“Is This Normal?” – The Feeding and Swallowing Edition
The title wouldn’t suggest it, but Speech Language Pathologists (SLPs) are qualified to work in many areas including voice, fluency, pragmatics, cognition, swallowing and feeding, to name a few.
The last two usually catch my friends and clients by surprise. Feeding and swallowing are important factors of growth and development, and SLPs are qualified to treat related disorders across the entire life span. Issues with feeding and swallowing can affect nutrition, health, and the parent/caregiver-child relationship.
On this edition of “Is this normal?”, I run through a few scenarios and discuss what is “normal” when it comes to feeding and swallowing, and what may need consultation from a speech therapist.
“When my toddler was a baby, he ate everything. Now it seems like he only wants chicken nuggets. Is this normal?”
Yes and no. Through growth and development, kids learn to prefer certain foods over others. Toddlers also LOVE consistency. So a food like chicken nuggets gives that “sameness” versus a blueberry that could be squishy, firm, sour, sweet, etc. Between the ages of 2 and 5, it’s common and “normal” for kids to limit the type of foods they will eat. It’s also normal for a child to have 15 to 20 “exposures” to a new food before they accept it into their food inventory.
However, there’s a point when typical picky (or selective) eating becomes disordered selective eating. Red flags to look for that warrant further consultation or investigation are:
Having a food inventory of fewer than 20 foods and the child does not add more even after consistent exposure.
“Dropping” preferred foods, or refraining from eating preferred foods.
Will eat only one texture of food (e.g. only smooth, only crunchy, or only squishy) or from a particular food group.
Refusal and strong avoidant responses to presentation of new or non-preferred foods.
“My baby keeps grabbing for the spoon. Is that normal?”
Yes! Absolutely normal. One way to help with the spoon battle is by giving your baby their own spoon to hold and play with. You can introduce spoons and start teaching self-feeding skills to your child as soon as you introduce solids. It may get messy, but that’s part of the fun in babies learning self-feeding skills. It encourages independence and allows your child to explore food in a new way.
It is important to keep in mind that when introducing solids and spoon feeding, your baby should be able to sit upright independently and hold their head straight so that they can keep their head and neck upright for safe swallowing.
“My child is gagging during meals. Is this normal?”
Gagging in young children 6 to 12 months can be normal. The gag-reflex is a protective measure that helps babies stay safe while swallowing and is more forward in their mouths than in older children. As children grow and develop and start to mouth toys, hands, and food—the gag reflex starts to become less sensitive and move “backward” to a typical place in their mouths.
Frequent gagging in older children can be a red flag of an oral-motor or sensory issue. “Oral-motor” refers to a child’s ability to move lips, tongue, jaw, and facial muscles in an age-appropriate way. A sensory issue means that children are responding atypically to the sensation of food in their mouths. Mouth stuffing or gagging with a slight change in texture are two different ways a sensory issue can show up.
“My baby has a coughing fit when I feed them. Is this normal?”
This is a tricky question with a few possible answers. Often, when babies are still getting the hang of the suck-swallow-breathe reflex, they may cough occasionally. You may also see coughing occur more frequently during times of airway congestion or a cold.
However, consistent coughing or choking while breast or bottle feeding (or swallowing in general) can be a sign of aspiration. Other signs and symptoms of aspiration are red face, watery eyes, and wet sounding breathing or cry. Aspiration happens when a foreign substance (food or liquid) is inhaled into the lungs. It can be painful and uncomfortable and cause feeding aversions. It’s recommended to consult with a pediatrician and a speech therapist to do a full swallowing evaluation to ensure safe swallowing. A speech therapist can provide tools and strategies to mitigate the risk and occurrence of aspiration.
