My daughter had some feeding issues when she and her twin started solids at 5.5 months. Luckily, we found Ms. Meng Yi Yui, Clinical Director and Senior Speech and Language Therapist (SLT) who runs the TLC Speech and Feeding Clinic very early on. Early resolution of these issues meant that my Kewpie Pie now feeds well and gets the nutrition necessary for her cognitive and physical development.
Note that not all speech therapists are specialised in feeding. Feeding clinics support children with feeding issues – from fussy eaters to those with swallowing difficulties. They are usually run in hospitals by teams of different professionals including speech therapists, doctors, dietitians, occupational therapists, psychologists, and other professionals. The speech therapist will focus on the oral-motor, feeding and swallowing components. It is important that the speech therapists have related experience and have attended specialised courses in oral-motor treatment and dysphagia (swallowing).
Some common feeding issues include:
- Gagging and coughing on textures
- Eating only a limited variety of foods
- Difficulty progressing from soft foods to table food
- Requiring distraction to feed
- Rejection of bottle or spoon
- Difficulty with swallowing
- Holding food in the mouth and refusing to swallow
- Taking only limited volumes of food
- Difficulty chewing foods and spitting
Very young babies may also experience difficulty with breastfeeding or bottling. The American Speech-Language Hearing Association provides a good overview of feeding and swallowing disorders in children. Parents can seek out a feeding clinic for any of the abovementioned issues.
Things parents can do to prevent feeding issues:
- Watch your baby’s cues – if they reject the food, trust and help them to problem solve. Do not force feed
- Do not feed an already sleeping baby i.e. bottling – feed only when baby is awake (parents can try to wake baby). Babies who get filled up in their sleep may not feel hungry during the day
- When introducing weaning foods, concentrate on the experience not quantity
- Feeding should be an interactive and bonding experience, avoid using distraction
- Understand that babies need multiple exposure to accept new foods
- Feeding is a multisensory experience – babies need to see, touch, smell, and taste the food. Do not worry about mess
- Observe your baby’s oral skills, feed foods that they can manage. Gradually increase the consistency or texture as they improve
- Teething and illness can affect baby’s appetite and intake – it is ok to fall back on familiar comfort food
- Be aware of possible food allergies and intolerances when your baby rejects certain food
Not many people know that good feeding can actually help to promote speech development. When children acquire age-appropriate feeding skills, they also develop oral muscles that support speech development. The body is dynamic, with overlapping systems. Children with oral sensory-motor feeding disorders often (though not always) have speech issues. Sometimes, children with poor feeding skills learn to compensate with inappropriate oral habits that can affect speech development. For example, if a child uses tight lip spreading instead of protrusion to “suck”, they may perpetuate this habitual oral-facial movement and have difficulty producing labial sounds like b, p and m. Research is still emerging in support of the correlation between oral motor skills and speech.
Some simple ways to improve your child’s feeding behavior, and enhance their speech development:
Bottles and Drinking
- Try to wean your children off milk bottles when they turn one (a general age guide). Introduce them to the cup and straw
- Try to avoid using sippy cups and pacifiers that perpetuate tongue protrusion patterns during sucking
Oral Play and Brushing
- Children go through oral play at about 8 months. Some will miss this period due to various reasons e.g. low muscle tone. It is important to encourage oral play with mouthing toys, fingers and toes!
- Brushing children’s gums (before they develop teeth) and teeth encourages oral awareness and reduces oral resistance
Eating and Chewing
- Encourage chewing (tongue lateralisation development) when your child is ready for solids. You may start with baby biscuits that melt in the mouth
- Get your baby to bite food at the sides. This helps with chewing development
- Do not stay on a soft, blended diet for too long. Once your child can take baby biscuits, you should gradually increase the texture
- Avoid tilting the spoon upwards when feeding. Encourage a flat spoon to help your child use both lips for spooning (some children may not move either or both of their lips to receive the spoon)
Posture and Sitting
- Body support for feeding is important for children with weak core muscles. Oral movement can only happen with oral stability, which is directly linked to postural stability
- Sit face-to-face with your child to promote bonding
Feeding issues are usually multi-factoral. We need to rule out medical issues like reflux, constipation, allergy or intolerance. In addition, there are sensory hyper- or hypo-sensitivities that can affect the child’s body. Overall motor development is closely linked to a child’s oral motor skills for feeding. Behavioral issues may also develop if feeding issues are not worked on early. Parents can monitor their children’s speech and language development using milestone charts from reliable online sources.
Some signs that your child may need to see a SLT:
- Does not smile or interact with others from birth to 3 months
- Is not babbling at 4 to 7 months
- Does not understand what others are saying at 7 to 12 months
- Says only a few words at 12 to 18 months
- Says p, b, m, h and w incorrectly in words at 1 to 2 years
- Does not put words into phrases or sentences at 2 to 3 years
When in doubt, Yi Yui advises parents not to wait too long to seek out a SLT. A good SLT that also specialises in feeding will advise you if there is anything to worry about, and offer suggestions for preventative measures. Early intervention is key.
Li-Hsian recently left a career in corporate communications to become a full-time mum to twins. She is learning new things daily as she tries to balance the romance of motherhood with the messy realities of her latest role.
Image Credit: Li-Hsian