Feeding Challenges in Children With Disabilities

Feeding challenges look different for every child. Some are just temporary phases, while others require extra attention and support. As children grow, they move from natural feeding reflexes to learning how to chew, swallow, and explore new tastes and textures. For children with developmental disabilities, this transition can come with unique challenges that might need additional support. It’s perfectly normal for children to be picky eaters at times, but when feeding struggles go beyond typical preferences and start affecting daily life, parents might feel unsure about what to do next. Concerns about nutrition and mealtime battles can make feeding feel stressful, but the good news is that effective options such as feeding therapy can make a big difference.

To explore feeding difficulties in more detail, we spoke with Joan Surfus, OTD, OTR/L, BCP, SWC, assistant professor of clinical occupational therapy at the University of Southern California’s Chan Division of Occupational Science Occupational Therapy, and owner of Surfus Pediatric Feeding and Occupational Therapy; and Marci Silver, MS, CCC-SLP, certified speech-language feeding pathologist and community outreach director at TheraPlay LA, and president/owner of Silver Speech.

Every child experiences food a little differently — some dive right in, while others take their time warming up to new tastes and textures. While picky eating is a normal part of development, some feeding challenges go deeper and might need extra support. Here are some of the most common areas where feeding issues can show up and what might be driving them.

Medical and physical factors

Feeding is a full-body process, and medical concerns can make it harder for children to eat comfortably or safely. Babies born prematurely might have weaker muscles or less coordination, making the suck, swallow, breathe pattern more difficult to master. Airway issues are a top priority to rule out. Silver explains that nasal congestion, enlarged tonsils or adenoids, or structural differences (such as tongue or lip ties) can interfere with breathing, and when breathing is disrupted, feeding often is too. Reflux, chronic congestion, or frequent vomiting can also cause discomfort during meals. Over time, that discomfort might turn into food refusal or anxiety around eating.

Motor development and posture

Feeding takes more than just mouth coordination; children also need to sit upright with stable posture. If their core muscles are still developing, eating can feel like hard work. Silver notes that therapists often start by looking at posture before digging into oral skills.

Oral-motor coordination matters, too. Dr. Surfus explains that if a child struggles to move their tongue, cheeks, or lips smoothly, they might have trouble chewing, clearing a spoon, or swallowing safely. These skills take time to develop and can be especially challenging for children with low muscle tone or motor delays.

Some children might also have difficulty with the fine motor skills needed for self-feeding, such as holding a spoon, managing an open cup, or coordinating bites and sips.

Sensory processing differences

Children with sensory sensitivities might react strongly to certain textures, temperatures, or smells. Dr. Surfus shares that when a child’s brain interprets those sensations as too much or not enough, food can feel confusing or overwhelming. Some children might gag on soft foods but crave the crunch of something crisp, while others prefer smooth textures and shy away from anything hard or crunchy.

Mixed textures (such as yogurt with fruit or chunky soups) tend to be the hardest. Some children might overstuff their mouths or pocket food in their cheeks to get more sensory feedback. It’s not just quirky behavior, but often a sign of how their body processes input.

Digestive discomfort

If eating is linked to tummy pain, constipation, or food intolerances, children might start to associate meals with discomfort. Dr. Surfus explains that even if symptoms aren’t visible right away, children can still form negative associations that lead to food refusal or selective eating.

Emotional and behavioral responses

Feeding issues often start with something physical or sensory, but over time they can affect a child’s emotions and behavior. Silver points out that if a child has experienced discomfort during meals, they might begin avoiding certain foods or mealtimes altogether. Those early negative experiences with food can lead to a pattern and eventually to aversions to specific foods.

When mealtimes become stressful, it can create a cycle of frustration or anxiety for both children and caregivers. Children might dig in their heels, while parents might feel pressure to get their child to eat, unsure of what’s a phase and what needs extra support.

Developmental transitions

Silver explains that feeding struggles often show up during big milestones, such as moving from breast or bottle through the typical food progression: from purees to hard munchables, meltable hard solids, soft cubes, and soft or hard mechanical foods. These transitions can reveal hidden difficulties with chewing, swallowing, or managing new textures. They’re also moments when routines and expectations change, which can bring previously unnoticed challenges to the surface.

Silver and Dr. Surfus both emphasize that feeding issues can appear at any age; some are noticeable early on, while others emerge as your child grows. They also outline red flags to watch for across developmental stages:

Infants (0–12 months)

• Struggles to latch or stay latched while feeding
• Gags, chokes, or spits up frequently
• Shows signs of reflux or visible discomfort while eating
• Arches, coughs, or refuses bottle or breast
• Has trouble moving from breast or bottle to purees or solids

Toddlers (1–3 years)

• Prefers certain textures, such as only crunchy or only smooth foods
• Gags, spits out food, or refuses mixed textures
• Overstuffs the mouth or holds food in cheeks
• Struggles to chew or coordinate mouth movements
• Has trouble sitting through an entire meal

Preschoolers (3–5 years)

• Becomes more selective or starts refusing familiar foods
• Avoids foods based on color, texture, or smell
• Shows stress or anxiety during meals
• Struggles with self-feeding, such as using utensils or drinking from a cup

School-age children (5+ years)

• Avoids more foods or entire food groups
• Withdraws from social situations involving food, such as school lunch or parties
• Needs food prepared in very specific ways
• Complains of discomfort after eating but can’t explain why

In the early months, babies rely on natural reflexes to assist with feeding. As they grow, these reflexes gradually evolve into learned skills that allow them to explore new textures and tastes — laying the groundwork for self-feeding. During this phase, caregivers play a critical role in introducing new foods and fostering a mealtime environment that feels safe and encouraging.

Typically, the shift from reflexive to learned feeding happens between four and six months. But as Silver points out, this stage can be tricky — especially today, when parents are often working and caregivers might take over feeding. It’s important to observe how a child’s motor patterns develop during this window, especially if they aren’t feeding themselves or they seem uncomfortable during meals. Silver adds that it’s equally important to pay attention to the reactions, cues, and verbal responses that parents or caregivers are giving the child during feeding.

For children with developmental disabilities, this transition can be more complex. Feeding involves a mix of motor coordination, sensory input, and social interaction — all of which might be affected by different conditions. As Silver explains, “The muscles that we learn for eating are the muscles we learn for speaking. That’s why we see such a range of developmental disabilities with feeding challenges. And, so, we as speech language pathologists took on this feeding journey because if our muscles aren’t working correctly while we’re eating, we may see speech-related difficulties as well. So we not only work on the sensory part of feeding, we work on the motor part of feeding.”

Some children might also struggle with the fine motor skills needed for eating — such as grasping a spoon, scooping food, or bringing a cup to their mouth. Dr. Surfus notes that occupational therapy often focuses on helping children build “graded control,” so they can lift a cup without spilling or use utensils with more precision. When these skills are still developing, mealtime can feel frustrating for both the child and the caregiver.

To support progress, Silver encourages a child-led approach to feeding, where children are invited to explore food at their own pace. Watching how a child interacts with food — whether they can bite, pull, or bring it to their mouth — gives caregivers helpful clues. Using a mirror with your child can also be valuable, Silver notes, since the face is the only part of the body we can’t see without one. These small steps build confidence and support independence over time.

Some developmental or medical conditions can make eating more challenging for children. Here’s a general idea of how feeding difficulties might show up in children with certain conditions:

• Cerebral palsy: children might have a harder time with the physical skills needed for eating — such as chewing or safely swallowing. Muscle tone, coordination, and posture all play a role, which can lead to coughing during meals or trouble moving food around in the mouth.

• Autism: many children experience sensory sensitivities that affect feeding. They might prefer foods of a certain color, texture, or brand — and strongly resist others. Some also struggle with trying new foods, changes in routine, or the overall sensory experience of mealtimes.

• Down syndrome: children might have low muscle tone (hypotonia) or anatomical differences that affect how they chew and swallow. They often need extra time to build oral motor skills and might benefit from tools or strategies that make eating feel safer and easier.

• Reflux and discomfort: reflux is common across many conditions and can make eating feel uncomfortable or even painful. When food is linked to discomfort, children might start avoiding it altogether — which can lead to picky eating or mealtime stress.

Interoception might sound a little fancy, but it’s really just our body’s way of signaling what it needs — such as when we’re hungry, full, tired, or cold. For children, it plays a big role in recognizing hunger cues. When those cues are hard to pick up on, mealtimes can become tricky. A child might skip a meal, then feel cranky or complain of a stomach ache, not realizing they’re actually just hungry.

What is interoception?

As Dr. Surfus explains, “Interoception, in short, is how we read our body signals. Do we recognize when we feel hungry or when we feel full? Another example is when we feel cold, we know to put on a sweater, or if it’s really hot, we know to wear short-sleeve shirts. As far as reading body signals, what happens when interoception isn’t sending signals or we’re not interpreting those signals correctly? For instance, we might be hungry but haven’t eaten yet. Let’s say we’re a really picky eater or a selective eater and when we don’t eat, we might get cranky or even get a stomachache. The caregiver might then offer food, but the child says, ‘'No, I don’t feel good.’ In this case, they’re misinterpreting the body’s signals. The child might think, ‘I don’t feel good, my stomach hurts, I don’t want to eat,’ but in reality, the stomachache is from missing the hunger cues. This misreading can lead to challenges because they’re not interpreting their signals well.”

Senses and emotions

Silver adds that eating involves far more than just chewing and swallowing — it’s a full sensory experience. Children engage with how food smells, feels, looks, and tastes. For some, even being near certain foods can feel overwhelming. That’s why a gentle, step-by-step approach — such as letting your child explore food with their hands or simply be near it — can help reduce anxiety and make eating feel safer. “Feeding and swallowing is the only physical task where we use all of our senses at once, and when we swallow, we use 26 muscles and six cranial nerves,” Silver explains. She also notes that eating is the only task children do that requires simultaneous coordination of all eight sensory systems.

But it’s not just about senses — emotions also play a big role, as Silver notes. When mealtimes are peaceful and encouraging, children tend to feel more comfortable trying new foods. Every child brings their own sensory preferences and past experiences to the table, so creating a warm, responsive environment can help build a more positive relationship with food.

Learning to read the body’s signals takes time. For children who struggle with hunger and fullness cues, gentle guidance from caregivers and therapists can make a big difference. That might mean using visual schedules to remind them to eat, modeling how to check in with their bodies, and creating routines that help connect sensations to actions. Over time, this helps children build awareness, confidence, and trust in their bodies — making mealtimes feel more manageable and less stressful for everyone.

It’s important to understand what feeding therapy is and what it involves. Feeding therapy is a type of specialized support that is used to teach a child with sensory or motor challenges how to eat or improve how they eat. It focuses on building the physical, sensory, and behavioral skills they need for more successful mealtimes. It can be administered by a speech-language pathologist (SLP), an occupational therapist (OT), or both working together. While an SLP might focus more on swallowing and upper gastrointestinal dysfunction, an OT might take a whole-body approach that can also include swallowing difficulties and upper gastrointestinal concerns, as well as posture, sensory processing, adaptive equipment, and with advanced training, the evaluation and treatment of dysphagia.

Some children might need help feeling comfortable with new textures or building the coordination to chew and swallow safely, while others benefit from consistent routines and gentle encouragement. At its core, feeding therapy focuses on creating a calm, supportive environment where children can feel secure and build confidence around food. We explore more about what feeding therapy looks like, how to find a feeding therapist, how to pay for therapy, and more in our article Feeding Therapy 101.

Every child’s relationship with food is unique — and so is the kind of support they might need. Feeding therapy brings together a range of professionals who tailor their approaches to help children build comfort, coordination, and confidence at mealtime.While speech-language pathologists (SLPs) and occupational therapists (OTs) often provide feeding therapy, not all are trained or certified to do so — titles alone don’t guarantee expertise. Both Silver and Dr. Surfus emphasize that effective feeding therapy requires specialized education, hands-on clinical experience, and in some cases, additional credentials. For instance, supporting infants in the NICU, treating swallowing disorders (dysphagia), or addressing complex sensorimotor issues typically falls outside standard training and requires advanced practice.

Silver and Dr. Surfus break down how various professionals might contribute to feeding therapy:

SLPs

• Focus on oral-motor skills, chewing, swallowing, and safe feeding techniques
• Help children strengthen the muscles needed for eating and speaking
• Often work with babies who have difficulty latching or swallowing or with children who struggle with certain food textures
• Might receive specialized training in approaches such as the Sequential Oral Sensory (SOS) method or tools that support oral-motor development

OTs

• Support many of the same feeding concerns as SLPs — including oral-motor skills, chewing, swallowing, and latching — especially when they’ve received advanced training in approaches like SOS, Beckman Oral Motor, or Sensory Integration
• Address sensory sensitivities, fine motor skills, posture, and self-feeding
• Help children feel more comfortable with food textures and mealtime routines
• Support skills such as using utensils or drinking from an open cup

Behavioral analysts (BCBAs)

• Use structured, reward-based strategies to encourage food exploration
• Help children build positive associations with eating and reduce mealtime anxiety
• Often focus on measurable goals, such as increasing the number of bites or expanding the range of accepted foods

While behavioral approaches can help some children expand their diet, Dr. Surfus cautions that they might feel too fast-paced or pressured — especially for children with sensory-based feeding challenges. She emphasizes that OT and SLP approaches often prioritize the child’s cues, comfort, and intrinsic motivation to eat, which might take more time but can be more sustainable in the long run.

Collaborative teams

Feeding is complex, which is why Silver highlights the importance of a collaborative team. Feeding therapists frequently coordinate with:

• Pediatricians
• Nutritionists
• Ear, nose, and throat (ENT) specialists
• Lactation consultants (especially for infants)
• Dentists or orthodontists (especially for older children or teens)

A feeding therapist should be clear about their own scope of practice and know when to refer out, Silver explains. Whether the challenge involves a baby’s latch, an adolescent’s oral structure, or a sensory struggle with food, the right support can make a big difference.

Finding the right fit

Feeding therapy is an intimate process — it happens in close physical and emotional proximity. That’s why Dr. Surfus encourages parents to find not only someone with the right skills but someone who clicks with their child. A good match helps build trust and makes therapy feel safer and more effective.

Dr. Surfus tells us that in California and some other states, additional certification might be required for feeding and swallowing issues. For instance, therapists working with dysphagia must hold an “advanced practice” credential, which families can verify online or directly with the provider.

Ultimately, the right therapist understands your child’s unique needs — whether motor, sensory, behavioral, or emotional — and tailors their approach with empathy and expertise.

Feeding is more than just nourishment; it’s deeply tied to connection, comfort, and confidence. When feeding is hard, it can bring up a lot of emotions for both children and caregivers. Silver and Dr. Surfus both highlight how emotional feeding can be. Since it’s such a core part of caregiving, parents often feel guilt, anxiety, or even shame when it doesn’t go smoothly. There can also be pressure to “fix” the problem quickly or disagreements between caregivers about the best approach, all of which can create extra stress. When feeding is hard, it can affect a child’s confidence. Silver reminds us that feeding is a skill — and like any skill, it takes time and support to build. But if a child has had tough experiences with food, such as gagging, choking, or not feeling understood, mealtimes can start to feel scary or frustrating.

Navigating mealtimes can be a little tough for families, especially when your child is still developing their relationship with food. But there are some easy and effective techniques you can try at home. As Silver points out, one of the most important aspects of feeding is that it’s a social activity. Families around the world gather around the table to eat together, and it’s essential to bring that practice back into your home.

• Make mealtimes social. Sit down and eat the same food as your child. Children learn by watching, and seeing you enjoy your meal might spark their curiosity.
• Keep things easygoing. Let your child explore food at their own pace — touching or being near food counts as progress. Avoid pushing them to eat.
• Aim for routine. Try to offer three meals and two snacks each day. These regular eating opportunities help build comfort and consistency.
• Model positive behavior. Mealtimes should be calm and enjoyable, not stressful. Avoid turning meals into a battleground.
• Start with familiar foods. If your child is picky or sensitive to textures, begin with foods they already like. From there, offer similar options to gently widen their comfort zone.
• Respect preferences. Forcing new foods can lead to negative associations. It’s better to go slow, follow your child’s lead, and honor their likes and dislikes.
• Celebrate small wins. Whether it’s a new food touched or a bite taken without protest, every bit of progress counts.

Every child has different needs at mealtime, and small changes can go a long way. The right spoon, cup, or plate can help kids feel more confident and in control while eating. Here are a few options that can support more comfortable, independent feeding:

Adapted spoons:

• Weighted spoons: heavier handles can help kids with shaky or low-tone hands feel more stable while scooping and bringing food to their mouths.
• Textured spoons: these spoons have bumps or ridges on the underside to offer extra sensory input, which can be helpful for kids with oral awareness or sensory needs.
• Maroon spoons: these soft, narrow spoons are gentle on the mouth and small enough to encourage proper lip closure.
• If needed, pack your kid's lunch or snack bag with adaptive flatware like EasieEaters Curved Utensils, which have angled handles to make self-feeding easier.

Adapted cups:

• Bear straw cup: designed to teach straw drinking, this cup lets you control the flow of liquid so your child doesn’t get overwhelmed.
• Recessed lid cup: these have a small opening that helps your child learn to sip without tipping the cup too far.
• Nosey Cup: with a cut-out rim to make room for the nose, this cup lets kids sip without having to tilt their head back.
• Munchkin Weighted Straw Cup: what I call “accidentally adaptive,” the weighted straw moves with the liquid, so it works at any angle, even upside down.

Adapted plates:

• Ezpz bowl or sectioned plate: these silicone mats stick to the table and have built-in sections, which can reduce spills and help kids feel more organized at mealtime.

Other:

• Z-vibe: a vibrating tool some therapists use before meals to help “wake up” the mouth and prep oral muscles for feeding.

Remember, connecting with other parents who are going through similar challenges can be really reassuring. Support groups are a great way to share tips, personal experiences, and encouragement.

And if you’re feeling overwhelmed, know this: you’re not alone. Many of us have faced the same questions, navigated stressful mealtimes, and searched for answers. With the right support, mealtimes can feel less overwhelming, and meaningful progress is absolutely possible — one bite, one step, one small win at a time. Next, head to our article on feeding therapy.