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Information papers in this section address oral-feeding development, issues surrounding tube feedings, diet and nutrition, and oral-motor development for feeding and speech.

Learning to Chew

Learning to Chew discusses the developmental progressions that most babies experience as they move from eating smooth pureed foods to table foods that require chewing. Early skills in mouthing of toys and successful experiences with lumpy textured foods create a foundation for comfortable and skill chewing. A set of Guidelines is provided for parents and therapists.

Mealtime Skills: Increasing Gastrointestional Comfort

Mealtime Skills Increasing Gastrointestinal Comfort presents a protocol for understanding the role played by gastrointestinal problems in feeding and mealtime programs for children who receive their nourishment through a feeding tube. Specific guidelines are included to increase the child's gastrointestinal comfort during the meal. Although geared toward the child who is tube-fed, most of the concepts and suggestions are applicable to children who eat by mouth.

Stress and Mealtimes

Stress and Mealtimes addresses the role that physical, mental and emotional stress play during mealtimes for both children and their parents. Recognizing stressful situations and incorporating approaches that reduce stress and support nourishing mealtimes enhance learning for everyone.

Choosing Feeding Equipment

Choosing Feeding Equipment presents guidelines for selecting equipment for feeding programs. Equipment can be a helpful partner in enabling the child to use the best eating patterns possible. Both major and subtle differences are found in equipment in each category. Variations in shape or size can make a major difference for a given child. This makes it impossible to list a specific piece or brand of equipment that will be most effective for your child. This paper provides a list of the general characteristics of nipples, bottles, cups, straws, spoons and oral-facial stimulation equipment that we've found helpful.

Is it Age-Appropriate?

Is It Age-Appropriate looks very specifically at a very common question and challenge that comes up for parents and therapists who are trying to balance their child's needs with products that are on the market. Because of the delayed development of many feeding skills as well as specific sensory and motor needs, our kids may need or be drawn toward equipment that was designed for infants and younger children. How do we balance their developmental needs with the question of age-appropriateness? This paper explores the many sides of this question. It looks at various products and child needs in relationship to size, skills, social and emotional, and construction characteristics.

Homemade Blended Formulas: A Nutritional Option for Tube-Fed Children

Homemade Blended Formulas: A Nutritional Option for Tube-Fed Children discusses the option of providing nutritious meals for tube-fed children through the creation of homemade blended formulas.  An historical overview of tube feeding formulas is included along with a discussion of the importance of a team approach to supporting parents who wish to explore this nutritional option for their children.  The article is adapted from the newly published Homemade Blended Formula Handbook.

The Happiness Option at Mealtimes

The Happiness Option at Mealtimes introduces the concept that our beliefs and attitudes play a central role in how children participate and learn at mealtimes. Happiness is the most important factor at mealtimes and in therapy programs to help children develop feeding skills. Unhappiness gets in the way of helping children move toward their most comfortable and skillful relationship with food and liquid.  Based on the concepts of Barry Neil Kaufman in his book Happiness is a Choice, this paper presents Kaufman’s 6 “Shortcuts to Happiness” within the context of mealtimes.

Becoming a Mealtime Partner

Becoming a Mealtime Partner emphasizes the concept that parents and professionals can develop or redevelop mealtime partnership skills with the infants and children in their lives. Becoming a more skilled Mealtime Partner involves conceptualizing the challenges of feeding and nourishing children in a different way. Work to improve swallowing, oral-motor skills, and sensory comfort is part of the journey in which children learn to enjoy and participate fully in the mealtimes they share with others.


Feeding Behaviors – The Tip of the Iceberg

Feeding Behaviors – The Tip of the Iceberg explores the concept that feeding behaviors are strategies that children and adults select to take care of themselves. When a child is uncomfortable due to gastrointestinal, sensory, swallowing or other physical difficulties, the strategy of limiting food intake may be chosen. The importance of identifying and treating the underlying reasons that lie beneath the "tip of the iceberg" of feeding behaviors is emphasized.

Finding an Appropriate Feeding Program for Children with Feeding Difficulties

Finding an Appropriate Feeding Program helps parents identify individual strengths and needs that can influence the type of feeding programs that are appropriate for both their child and family. The paper discusses ways of preparing for intervention services, documenting what you know about yourself and your child, identifying appropriate feeding resources, and preparing for the initial meetings with service providers. A series of questions is provided that will help parents identify and understand the resources and approaches used by individual therapists and feeding teams. From this information, parents are able to make a more informed decision about feeding programs that are available.

Food Progressions for Biting and Chewing

Food Progressions for Biting and Chewing describes how learning to bite and chew foods efficiently is influenced by the sensory properties of the food and its placement in the mouth. Selecting food can be a challenging task for the parent or therapist because each food has multiple sensory features. Each food has at least 8 sensory features that simultaneously determine the degree of ease or difficulty for biting and chewing. These include resistance, sensory input, size, shape, texture scatter, consistency, placement, and need for transfer during chewing. The combination of these features determines the overall sensorimotor skills required in biting and chewing. These, in turn, interact with the specific skills and needs of the individual child.

Gastrointestinal Health and the Child with Feeding Problems – Part 1: The Issues

Gastrointestinal Health and the Child with Feeding Problems Part 1: The Issues discusses the impact of gastrointestinal discomfort on the development of feeding skills and the child's desire to eat. The paper explores the role played by tube feedings, gastroesophageal reflux, poor digestion, lack of appetite and antibiotics.

Gastrointestinal Health and the Child with Feeding Problems – Part 2: Therapy Alternatives

Gastrointestinal Health and the Child with Feeding Problems Part 2: Therapy Alternatives explores strategies for improving gastrointestinal health and function that can be incorporated into feeding programs. The paper presents ideas for increasing dietary diversity, building gastrointestinal comfort, reducing food allergies and sensitivities, and developing the child's internal regulation of eating.

Children with Feeding Tubes: Part 1-The Issues

Children with Feeding Tubes: Part 1-The Issues describes the group of children whose feeding skills do not support full oral feeding. The role of feeding tubes in the well-being of these children is discussed. Strategies to support the child's ability and desire to eat by mouth are discussed.

Children with Feeding Tubes: Part 2- Treatment Programs

Children with Feeding Tubes: Part 2–Treatment Programs continues the online discussion of children who receive tube feedings by describing a comprehensive oral-motor treatment program and its components. A focus is placed on the foundation skills that children need to begin oral feeding.

Children with Feeding Tubes: Part 3- Making the Transition to Oral Feeding

Children with Feeding Tubes: Part 3–Making the Transition to Oral Feeding discusses criteria and progressions for helping children make the transition to partial or full oral feeding. Specific readiness guidelines are provided.

Expanding Children's Diets

Expanding Children's Diets describes an approach and series of practical ideas for helping children with sensory-based feeding problems increase the types of food and liquid they are willing to eat.

Mouth Stuffing

Mouth Stuffing discusses a common feeding characteristic of children with mild and moderate sensorimotor difficulties. Treatment strategies are suggested for children with poor sensory awareness and poor chewing movements.

Issues in the Anatomy and Physiology of Swallowing

Issues in the Anatomy and Physiology of Swallowing: Impact on Assessment and Treatment of Children with Dysphagia discusses the interplay between the anatomy and physiology of the swallowing mechanism in infants and children. Changes in structure during infancy influence the child's ability to swallow and learn to eat safely.

When a Child Aspirates

When a Child Aspirates provides a detailed overview of swallowing difficulties in children, and discusses the significance of aspiration in assessment and treatment programs. Practical suggestions are given to prepare a child for a swallowing study and to introduce small amounts of food and liquid safely.

Feeding and Speech Relationships

Feeding and Speech Relationships looks at how feeding skills support the development of oral motor skills for speech.

Formula Rotation for Children Who Receive Tube Feedings

Formula Rotation for Children Who Receive Tube Feedings presents a rationale for using formula rotation to increase dietary diversity and prevent the development of food sensitivities and allergies in children who typically receive the nutrients in a single formula. Implications for the transition to oral feeding are discussed.

Why Evaluate and Treat Mild Feeding Delays and Limitations?
Why Evaluate and Treat Mild Feeding Delays and Limitations? discusses the impact of mild feeding problems on the child's speech and social development. Specific suggestions are given for selecting food for snack time at home and in the classroom.

Feeding and Pre-Speech Characteristics - Children with Mild Sensorimotor Impairment
Feeding and Pre-Speech Characteristics - Children with Mild Sensorimotor Impairment describes issues which influence a child's development of efficient feeding and early speech patterns. An emphasis is placed on children with mild and minimal sensorimotor involvement.

Refusal of First Foods

Refusal of First Foods offers a perspective on infants with no prior feeding difficulties who gag and refuse smooth solid foods.

Enhancing Infant Readiness

Guidelines for Success: Enhancing Infant Readiness. . . introduces the concept that infants let us know they are ready to move on to soft solid foods through a series of Readiness Cues. Practical suggestions are provided to increase the ease and pleasure of this learning period.

Mouth Toys Open the Sensory Doorway
Mouth toys provide optimum experience for the development of oral sensory awareness and discrimination and oral movement for feeding and speech development.

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