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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The image shows different types of food with labels under the title "Why does my child struggle with fruits and veggies"
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13 tips to support children and young people with food aversions

ByLondon Speech and Feeding

When you have a picky eater it’s easy to feel on edge and that others are judging your parenting skills. It is astonishing how suddenly the world and its brother/sister are all experts on how to feed your child, even the lady in the corner shop is not shy to offer unsolicited tips and advice on your child’s nutrition intake. They will say “try this or that“, “how about these new crackers (only £1.99 special offer)” but…

The fact is often that you are very concerned about what your child is eating. And you desperately want to give them a healthy, nutritious packed lunch but you know that it will get left, unopened, and unfinished. So, instead, you stick to the same sad soft cheese sandwich on white bread as it is at least something you know they’ll eat.

Sensory needs can impact on eating with both individuals with and without other conditions. We need to consider all these elements:

  • taste (sweet vs. sour)
  • consistency (crunchy vs. soft)
  • temperature (hot vs. cold)
  • colour (beige vs. colourful)
  • and smell (pungent vs. mild)

Let’s take a blueberry as an example: it can be sweet or sharp; it can be firm or mushy; it can even differ in colour. Now let’s look at a piece of cereal: it’s crunchy all the time; it looks the same. It’s very predictable, and therefore less anxiety provoking.

Speech Therpaist in London

Find our top tips here:

  1. Check with a medical professional that there is nothing physically wrong (e.g. gastrointestinal, or anatomical structural difficulties).
  2. For swallowing difficulties, whether confirmed or suspected, please book an assessment with a certified swallowing/feeding Speech and Language Therapist or please contact me.
  3. Does your child have confirmed or suspected allergies? If so, please contact a dietician who has experience with allergies and can advise, for example: Dr Rosan Meyer.
  4. Talk to other family members about food and their experiences of food. Perhaps there is a family tendency to be picky with eating/food avoidant. This may be important information that you can share with your clinician during the case history taking.
  5. Be patient, though this is easier said than done/felt! Know that many children need repeated exposure to food(s) before liking them, up to 14 spoons! So, take it at your child’s pace and it’s vital we don’t force them to try new foods or use bribes.
  6. You can provide opportunities to engage with food, perhaps you could cook with your child, and allow them to choose what they want to cook. For younger children try Messy Food Play – there are tons of suggestions on Pinterest for ideas on how to incorporate foods into play activities or ask your feeding-Speech and Language Therapist.
  7. You may want to talk about pictures in books that introduce new foods (e.g. The Very Hungry Caterpillar for younger children or magazines if older).
  8. You can play with toy food in a toy kitchen for little ones, or comment on supermarket adverts for young people who are older.
  9. Offer opportunities to taste new foods. You could use a toothpick for bite-sized pieces.
  10. Be sure you eat together with your child as often as you can, modelling positive eating behaviour is most important and can be really effective over time.
  11. You could ask your child to sort foods by colour or stack them on a plate.
  12. We know that Autistic Spectrum Conditions often come with hypersensitivity to textures, so consider what your child prefers (e.g. they may not like slices of tomato but prefer the runnier texture of a tomato sauce).
  13. Reward and give praise following your child’s flexibility with foods and their attempts to try and not whether they like/dislike the food, for example “well done for touching the avocado!” Or “great you licked your fingers with the humous on, that’s excellent”.

We are always here to support you in whatever way we can. Contact me for support.

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.

Happy child being fed
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Transforming Mealtimes

ByLondon Speech and Feeding
Speech Therpaist in London

Transforming Mealtimes

Below are two reviews I got from grateful clients over the past 4-6 weeks; this blog is more about how Feeding Therapy can help you than blowing my own trumpet…. though that said, it is always so nice and gratifying to hear when parents are happy and hopeful about their little one’s feeding journey. Feeding Therapy is a substantial part of my work as a Children’s Speech and Language Therapist. One of my specialist subjects is Autism and we find that many children on the Autism Spectrum are very specific about eating, and will often refuse a range of typical family foods in favour of a narrow range of foods/snacks.

Mostly, feeding difficulties are a combination and complex cocktail of factors that have contributed to the current status quo: sure, there may have been some physical problems to start off with, such as reflux causing the baby discomfort, constipation, a very tight tongue tie or a swallowing problem caused by neurological difficulties and of course sensory processing difficulties are also very physical experiences. We always begin with a very thorough case history taking and information gathering, followed by an oral assessment and observation of the actual swallow to establish what might have been – or still might be – the cause for the feeding difficulties.

In most of the cases I see in my practice, the original obvious cause is no longer present, especially with older children. So, if the swallowing is fine, the reflux is no longer present, the tongue was divided (twice!) why are they still not eating much, refusing to try new foods, only accept certain textures etc.

The answer is extremely complex and multi-faceted and this little blog is not covering any factors in detail (we would be here all night) -I mentioned sensory processing difficulties earlier on. These are mostly still present but often not acknowledged or recognised by parents. And it is certainly the case that one of the contributors is parental anxiety; this tends to run very high and has been for many months, sometimes years. This in turn often leads to very tense and unpleasant, endlessly long meal times and many times children are force-fed several times a day in order to “get something down there” as otherwise they would probably starve themselves.

Additionally, parents end up only offering a very narrow range of foods because that is all their child will eat. This ends up in a vicious cycle of children being fed porridge-style food for all meal times and of course they won’t progress to more mature foods if these mature foods are never on offer.

In order to help address and disentangle some of the issues I often introduce the “Division of Responsibility in Feeding” as researched and recommended by Ellyn Satter (The Satter Feeding Dynamics Model)

Here are the main points of her approach:

Children have a natural ability with eating, they eat as much as they need and they grow in the way that is right for them and they learn to eat what their parents eat. (E Satter). The parent is responsible for WHAT the child eats, WHERE and WHEN the child eats. The child is responsible for HOW MUCH they eat or WHETHER to eat. Satter proposes that parents should guide their child’s transition from nipple feeding through semi-solids, then thick and lumpy foods to finger foods and then on to normal family meals.

Please note: this model is only appropriate for children where the original physical cause is no longer present!

Of course it’s not easy! It requires a huge shift in thinking about feeding and it requires to trust our children to know what is best for them. This is very big for most parents, as it is not how we were brought up and it is not commonly known that babies and children know what is good for them!

However, it is certainly true that parents who follow this particular approach and make small, steady changes in the way the offer foods, and in the way they create family meal times differently, children make very nice, pleasing progress and over some months we often see remarkable positive changes.

I like to work in a team and especially for this type of problem it is essential to have a multi-disciplinary approach. A knowledgeable dietician is an enormous plus in any feeding team as is of course a

Paediatrician and/ or a Gastroenterologist and the most important people in the team are the parents!

Feeding Therapy is all about collaboration and a ‘team around the child” approach. When we have this in place and there is trust amongst the team members then we make fantastic progress.

Do get in touch with me if you would like some help with your tricky feeder.

Lovely Reviews

I visited London Speech and Feeding a couple of days ago with my 8-month-old granddaughter and her mother. Sonja made us feel comfortable and at ease from our first introductions. She was able to pinpoint my granddaughter’s mum’s anxiety around weaning very quickly. She not only gave her the tools to do this successfully, but also really encouraged my granddaughter’s mum and instilled confidence that she had everything she needed to make this sometimes-difficult transition without further anxiety.

Sonja was very thorough in her initial assessment of my granddaughter’s physical milestones and her developing speech. My granddaughter felt very comfortable with Sonja and happily played along with her. Then came the big moment – trying out various foods! We were amazed to see just how easily my granddaughter, with Sonja’s expert encouragement, took to sampling the wonderful array of different delicious morsels Sonja had prepared for the session. My granddaughter even drank from a cup for the first time! Wonderful!

Sonja then emailed a summary of the session and an extensive array of resources with suggestions for my granddaughter’s mum which she has now put into action. My granddaughter’s mum couldn’t thank Sonja enough for her caring attitude, extensive knowledge, and warm professionalism. I have no hesitation in recommending Sonja, she’s a fantastic Feeding Therapist!

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Sonja (and her lovely colleague, Sandra) were stupendous. I had brought my one-year-old son to see them as I was concerned that he wasn’t eating enough. They looked at his history and we ate together to make sure they had all the information they needed to give an accurate diagnosis. Whilst our outcome was that Henry was in fact doing brilliantly (and I just needed to chill out a bit!), I would imagine if there was something more serious going on, Sonja would make you feel just as supported and empowered as she did with us. Excellent follow-ups too. Money well spent for a bit of reassurance for a stressed out mama. Thank you, Sonja!

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.

Top tips for the best chair when weaning / feeding your toddler
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Top tips for the best chair when weaning / feeding your toddler

ByLondon Speech and Feeding
Kids Speech Therapist London
Top Tips For The Best Chair When Weaning / Feeding Your Toddler

Many times I consult families for weaning or feeding difficulties and the immediate and most obvious problem I spot, as soon as I arrive or see any video footage for analysis: the high chair has no footrest! You know the one that is so popular from a certain Swedish company…and don’t get me wrong, most of my furniture is still from that same company and I mostly love it…after assembly and a fair bit of cursing…but the very cheap chair they sell is literally one of my pet hates…perhaps ‘hate’ is a bit strong, but I just do not like this chair at all. And the reason is simply this: IT HAS NO FOOTREST!? PS: it may do now, I have not been to said store in a while, but I have not come across any improved chairs in any of my clients’ homes!

Who likes to have their feet dangling in mid-air at any time of the day? I really don’t!. I need to always have my feet firmly planted on the ground or on a footrest – should I find myself lucky enough to be sitting on a bar stool these days! As soon as I clamber up that stool and I have managed to find a hook for my handbag – here’s another bugbear, but I digress – as soon as…my feet are looking and rooting for that foot rest. Because it gives us stability and let’s face it, when on a bar stool…stability is what gets us through the evening.

So back to our toddler: why would we imagine that our toddler feels any different about dangly legs? Imagine if you will, sitting on one of those bouncy gym balls… where would your feet be? Yes of course, on the floor, because otherwise all hell will break loose or, more to the point, your tummy muscles would get a nice work out, and that is FINE, no problem. Go for it, I know I should…

But if you imagine sitting on a ball like this with your feet off the ground and now you are given a plate of food as well….. I personally don’t think that would end well.

Of course our toddler in that high chair without a footrest is not quite as wobbly as you would be on that ball, but the principle is the same: there is very little stability and now s/he is meant to be tucking into some veggies as well.

As I mentioned in my PS above, I do understand that there are now some additional footrests that can be fitted on the above Swedish chair, and if that becomes a bit more common place and is easy enough to do, then all is forgiven and please go ahead. However….. and I am not on ANY commission from the company I am about to recommend, but really, I have not come across a better chair that is so versatile and will last your child until they are about 12years old!! (Both my boys had one each and 20 years later, I still use both their hairs now for children that come to see me in my clinic. They are almost as good as new and adjust so easily and well to all different heights)

Tripp Trapp® Chair
Tripp Trapp® Chair

Enter, the Stokke Tripp Trapp Chair. It costs a small fortune to be fair, but it did win the “best high chair award” in 2021. There are many cheaper versions available, for example, John Lewis sell a similar chair for about half the price! So do shop around.

But what is so important to consider is that your child has a foot rest and that his trunk is at a 90 degree angle with your child’s thighs.

This affords your child maximum stability and so now we can have a look at the rest of your child’s feeding skills and see what else can be done to help things, and there are many more strategies. But this is usually the first and a hugely important bit of advice I will give and the effect of better sitting, and increased stability is huge!

Best of luck with shopping for your great new high chair. I would also say, if you have already got a chair without a footrest and you don’t want to get another one, I totally get that too. In that case, perhaps have a think about how you could enable your child to rest his/her feet on something, with the right 90 degree angle I mentioned above: perhaps a crate of some sort? a coffee/side table that could be placed under the chair for feet to rest on? a box? Once we become aware of the problem there is most often a solution to this issue. Your toddler will thank you!

I hope this is helpful, please feel free to contact me if you have struggled with finding the right position for your child or if you found this blog post helpful.

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.