Red flags for feeding difficulties

Parents know how important eating is in making sure  their infant and toddler grows and develops. And they want to know  "what's normal" particularly if meals aren't going as well as they expect. "Is my baby  on track or does he has a "feeding difficulty?".

The good news is there are some signs, or red flags, when you need to see a specialist in feeding issues.  These include: 

• Poor weight gain or consistent weight loss. A baby or child's length and weight are regularly measured at  doctor's visits. If a child loses weight or has difficulty gaining, the child's growth curve can suggest testing may be needed.
• Coughing, gagging, choking, and/or vomiting: These scary behaviors can cause concern, especially if they are seen with feedings and continue to occur. Difficulty managing the size of a bite, not tolerating certain textures, or manipulating foods can be signs of a potential problem. Or they may be behaviors the child has learned to avoid certain foods, to gain attention, or to escape from a meal.  
• A history of reflux. When children have regular GI issues, they may associate eating/drinking with pain and discomfort. This can lead to "food avoidance" with the child not eating or drinking enough. 
• Difficulty transitioning to new food textures or tastes. Many children need to try a new food as many as 12 times  before they will eat or drink it when it's offered. If a child constantly rejects most new foods, this may be cause for concern.
• Difficulty transitioning from liquids to solids. Children should be eating baby food purees by 10 months, table food purees/solids by 12 months, and be weaned from baby foods by 16 months of age. Those who don't may need evaluation, especially if they have other problems as well.
• Negative behaviors during meals. When every meal is a "battle," parents often try negotiating, bribing, distracting, and doing almost anything to get their child to eat. Sometimes with little success. 
• Aversion or avoidance of all foods of specific textures or nutritional groups. Most children have a preference for specific textures and tastes.  However, if they avoid an entire group of food textures (purees, chopped foods, soft foods, or chewy foods) or an entire food group (proteins, fruits, vegetables, dairy), this can cause a nutritional problem.
• History of eating/breathing coordination. If your child has difficulty with ongoing breathing issues, he may tire easily during meals and/or have decreased intake.  
• A range of less than 20 foods eaten. A child should gradually increase their food repertoire to, at least, 20 foods. This would allow for three to five meals per day without repeating a food. Many kids with potential feeding issues will go on a "food jag" – eating the same foods every day or every meal.  When a "food jag" takes place, a child will typically grow tired of the food and eliminate it from their diet. He may go on to a healthier diet or another food jag. .    

These "red flags" occur in lots of infants and toddlers for short periods of time. When they continue, your physician can help you sort through the issues and refer you to the right expert.

Amanda is a speech-language pathologist and feeding therapist, addressing the needs of clients with oral-motor, sensory, and/or behavior-based feeding difficulties.  Her use of Sequential Oral Sensory (SOS) approach incorporating behavior modification and desensitization helps to facilitates positive interactions with food for her clients and their families. We are pleased that she is sharing some of the red flags that parents need to watch for. 

Dr. Stan