Eating in most societies is a social event, and therefore, a great deal of emphasis is placed on food and food related activities. Eating has been a growing concern with parents of young children.

When your child is eating, there are times when he/she may;
  • Gag at the sight and/or smell of the food
  • Be a picky eater (likes to eat only specific food)
  • Deny eating food altogether
  • Spit the food out
  • Tend to choke when trying to chew or swallow food
  • Vomit at the taste of food
  • Only be interested in bottle feeding
  • Only eat with distractions like TV time, phones, videos
  • Not feed themselves when they can

Are all these really a problem? Or are these children being difficult?

Feeding is not as simple as eating the food placed in front. Starting from smell of the food, to seeing it, then picking it up, to putting it into the mouth, to chewing the food and then finally swallowing it is a complex process.

Feeding is a unique process of setting up, arranging, and bringing food from the plate/cup to the mouth. It is a complex process that involves the use and co-ordination of many muscles to manipulate the food/liquid in the mouth.

Let’s go over this process in detail as described by stages


Oral preparatory phase

  • Lip closure
  • Cheek tone
  • Rotary and lateral jaw movement
  • Rotary and lateral tongue movement
  • Anterior bulging of the soft palate
  • Tongue forms a bolus with the food


  • Removes food from spoon, and liquid from cup
  • Need adequate ability to move (range of motion)
  • Need adequate strength
  • Need ability to maintain closure while chewing and swallowing

Oral Phase

  • Bolus is held between the tongue and palate
  • Tongue pushes bolus to the back of the mouth
  • Tongue elevates and retracts, squeezing the bolus along the palate
  • If tongue control is poor, food may go into pharynx (throat) and be aspirated


  • Need to adequately chew food
  • If food is not chewed, choking may occur
  • Nutrients may not be adequately broken down and used by the body if not properly chewed and broken down first (masticated)
  • If not cared for can lead to drooling
  • Poor jaw alignment may impact feeding

Pharyngeal Phase

  • When food reaches anterior facial pillars, the pharyngeal phase is triggered
  • Velum (soft palate) closes
  • Larynx elevates (epiglottis flips, true and false vocal folds slam together)
  • Tongue has a major role in triggering the swallow


  • Needs adequate strength to break down foods, transfer foods, and maintain control of foods
  • Needs adequate range of motion to clear oral cavity
  • Needs stamina to maintain strength and agility throughout a meal
  • There are many muscle groups in the cheeks
  • In feeding they help to control the liquid and food in the mouth
  • If the cheeks do not work properly, food can fall into the lateral sulci (between the outer gums and cheek walls)

Oesophageal Phase

  • Begins when the Upper Esophageal Sphincteropens and the food is transferred to the esophagus
  • Peristaltic action pushes the food down into the stomach
  • This phase lasts 8-20 seconds
  • Ends when the Lower Esophageal Sphincter opens and the food is passed into the stomach

Soft Palate

  • Elevates at the point of the swallow to prevent nasal reflux
  • If cleft, there is no prevention for the nose
  • Lost food means lost nutrients


  • Protects airways
  • Epiglottis flips over the larynx
  • Vocal folds close over the trachea (windpipe)
  • Larynx elevates to allow food to pass into the esophagus

Children develop problems with feeding, eating, and swallowing as a result of;

  • Medical conditions: cerebral palsy, downs syndrome, other genetic conditions
  • Delayed Oral motor skills: developmental delays
  • Sensorimotor: sensory processing disorder, autism spectrum disorder
  • Behavioural difficulties

What is feeding therapy?

In the simplest terms, feeding therapy helps children learn how to eat or how to eat better.

Problems with feeding, eating, and swallowing are caused by multiple underlying factors. We provide direct intervention for these difficulties to improve functional participation in mealtimes.

How is feeding intervention done?

An evaluation is completed first, which usually consists of observing the child eat and interviewing the parent. Goals are written that guide the direction of therapy based on parents’concerns.

Depending on the child’s underlying challenges, you may see your child participating in sensory integration activities or completing exercises to strengthen the muscles they need for eating.

We provide feeding therapy on one-on-one basis or in a group setting. We have noticed that a group dynamic is very motivating for these kids.

Global consideration

We as Occupational therapists work closely with families to ensure carryover within daily routine. These children often require individual attention or increased caregiver time and effort. Mealtimes may be quite stressful for parents and child, especially when the oral feeding difficulties create ongoing problems with nutrition and growth.

Environmental adaptations

  • scheduled meals at consistent time
  • specific locations from day to day
  • Shorter meal lengths
  • Order of presentation


Intervention for sensory problems

  • Oral hypersensitivity to food tastes, textures, or smells who often react negatively to touch near or within the mouth. They may resist food, brushing, gag frequently, or difficulty transitioning to age-appropriate food textures.
  • Low sensory registration demonstrating poor oral awareness. These children may frequently seek sensory stimulation by mouthing their hands, toys, or clothing.

Neuromuscular intervention for oral motor impairments

  • Promote strength and co-ordination for the development of functional oral feeding skills.

Adaptive equipment

  • Use of variety of adaptive devices like modified/adaptive spoons, forks, cup, straws, etc.

Hand skills required to manipulate the food while using spoon, hand, fork etc.

Modification to food and liquid properties

Behavioural intervention

  • Gradual progression of new skills
  • Praise or positive reinforcement
  • Clear expectations
  • Choices and turn-taking


At REACH, we practice inclusion of primary caregivers within all stages of therapy. Be it the assessment, treatment or home program, we believe a team approach is extremely important for the child’s success within natural environment. We are glad to see our families (who approached us with feeding concerns) achieve their goals/expectations. Difficulty with feeding, that was a block or an anxiety-provoking situation, has now been a fun experience during various social events.

Our ultimate aim at REACH is to create a fun-loving environment for eating (presenting food in a fun way), keeping in mind the child’s inner drive. It’s a gradual process of achieving victory in EATING a variety of foods independently, which helps improve self-confidence, self-esteem and thus social achievement.