Nutritional Disorders Telehealth Network Project

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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
© 2015 Medical College of Wisconsin
Page Updated 04/15/2014