, drinking and swallowing they must undertake further training and complete increasing levels of competency in this field. This is something to bear in mind for parents when looking for a suitable feeding therapist for their child.

Important to know

Parents are not alone. Many families are experiencing the same difficulty and there is help available both in the NHS and in the private sector.

Children’s feeding can be improved greatly and the best approach is a joint team centred around the child between the parents, the dietician, medical and therapy professionals.

By working closely together we can build confidence and skill and find ways of making mealtimes enjoyable and free of stress.

What happens in my feeding clinic

Parents feed their child and I coach them, model strategies, and support the feeding process.

I provide information on their child’s developmental skill level, oral motor skill. I advise on appropriate food consistencies, optimal positioning. We talk about self-feeding and parent feeding. And we look at strategies during feeding that will improve feeding skills.

I can help with mealtime planning and scheduling. And we decide together on when to practise what type of strategy.

We create our meal goals together based on what is important to the families.

Parents are invited to videotape strategies and advice I give to serve as reminders for home practice.

I offer episodes of follow-up which sometimes can be online. Or parents can bring their child back to the clinic for another mealtime and practice of certain strategies, to follow on from our current status, and take things forward gently and steadily.

If I can be of help with your child’s feeding journey, please get in touch on via my contact form.

Sonja McGeachie

Early Intervention Speech and Language Therapist

Feeding and Dysphagia (Swallowing) Specialist The London Speech and Feeding Practice

The London Speech and Feeding Practice

Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

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A bite-sized guide to Speech and Language Therapy: feeding and swallowing
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A bite-sized guide to Speech and Language Therapy: feeding and swallowing

ByLondon Speech and Feeding

What is a Speech and Language – Feeding Therapist?

You’ve probably heard of speech therapists helping people who stutter or struggle to pronounce words. But did you know that they also work with children and adults who have problems with eating and swallowing? This specialised area is called Speech and Language Therapy: Feeding and Swallowing, or Dysphagia Therapy.

Why does a Speech Therapist help with eating and swallowing?

The mouth, tongue, and throat are all involved in both speech and swallowing. When there’s a problem with any of these parts, it can affect both your ability to talk and to eat. For example:

  • Weak tongue muscles: Can make it hard to chew food and to form sounds.
  • Difficulty coordinating swallowing: Can lead to choking or aspiration (when food or liquid goes into the lungs).
  • Sensory issues: Can make certain textures or tastes feel unpleasant or overwhelming.
  • Communication: If we are not able to express ourselves we are likely to have difficulties during daily mealtimes: how do we ask for ‘more’ of something, how do we say we have had enough or we don’t like a particular food?

How does a Speech and Language Therapist help?

Our work involves a combination of assessment and therapy. We carefully observe how your child feeds, eats and swallows, and we look into your child’s mouth to help us see what the cause of the difficulties are: could be a very highly-arched palate, it could be a very flaccid/low tone tongue, it could be poor dentition. Then, we create a personalised treatment plan to address your specific needs.

Here are some of the things we might do:

  • Teach swallowing techniques: We can help your child learn strategies to improve or facilitate a safe swallow.
  • Recommend dietary modifications: We may suggest changes to your child’s diet to make it easier to eat and swallow.
  • Provide sensory therapy: If your child has sensory needs we can help your child become more comfortable with different textures, tastes, and smells.
  • Work on oral motor skills: We can help to encourage more effective chewing, or drinking skills, or we can help your child to close his/her mouth more during chewing or drinking from a straw.
  • Collaborate with other professionals: We often work closely with doctors, nurses, occupational therapists, and dietitians to provide comprehensive care.

What kinds of problems do Speech and Language Therapists help with?

We see a wide range of feeding and swallowing difficulties, including:

  • Delayed feeding: Children who are slow to develop feeding skills or who have difficulty transitioning to solid foods.
  • Tongue-ties: Babies can have significant difficulties with feeding when the tongue is very tightly tethered to the floor of the mouth.
  • Refusal to eat: Children who refuse to eat certain foods or textures.
  • Aspiration: When food or liquid goes into the lungs, which can lead to pneumonia and other serious complications.
  • Chewing difficulties: Problems with chewing food, such as difficulty breaking down food or keeping food in the mouth.
  • Swallowing difficulties: Problems with swallowing, such as feeling like food is stuck or choking.
  • Neurological conditions: Conditions like cerebral palsy, down syndrome or other genetic syndromes can affect feeding and swallowing.
  • Developmental delays: Children with developmental delays may have difficulties with feeding and swallowing.

Is there hope?

If your child is struggling with feeding or swallowing, know that there is help available. Speech and Language Therapy can make a significant difference in your and your child’s quality of life. We’re here to support you every step of the way.

Remember, you don’t have to suffer in silence. If you’re concerned about your child feeding or swallowing, please reach out. You can find a Speech and Language Therapist with a Feeding/dysphagia qualification near you via www.asltip.co.uk or contact me.

Sonja McGeachie

Early Intervention Speech and Language Therapist

Feeding and Dysphagia (Swallowing) Specialist The London Speech and Feeding Practice

The London Speech and Feeding Practice

Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

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Feeding therapy: A guide for parents and caregivers
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Feeding therapy: A guide for parents and caregivers

ByLondon Speech and Feeding
Image by gpointstudio on Freepik

Feeding therapy is a specialised form of therapy and support that helps children develop healthy eating habits and overcome challenges related to food. It’s often used for children with picky eating, feeding disorders, or sensory processing issues.

What is feeding therapy?

Feeding therapy involves a series of techniques designed to improve a child’s eating skills and attitudes towards food. In the UK it’s typically provided by speech and language therapists and dietitians. These professionals work closely with parents and caregivers to create a personalised treatment plan tailored to each child’s unique needs.

How does feeding therapy work?

Feeding therapy sessions are typically 30–60 minutes long and involve a variety of techniques, including:

  • Family counselling: Providing support and guidance to parents and caregivers. This can help address any practical, behavioural and emotional issues that may be impacting the child’s eating.
  • Play-based activities: Engaging children in fun activities while introducing new foods or textures. This can help alleviate anxiety and make mealtimes more enjoyable.
  • Sensory exploration: Helping children become more comfortable with different tastes, smells, and textures. This can be achieved through activities like touching, smelling, and tasting various foods.
  • Oral motor exercises: Improving chewing, swallowing, and lip coordination. These exercises can help children develop the necessary skills for eating independently.
  • Behavioural techniques: Using positive reinforcement to encourage healthy eating habits. This can involve rewarding children for trying new foods or eating a variety of meals.

When is feeding therapy needed?

Feeding therapy may be beneficial for children who:

  • Are picky eaters: Refuse to eat a variety of foods or have strong preferences.
  • Have feeding disorders: Experience difficulties with eating, such as swallowing or chewing.
  • Have sensory processing issues: Are sensitive to certain textures, smells, or tastes.
  • Have medical conditions: Such as autism, cerebral palsy, or gastrointestinal disorders.

Feeding therapy strategies you can try at home

While professional feeding therapy can be invaluable, there are several techniques you can try at home to support your child’s eating development:

  • Create a positive mealtime environment: Make mealtimes enjoyable and stress-free by avoiding distractions, limiting screen time, and creating a calm atmosphere.
  • Create regular mealtimes and mealtime routines: Introduce set ways of announcing meal times, including songs or short nursery rhymes, try and involve your child with table setting, even just carrying their spoon to the table and putting the beaker next to the plate and ensure that meal time finishes after about 30 minutes, again with a set routine so that the child always knows: this is how we do it in our home, now I am finished and meal time is over.
  • Introduce new foods gradually: Start with small amounts and gradually increase exposure. This can help reduce anxiety and make new foods less overwhelming.
  • Model healthy eating: Show your child how to enjoy a variety of foods by eating a balanced diet yourself.
  • Avoid forcing food: Allow your child to choose and explore foods at their own pace. Forcing them to eat can create negative associations with food.

Seek professional help

If you’re concerned about your child’s eating habits, consult with a feeding therapist. We can provide guidance and support.

Remember, feeding therapy is a collaborative process between parents, caregivers, and professionals. With patience, understanding, and the right strategies, you can help your child develop healthy eating habits and enjoy meals.

Would you like to know more about specific techniques or have any other questions about feeding therapy?

Please feel free to contact me.

Sonja McGeachie

Early Intervention Speech and Language Therapist

Feeding and Dysphagia (Swallowing) Specialist The London Speech and Feeding Practice

The London Speech and Feeding Practice

Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

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My child won't eat!
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My child won’t eat! What can we do to help?

ByLondon Speech and Feeding
Image by freepik

I get lots of enquiries about this topic, parents up and down the country struggle to feed their children. Mealtimes with toddlers can sometimes feel like a war zone!

Reasons

The reasons for food refusal are many and very varied. Perhaps your child was born prematurely and had lots of tubes and things sticking to his or her face? Or maybe your child had gastro-oesophageal reflux and this caused pain every time he or she swallowed. Some children have motor problems so it was hard to coordinate swallowing with breathing and caused frustration and anxiety? Many children have sensory integration difficulties and these make it difficult for them to grasp all the different textures and colours they are eating.

When I take a case history for a new feeding client, I always try to first establish how the child learned not to feed/eat. I use the word ‘learned’ here with intent as eating is a learned behaviour. We tend to think that it must just be instinctive and natural but this is not the case. Instinct is a small part of the very beginning of feeding, in that a baby naturally roots for the breast but this only works out well and leads to more natural ‘instinctive’ feeding if that initial instinct is not interrupted or impacted on negatively by any of the above reasons.

So just as a baby learns to eat or drink the milk it can also learn not to do so. The baby can learn to avoid eating in order to bypass discomfort, or — and this is another important factor — in order to gain more positive attention from the caregiver!

Research shows that we learn about food in two ways:

  1. A connection is made between a food and a physical reaction. This needs to happen only once and it can stick: think about feeling sick after a binge on a certain food/drink… You won’t want to go near that very food again for some time, if ever! If a certain food causes pain then that connection can be made quickly and we won’t want to touch this food again.
  2.  We learn through reinforcement and punishment:
  1. Reinforcement:
  • If we get praised for eating our plate with a pudding, then we tend to eat more to get the pudding.
  • Equally if granny sits with us for hours at the table reading us a story because we do not eat or don’t eat much/quickly, we will continue this because we want granny to keep reading for us.
  1. Punishment can work in two ways:
  • Child gets punished for not eating and will eat more to avoid punishment.
  • Child eats less as the fear of punishment is so unpleasant and leads to total lack of appetite.

As speech therapists we do not endorse any of those above strategies because none of them give us the desired effect.

What do we want to achieve? We want our children to eat naturally, with enjoyment. We don’t want them to over eat, to binge eat, or to starve themselves. Eating needs to become a joyful, natural and organic behaviour if our child is to be healthy and thrive.

Recommendations

Here are three top recommendations I make regularly with good effect:

  1. Structure: have a routine at mealtimes, eating at the table, in the same room with our favourite utensils. Always helping in food preparation, perhaps setting out the table placemats etc, and then tidying up — taking the plate to the kitchen counter, scraping left overs into the recycle bin can be part of this. This way we can introduce repetition to our food/eating learning.
  • Positioning: the right chair with a good footrest, supporting our child’s trunk well, and facilitating our child eating at the table (instead of sitting in a high chair with a tray) is one of my first and favourite tips. I do favour a Tripp Trapp style chair (I have no association with that company).

Tube fed children ought to also sit at the table with the rest of the family and first of all be offered foods and drinks to handle or play with. Some tube fed children are able to eat a small amount of pureed foods and they ought to be offered this first before being topped up with their tube feeds, whilst sitting down. Lying down for your tube feed is not a normal way of eating. Tube feed infants should be offered a pacifier whilst being tube fed and be in an upright position so that they start having an association between getting full/feeling satiated and their mouth.

  • Sociability: I encourage family mealtimes, or at least the caregiver eating with their child together, so that the child is able to copy and observe what normal eating looks like. We need to be super positive about eating and food consumption so that our child can see and copy this. If the parent is a fussy eater then this may cause the child to copy exactly the same behaviour. Many parents who come to me with their fussy children are themselves also picky about food.

There are many other tips and strategies and I will be more than pleased to assist, please contact me.

Sonja McGeachie

Early Intervention Speech and Language Therapist

Feeding and Dysphagia (Swallowing) Specialist The London Speech and Feeding Practice

The London Speech and Feeding Practice

Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

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Baby-Led Weaning: A Speech and Language Therapist's Take
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Baby-Led Weaning: A Speech and Language Therapist’s Take

ByLondon Speech and Feeding
adorable baby playing with food
Image by freepik

Let’s face it, introducing solids is a rollercoaster for parents. You’re bombarded with advice (solicited and otherwise) on purees, spoon-feeding, and the much-discussed ‘baby-led weaning’ (BLW). As a speech-language/feeding therapist I see the world through the lens of communication and development, as well as safe munching and swallowing. BLW can be a fantastic option for many little foodies. But is it right for yours? Let’s take a dive into the messy, hilarious world of toddler feeding.

BLW in a nutshell

Your baby, perched in their highchair, eyes wide with excitement and curiosity reaches out for a platter of food. He/She grabs a fat avocado slice, and curiously explore it with his/her lips, gums and tongue. He/She spits some of it out, mashes bits of it into his/her hair, there was a tiny swallow and the rest is smeared onto the high chair tray. Now he/she grabs a bit of the banana and rinse and repeat as before, except this one he/she keeps in his/her mouth for bit longer and takes a tiny bit more before the rest gets deposited into his/her bib.

This, in a nutshell, is BLW! It’s all about letting your little one take the lead in exploring new foods, textures, and tastes. No spoon-feeding, just pure, messy, self-directed feeding fun.

The pros of letting your little one loose on solids:

  • Motor Skills: BLW is a sensory party for developing motor skills. Picking up that slippery banana or gumming a chewy piece of toast strengthens those tiny hands and mouth muscles. These are the very skills they’ll need for future talking and chewing.
  • Texture Time: BLW exposes your baby to a variety of textures right from the start. Think soft, steamed broccoli florets or smooth, banana half-slices. This sensory exploration helps them develop an understanding of different textures in the world, which can translate to better oral motor skills needed for speech development.
  • Independence: BLW fosters a sense of self-feeding independence. Your toddler learns to control how much he/she eats and the pace of his/her meal. This can lead to better self-regulation later on, not just with food, but in other areas of his/her development too.
  • A wider variety of flavours: BLW encourages exposure to a wider variety of tastes and smells. Let your baby discover the sweetness of roasted sweet potato or the tang of mashed avocado! This early exploration can lead to less picky eating down the road.

There are some valid concerns:

  • Gagging vs. Choking: One of the biggest concerns parents have about BLW is choking. However, gagging is a natural reflex that helps babies learn to move food safely around their mouths. Choking is much rarer, and with proper food selection and supervision, the risk is very low. The con here really is parental anxiety more than anything else and if you can overcome this then a bit of gagging is just fine and part of the process. Choking, again most children do choke occasionally a bit! Of course, close supervision and common sense is very important here.
  • It’s ever so messy!: Be prepared for mashed banana on the highchair tray, rogue peas flung across the room, and a general sense of chaos. But then again, this is an important part of the learning process! I would encourage you to embrace the mess (within reason and your personal tolerance level) and focus on the fun of exploration.
  • Nutritional Concerns: Some parents worry that babies won’t get enough nutrients with BLW. While it might take a while for them to master the art of self-feeding, a healthy child’s body is pretty good at self-regulating. Offer a variety of healthy options, and he/she will eventually get the hang of it.

BLW: Is it right for your Little One?

BLW isn’t a one-size-fits-all approach. Here are some things to consider:

  • Developmental Milestones: Babies should be able to sit up with good head control and show an interest in food before starting BLW.
  • General good health and absence of food intolerances, allergies, or other significant health issues which might dictatea more controlled feeding regime.
  • Gag Reflex: A strong gag reflex is a good sign. It shows your baby’s natural ability to move food safely around their mouth. If, however, your baby’s gag is overly sensitive and causes frequent bouts of vomiting please consult your health care professional for an assessment (GP, Paediatrician, Dietician, Speech and Language – Feeding Therapist).
  • Your Comfort Level: BLW requires a relaxed and patient approach. If you’re feeling stressed about the mess or potential choking hazards, it might not be the right fit for you.

A final mouthful:

BLW can be a fantastic way to introduce your baby to solids. It promotes exploration, independence, and a love for food. Remember, there’s no pressure to go all-in on BLW. You can always combine it with spoon-feeding or purees to find an approach that works for your family and your child. The most important thing is to create a positive and relaxed mealtime environment where your little one can explore the wonderful world of food at their own pace.

P.S. As an SLT, I always recommend chatting with your health care professional. This way you can address any concerns you might have and ensure your baby is developmentally and physically on track for this exciting new chapter.

Don’t hesitate to contact me!

Sonja McGeachie

Early Intervention Speech and Language Therapist

Feeding and Dysphagia (Swallowing) Specialist The London Speech and Feeding Practice

The London Speech and Feeding Practice

Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

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Answers to very common questions I get as a Feeding Therapist
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Answers to very common questions I get as a Feeding Therapist

ByLondon Speech and Feeding

What are hunger cues in newborn babies? How do we recognise when our baby is hungry? How often should we feed our baby?

These are very common questions I get as a Feeding Therapist. And so I thought I would write a blog on it.

A mother holding her baby on one arm in her lap while holding a cup
Image by Freepik

First-time parents’ journey

First-time parents often imagine that feeding, particularly breastfeeding, will be an easy and natural process without too many problems. It can be a rude awakening to find that feeding our newborn is not at all easy and can be fraught with complications. It is fair to say that in most cases by the time our baby is about eight weeks old most mums have got the hang of feeding, either by breast and/or bottle, and things are falling into place.

But until that time it can be a difficult journey:

  • getting to know one’s baby,
  • getting to know their feeding rhythm,
  • falling in with it,
  • TRUSTING that baby knows what they need and knows when they have had enough,
  • TRUSTING and not going crazy with going down an on-line rabbit hole of information and guidance mostly unnecessary and often quite simply FALSE!

Many mums I have met set out with the best intentions to breastfeed for as long as possible. However, they arrive in my clinic anxious and often have given up with the breast; now we are on bottle feeds and things are still very tricky for several reasons. There are too many reasons for this blog to cover but I thought I would start with the basics and ‘reading hunger cues’ is one of those early basics.

Image by shurkin_son on Freepik

Reading hunger cues

So let’s dive in:

Newborns communicate hunger through a variety of cues. Here are some early signs to look for:

  • Early hunger cues: These are the best times to respond to baby’s hunger for a more peaceful feeding. Look for things like:
    • Becoming more alert and active
    • Turning head from side to side in the cot
    • Rooting (turning their head towards your breast or a bottle, especially when stroked on the cheek)
    • Putting hands/fists to mouth
    • Sucking on fists or lips
    • Opening and closing mouth, smacking sounds
TOP TIP: THIS IS WHERE YOU SHOULD GET READY TO FEED. Breast or bottle. Either way get ready. We do not want our baby to get into later hunger cues, which are below:
  • Later hunger cues: If we miss the early cues, babies will progress to more insistent hunger cues. These include:
    • Fussiness or whimpering
    • Rapid sucking motions
    • Increased squirming
    • Head bobbing

Generally, remember that we do not want our baby to cry for their food. Because once they are riled and cry they are not relaxed enough to latch, especially when latching is hard!

Feeding on demand vs. scheduled feeds

We now know and have researched how babies are fed best and safest, how weight gain is ensured best, both for breastfed and bottle-fed babies.

It’s generally recommended to feed on demand—unless your baby is tube-fed or has some other pressing health concerns or is failing to thrive.

What are the benefits of on demand feeding?

  • We need to respond to baby’s individual needs and hunger cues because every person is unique!
  • Babies need to learn and regulate their own hunger and satiation cycles
  • Promotes better weight gain and growth
  • Leads to more peaceful feeding experiences

Scheduling can come later

A loose schedule might emerge naturally when your baby is around 2–3 months old, but it’s best to follow your baby’s lead.

Tips:

  • Some newborns may feed every 2–3 hours, while others go longer stretches. Pay attention to your baby’s cues and feeding habits.
  • Crying is a late hunger cue, and frequent crying can make feeding more difficult. Responding to earlier cues is best.
  • If you have concerns about your baby’s feeding patterns or weight gain, consult with a Speech and Language Therapist/Dysphagia Therapist and/or Lactation Consultant.

Check out these useful resources on  the topic of Demand Feeding:

Do get in touch if you would like some in-person or on-line 1:1 support with this. It can be overwhelming to figure it all out alone.

Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

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Strategies to support children with eating difficulties
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Strategies to support children with eating difficulties

ByLondon Speech and Feeding

where the cause is NOT a swallowing problem, but we are having a “fussy eater” in the family, seeming for no obvious reason

When parents have a child who find mealtimes or eating difficult, it can put pressure on the whole family dynamics. Once we have observed a child’s eating and drinking skills and found that they are not swallowing impaired, but are for want of a better word “fussy” or “picky”, we can then start to look at what might be underpinning the food aversions/picky eating/food avoidance. Two of the main questions parents have (of course) are:

  • ‘is my child getting the right nutrition?’
  • ‘how can I have less anxiety-provoking and stressful mealtimes?’

We all tend to have an image in our minds about the ‘perfect mealtime’, and how mealtimes ‘should’ be. Speech and Language Therapists with a Feeding Specialism are the perfect professionals to help you unpick feeding issues. We are trained to look at swallowing and oral skills and we also know a lot about feeding behaviours and sensory difficulties which could be causing your child’s eating avoidance.

Here are some strategies that can support children with their eating:

  1. Create and maintain a mealtime culture that suits your home and lifestyle. Then stick to that. We all need some routine in our lives to thrive. Mealtimes are no different. It might be that you eat in the same place for every meal, with the same knives and forks, concentrating on maintaining good posture. Children learn by repetition so the more familiar it is, the easier they will find it. In the physical sense, our bodies also need preparing for food, regardless of whether we are eating with our mouths or we are tube-fed. We want every child to connect all the dots of the process. It starts with their eyes, noses, expectations, memories of past experiences, feelings and then finally their mouths….
  2. Be an excellent role model. Children learn through watching others, so your child will be observing you without you knowing. Ensure that you are positive about the food you are all eating, and talk about how delicious, tasty, juicy, and yummy the foods are. Make the atmosphere around the dinner table light hearted. Even though you are secretly stressed about your child not eating, try and not show this. Instead pick a topic or put on some nice music, or talk about something your child might be interested in, and try and avoid coercing your child to eat. Leave small finger foods on their plates and have a range of foods available on the table so that your child can see that everyone is eating a range of foods and enjoying them.
  3. Use positive reinforcement. Try and think of mealtimes as fun and motivating. Children who are happy will likely be more inclined to try foods and take part in family mealtimes. Reward all interactions around food, so if your child merely touches a new food then praise this behaviour. Or if your child licks a food just once, again make a nice comment and praise your child for touching and licking the food. The takeaway here is to try and keep all messages positive around food.
  4. Keep offering all types of food. What often happens is that parents stop serving foods they know will not be eaten. This makes sense in a way; we don’t want wastage! However, try and keep the doors open and re-offer all types of foods, even the ones that your child has not wanted in the past. Try and give your child one food they will like and one food they have tasted before and liked before, even a little, and then one new food to try. So, your child always has something to fall back on and they can join in with eating. But they can also try (or at least look at and think about trying) other foods that you and perhaps the siblings are eating.

Take a look at this website, I find it very helpful in showing parents what types of foods and how big a portion to offer

Have a go and try and implement some of the ideas above, and should you get stuck please get in touch!

Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

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