Feeding Therapy

Food is at the center of our lives. Mealtime helps us build strong family relationships. It can be a source of pleasure, celebration, and sometimes challenges! At Big Blue Canopy, our Occupational Therapists and Speech-Language Pathologists have extensive training in feeding and swallowing to meet the specific needs of your child. Our approach works on improving oral motor skills necessary for safe/efficient intake, increasing the variety of foods tolerated within a child’s diet, and increasing tolerance with various textures of foods. Therapists’ training includes the Beckman Oral Motor Protocol and provides hands-on intervention to increase functional response to pressure and movement, range, strength, variety, and control of movement for the lips, cheeks, jaw, and tongue. Therapists may utilize the Sequential-Oral-Sensory (SOS)Approach to Feeding. Therapists will utilize the Steps to Feeding within the SOS approach to help increase a child’s tolerance for a variety of textures and types of food.

A feeding evaluation may be necessary if your child demonstrates any of the following signs:

  • Refuses certain foods or liquids
  • Picky eater (lacks variety within diet)
  • Poor nutrition
  • Difficulty with chewing foods completely prior to swallowing
  • Fatigue during meals (child may spit out foods that are difficult to chew)
  • Poor control of foods while chewing
  • Poor pacing in between bites (stuffing too much food into mouth at one time)
  • Requires a longer duration of time to complete meals
  • Excessive drooling
  • Difficulty accepting new textures of foods
  • Coughing or gagging during meals
  • Vomiting during or after meals
  • Less than normal weight gain or growth
  • Difficulty with drinking from a straw or open cup (after 18 months)
  • Family history of feeding disorder

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  • Breastmilk and formula continue to provide majority of caloric intake/nutrition
  • Tongue begins to move without the lips
  • Develops a munching pattern
  • Mouths and gums solid foods
  • (4-6 months of age) Spoon feeding is introduced with thin baby food cereals and thin purees (stage 1)
  • Opens mouth when a spoon is presented
  • Starts to use upper lip to clear spoon
  • Starts to hold a bottle
  • Sits upright with assistance
  • Holds head steady without assistance

  • Frequently mouths objects
  • Feeds self puffs/meltables
  • Gagging decreases as more solid foods are introduced
  • Thicker purees introduced (stage 2)
  • Vertical chewing pattern (munching) observed
  • Sits in a more upright posture during feeding (place in highchair)
  • No loss of liquid observed with breast/bottle feeding
  • Drinks from an open cup held by an adult (some loss of liquid)
  • Puts fingers in mouth to move food or to keep food in mouth

  • Holds a soft cookie or cracker in mouth (9 months)
  • Bites through soft cookies/crackers (12 months)
  • Chewing matures to more rotary jaw action (emerging) instead of vertical up and down munch pattern
  • Progresses to thicker purees (e.g. Stage 3)
  • Clears food items from lower lips by drawing lip inward and using upper teeth to clear
  • Increased upper lip activation on a spoon to clear food
  • Deliberately reaches for spoon
  • Introduce soft cubes of mashable food items (e.g. bananas) and soft table foods (e.g. scrambled eggs)
  • Begin to wean bottle feeding and present cup (e.g. sippy cup, straw cup, 360 cup, etc.)

  • Tongue tip elevation observed
  • Solid foods become child’s primary nutrition source
  • Grasps spoon with hand
  • Brings a full spoon to mouth
  • Begins to drink through a straw
  • Holds cup with both hands
  • Drinks with 4-5 consecutive sips
  • Eat ground, mashed, or chopped table foods (including soft pieces of meat) by 15 months
  • Use her tongue well to move food from side to side in the mouth
  • Lose a bit of food or saliva out of the mouth while chewing
  • Bite foods well
  • Eat coarsely chopped table foods, including meats and raw vegetables by 18 months
  • Sometimes chew with lips closed
  • Feed herself using a spoon, dropping some food off the spoon
  • Start to refuse some foods

  • Scoops food with a spoon and brings it to mouth with minimal spillage
  • Drinks from a cup with limited spillage
  • Swallows liquid with lip closure and no loss of liquid
  • Self-feeds frequently
  • Chews a variety of textures
  • Swallow food well with good lip control and no loss of food
  • Chew with jaw movements that go round and round, as well as up/down and side to side
  • Know the difference between food and non-food items
  • Scoop foods with a spoon, with minimal spills
  • Start to stab food with a fork and get it to her mouth
  • Start to show clear likes and dislikes of some foods

  • Child is able to chew/eat a variety of foods (fruit, vegetables, meats, and grains) and textures
  • Bites through a variety of food thickness
  • Self-feeds with little spillage
  • Holds a small, open cup with little spillage
  • Holds a cup with one hand
  • Uses fingers to put food on fork
  • Chews with lips closed
  • Chews using stable rotary (circular) chew pattern

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