Feeding Difficulties

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    Why tongue lateralisation matters: The hidden feeding skill that every toddler needs

    ByLondon Speech and Feeding

    When parents think about feeding milestones, they often focus on what their child is eating. Are they accepting lumps? Will they eat vegetables? Are they managing finger foods?

    However, one of the most important skills happening behind the scenes is something many parents have never heard of: tongue lateralisation.

    Tongue lateralisation simply means the tongue’s ability to move from side to side inside the mouth. Although this sounds like a small movement, it is one of the key building blocks for safe chewing, efficient eating and later speech development.

    As a Speech and Language Therapist specialising in infant feeding, I frequently assess children who have delayed or absent tongue lateralisation. The encouraging news is that this skill can often be developed. But like many areas of development, there is an optimal window during which children learn it most naturally.

    What does the tongue actually do during eating?

    Eating is an incredibly complex process involving the lips, jaw, cheeks, tongue and swallowing muscles all working together.

    For mature chewing, the tongue needs to:

    • move food from the centre of the mouth onto the back gums and molars
    • keep the food positioned while the jaw chews
    • collect scattered pieces of food from around the mouth
    • reform the chewed food into a single cohesive bolus
    • move that bolus safely to the middle of the tongue before swallowing.

    Without good tongue lateralisation, food often stays in the middle or front of the mouth where it cannot be chewed effectively.

    Children may compensate by:

    • swallowing pieces whole
    • mashing food with the front teeth only
    • relying on sucking instead of chewing
    • holding food in their cheeks
    • gagging frequently
    • refusing more challenging textures altogether.

    These children are often described as ‘fussy eaters’, when in reality they may simply lack the oral motor skills needed to manage more advanced textures comfortably.

    When should tongue lateralisation develop?

    Tongue lateralisation begins to emerge during the second half of the first year of life as babies start exploring textured foods.

    Between approximately 6 and 12 months, babies naturally begin learning to move food sideways towards their gums for early chewing. As molars develop during the second year, these movements become more refined and efficient.

    This period represents an important developmental window because babies are biologically programmed to experiment with increasingly varied textures. Repeated opportunities to chew different foods strengthen the tongue, jaw and cheek muscles while building the complex movement patterns needed for mature eating.

    If a child remains on smooth purées or very soft foods for too long, they may miss hundreds of opportunities to practise these essential movements.

    Why does this developmental window matter?

    Like learning to crawl, walk or ride a bicycle, oral motor skills develop through repeated practice.

    Children who do not experience enough chewing opportunities during infancy can sometimes continue to rely on immature sucking and munching patterns well into toddlerhood.

    This does not mean the opportunity is completely lost after infancy. Many toddlers can still learn tongue lateralisation successfully with the right support. However, the longer an immature pattern is used, the more established it becomes, making change more challenging.

    That is why early assessment is so valuable.

    Signs your toddler may have poor tongue lateralisation

    You may notice your child:

    • chews mainly with the front teeth
    • bites but does not chew efficiently
    • keeps food in the centre of the mouth
    • pockets food in the cheeks
    • frequently spits out textured foods
    • gags on lumps
    • prefers soft foods
    • swallows before food has been adequately chewed
    • takes a very long time to finish meals.

    Not every child showing these signs has an oral motor difficulty, but they do warrant further assessment.

    How can we encourage tongue lateralisation?

    The good news is that the tongue learns through experience.

    One of the best ways to encourage side-to-side movement is by offering long, resistive foods that naturally encourage the tongue to move food towards the side gums for chewing. We also call them sometimes HARD MUNCHABLES – they look like on the following image.

    Hard munchablers

    Examples include:

    • mango pits with most of the flesh removed
    • pineapple core strips
    • thick steak strips
    • cooked pork strips
    • peeled celery sticks
    • thick cucumber spears
    • roasted pepper strips
    • corn on the cob cut into manageable rounds
    • dehydrated apple rings
    • large clean cooked rib bones with a little meat remaining for supervised chewing practice.

    These foods are not intended for children to consume large pieces quickly. Instead, they provide resistance that encourages the jaw, cheeks and tongue to work together while giving valuable sensory feedback.

    A simple technique that can help

    Some toddlers struggle because they never naturally move food to the side of their mouths.

    In these cases, placing a long strip of food gently onto the side gums can sometimes trigger the chewing pattern automatically. This gives the tongue an opportunity to experience where chewing should occur.

    This should always be done calmly, with the child sitting upright and under close adult supervision.

    Every child develops differently

    Some children are more likely to experience delayed tongue lateralisation than others.

    This may include children who:

    • remained on purées for an extended period
    • have developmental delays
    • have low muscle tone
    • were born prematurely
    • have significant sensory processing differences
    • have experienced prolonged tube feeding or medical conditions affecting feeding.

    A feeding assessment can identify whether tongue movement, jaw stability, sensory processing or another factor is contributing to the difficulty.

    Early intervention makes a difference

    One of the biggest misconceptions I hear is:

    ‘They’ll grow out of it.’

    Some children do. Others don’t.

    Without intervention, inefficient chewing patterns can persist for years, affecting food variety, mealtime confidence and nutritional intake. In some cases, immature oral motor patterns may also contribute to unclear speech production later on, although feeding and speech skills do not always develop at the same rate.

    The earlier we identify a problem, the easier it usually is to help children develop more mature, efficient chewing patterns.

    Final thoughts

    Tongue lateralisation may not be a term many parents recognise, but it is one of the foundations of successful feeding.

    By offering opportunities to chew a variety of safe textures during infancy, parents help build the complex tongue movements needed for efficient eating throughout childhood.

    If your toddler still struggles with chewing, gags on textured foods, or seems unable to move food around their mouth, don’t simply wait and hope they will outgrow it. A comprehensive feeding assessment can identify exactly where the difficulty lies and provide practical strategies tailored to your child’s needs.

    Sometimes a few small changes at the right time can make a lifetime of difference. Do get in touch with me. I would love to hear from you and help your little one develop good chewing skills and eating habits.

    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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    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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    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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    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.