Physical Competence Interventions

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  Developmentally Appropriate Diet Modifications

The foods and beverages offered to a child should match their oral-motor skill set. Occasionally, developmental challenges and/or medical conditions may cause a child’s skill set to be behind their chronological age. In these instances, caregivers must be aware of the child’s limitations and provide developmentally appropriate foods and beverages.

Background Education for Providers

Well intentioned caregivers may provide a diet which is beyond a child’s true developmental ability. The range of appropriate foods and textures gradually increases with a child’s age. By the age of 2 years, appropriate foods and textures include whole milk, coarsely chopped foods, toddler foods, bite-sized pieces of foods, and the child should be advancing to table foods. However, developmental delays and/or medical conditions may have hindered the child from learning to eat. For example, children who have been diagnosed with FTT or certain medical conditions may have required a G-Tube. In these cases, they are likely to have missed the critical period to develop texture acceptance, in turn, they may develop texture resistance to higher and coarser textured foods (eg. meat, raw vegetables). Other children, who may have missed this critical period due to limited food exposure from caregivers, behavioral issues, medical, or other factors, are also at risk for texture resistance. Such children may then fixate on specific foods and textures, which in turn may result in nutrition deficiencies. For these children, appropriate evaluation and treatment services should be provided.

Instructions for Provider

Knowledge of a child’s response to the full variety of textures is essential in judging a child’s skills and needs for further assessment. Completing an interview reviewing the range of textures accepted will help to identify these children if the caregiver has not already expressed concerns in this domain. Common symptoms of a primary oral-motor skills problem include, but are not limited to, coughing/gagging/vomiting while feeding, slowed pace for feeding, expelling food or liquid bolus, pocketing of foods in cheeks, preservative/non productive chewing, fixation on specific textures or “safe foods”, behavioral resistance when confronted with foods outside of the child’s skills comfort ability. When these behaviors are reported or observed, referrals to a speech and language pathologist with experience in the diagnosis and treatment of feeding problems should be made. Routine follow-up with the family to ensure they are receiving appropriate care is also recommended.

Supplemental Materials

  Referral Worksheet

Background Education for Providers

To understand the nature of feeding problems, one should first be familiar with the stages of feeding development. Although these stages are typically observed in children living in the United States, there may be variations in these stages across cultures due to differences in parenting practices and beliefs. During infancy, children typically are fed breast milk or formula for the first 4-6 months of life. Smooth foods and pureed textures are usually introduced at about 6 months of age, and easily dissolvable foods between 6 and 9 months. Most children are introduced to table foods by 12 months, and by 24 months most children are eating a diet consisting primarily of solid foods similar to those eaten by the entire family. Interest in self-feeding emerges as fine motor skills develop, typically between 9 and 24 months, with skills advancing from fisted feeding and holding a bottle independently to the use of utensils and an open cup. As children progress in their feeding skills, they are given and/or allowed more control over the foods selected and the volumes of food consumed. Feeding problems often are first identified in the first 2-3 years of life when the child does not progress from one feeding stage to the next or when feeding transitions are difficult.

Instructions for Provider

If a child does not advance their diet within these expected norms or appears to have excessive coughing, gagging or vomiting then a speech and language evaluation may be necessary.

Contact Us

Email the Nutritional Disorders Telehealth Network Project Team

Please contact us if you are interested in using any of the project materials or if you would like more information regarding the project.