Understanding Feeding Difficulties in Children
Feeding difficulties are more common than many parents realise — and more complex than simply being a “fussy eater.” When a child consistently refuses food groups, gags at textures, struggles to chew or cannot sit through mealtimes, there is usually a reason. Finding that reason is the first step.
As a paediatric occupational therapist in Malta, I work with children across the full spectrum of feeding difficulties, from selective eating to more complex oral motor and sensory-based feeding challenges.
Common Types of Feeding Difficulties
Selective Eating
Some children eat only a very limited range of foods — often beige, smooth or crunchy foods in consistent brands or presentations. This goes well beyond typical fussiness. The range may shrink further over time. These children are genuinely distressed by food outside their accepted range, not simply being difficult.
Oral Motor Difficulties
Oral motor skills are the movement abilities of the mouth, lips, tongue and jaw. Children with oral motor difficulties may:
- Drool excessively beyond typical developmental age
- Have difficulty chewing and swallowing effectively
- Pocket food in their cheeks rather than swallowing it
- Take very long to finish meals
- Gag easily on lumpy or textured food
- Struggle to manage mixed textures (e.g., soup with vegetables)
Sensory-Based Feeding Problems
Many children with feeding difficulties have an underlying sensory processing difficulty. They may be hypersensitive to the texture, smell, taste, temperature or appearance of food. The thought of a new food touching their lips can provoke genuine distress.
This is different from behavioural refusal, and it requires a very different approach.
Behavioural and Anxiety-Based Feeding
Some children develop food refusal or anxiety around mealtimes following a traumatic experience — a choking episode, a period of illness, a painful swallow or a medical procedure. Mealtimes become associated with fear, and avoidance is the natural response.
Oral Motor Development: What Is Normal?
Understanding typical oral motor development helps parents know when to seek support:
- 4–6 months: Beginning pureed foods, tongue pushing food forward is normal at first
- 6–9 months: Moving food to the sides of the mouth for mashing, managing soft lumps
- 9–12 months: Chewing soft solids, self-feeding finger foods
- 12–18 months: Managing most family foods of appropriate texture, using a spoon
- 3–4 years: Eating most textures; diet should include a reasonable variety across food groups
Persistent difficulties beyond these ages, or a diet that is becoming more restricted rather than expanding, warrant professional assessment.
How Occupational Therapy Addresses Feeding Difficulties
OT assessment for feeding looks at the whole picture: oral motor skills, sensory processing, mealtime environment, feeding history, family dynamics and the child’s relationship with food. Only with a thorough assessment can we understand what is driving the difficulty.
Oral Motor Therapy
For children with oral motor difficulties, OT uses specific exercises and activities to develop strength, coordination and control in the mouth. This might include oral massage, blowing activities, resistive chewing or structured food exploration. The approach is always gradual and child-led.
Sensory-Based Feeding Intervention
Working with sensory-based feeding difficulties requires a slow, systematic approach. We start well outside the child’s anxiety zone — perhaps not with food at all, but with play activities that involve touch, smell and exploration. We use the Sequential Oral Sensory (SOS) Approach and similar frameworks that respect the child’s tolerance while gently expanding it.
Progress is measured in interactions with food, not bites. A child who can tolerate a new food on the table is making progress, even before they eat it.
Mealtime Environment and Structure
How mealtimes are structured matters enormously. OT works with families to create positive, low-pressure mealtime environments. This includes practical advice on:
- Seating position — feet flat on the floor, supported trunk
- Reducing mealtime pressure and anxiety
- Division of responsibility — parents decide what is offered, children decide what and how much they eat
- Introducing new foods without pressure through repeated low-stakes exposure
Tips for Families Dealing with Feeding Difficulties
- Avoid pressure and force. These consistently make feeding difficulties worse, not better.
- Keep mealtimes calm and predictable. Eat together as a family where possible.
- Serve new foods alongside accepted foods — never as a replacement.
- Involve your child in food preparation. Handling food in a non-eating context builds familiarity and reduces anxiety.
- Be patient. Research suggests it can take 15–20 exposures before a child accepts a new food. This is normal.
When to Seek Help
Seek an assessment if your child’s diet is very restricted, if mealtimes are consistently stressful, if your child is not gaining weight appropriately, or if you notice signs of oral motor difficulty such as excessive gagging or very slow eating. In Malta, paediatric OT support for feeding difficulties is available — and the earlier it starts, the better the outcomes.
If you’re concerned about your child’s development, contact us at +356 99872936 or visit wonderkids.mt to book an assessment.