Q&A: Toddler Gags on Table Food

CME WebsitesBehavior, Child Routines, Mealtime

blockquote_bgMy daughter just turned one. She is not eating table food. She is basically only eating stage 3 jar food. She will eat stage 3 fruits, veggies and “meals.” The meals I will typically mix with milk to make somewhat thinner (but not too thin) as she will gag on the thickness of the puree sometimes. She does well with the “chunks” in the stage 3 meals but she doesn’t chew the chucks, she just swallows them. We have spoken to her doctor about this and the doctor says my daughter needs to learn to chew. I don’t know how to get her to do that.
My daughter will put some things to and in her mouth. For example, she will put Cheerios and Kix in her mouth and suck them. But then she will eventually push it back out with her tongue. She rarely swallows them and sometimes will gag on them. She will “eat” puffed doodles (like cheese doodles but healthier) by putting them in her mouth and “chewing.” But they dissolve eventually. She will also “eat” cookies the same way; she will chew but basically they dissolve so that’s how she swallows them.
Our doctor says as long as she is doing some of that, she is ok but I feel like she should be eating more at this point. She will eat her stage 3 jar foods and yogurt pretty well most of the time but when offered other things she just clenches her mouth or pushes the spoon away. I offered her pastina the other day. The pastina is much smaller “chunks” then the stage three “chunks” but she wouldn’t take the pastina; she barely let me get it in her mouth. Then when I offered her the stage 3 food, she ate it up with no problem.
I then decided to put the pastina in the stage three food and she ate it fine. The doctor says just keep offering her table food first and then she will eventually get it. But if she doesn’t eat the table food I give her stage 3 so she doesn’t starve. But it almost seems as if my daughter knows the stage 3 will come if she doesn’t eat the table food. But also she doesn’t even put some of the table food IN her mouth. She will put it TO her mouth but not IN it.
Some people say some kids just take longer to get used to the texture of solid foods. Some people say I am overreacting and she is making progress but I just want to know if there is something wrong, if she is being picky or if she is just “slower” in getting to table food then others. Other information that may be helpful: My daughter did have reflux and was on medicine until 11 months. She stayed with stage 1 food at 6 months. She has had ear tube surgery due to many ear infections and the ENT said her adenoids are slightly enlarged. After her first birthday she got hand/foot/mouth which made it painful for her to eat. She is a very healthy weight (and always has been) in the 60% percentile. She is in 75% percentile for height. She continues to grow; she is talking and walking (walked at 9 months) and has above average number of words (about 8-10 words). She has met (and continues to meet) almost every milestone on time or early.

I bounced your question off a few of our occupational therapists and speech therapists who specialize in feeding issues. We all agree that you should call your local early intervention provider and ask for a feeding evaluation. This is a link for resources in your area: http://www.ncei.org/ei/itp/branch.html  We do not think you are over-reacting and we take feeding concerns very seriously and it is important to address them as early as possible to make future eating experiences enjoyable.

We wonder if her enlarged adenoids could be contributing to her ability to breathe freely and therefore chewing and swallowing could be more difficult for her. Also, since she was on reflux meds until age 11 months, is her reflux completely resolved or could this be a contributing factor as well? These things are of course medical in nature and would be things to discuss with your doctor.

Three of our therapists have offered the following suggestions for some things you can try in the meantime:

  • Start out encouraging her to play with toys in her mouth, and keeping mealtimes positive and playful with table foods. It would be great to encourage her to imitate play with different types of teether, chew tubes or even a tooth brush. Anything that she can get to the sides of her mouth. If she doesn’t tolerate that, mom could start with just touch/play around the mouth and face with stuffed animals or a washcloth. As far as the food goes, I would encourage her mom to keep offering the table foods. Praise any action the child does, even if it is just bringing it to her mouth or giving it a kiss. She can make sure she is having “family” mealtimes so she can observe others eating. I know it is gross, but she can show her daughter how she is chewing by keeping her mouth open. I would encourage foods that melt and stick together, like the cheese curls she mentioned – also graham crackers and teething biscuits. (large “stick shaped” foods that she can practice chewing on-toast cut in strips, etc)
  • Do a lot of activities like bouncing with her while using a chewy tubes during playtime and also a lot of food play. Also, I would have her add less and less milk to the solids to little by little increase the thickness/texture. Then increase it even more by adding like elbow mac and rice, etc…kinda like she did with the pastina. Then move laterally into foods that look like the baby food… i.e . chef boyardee, soups thickened with crackers, etc and continue to offer meltable solids and cookies, etc.
  • The place I start with all my feeding kids is to ensure that the mealtime is a positive social experience. I would encourage the mom to do a self check of her anxiety and stress level during mealtimes because her child is probably very in tune to those emotions and is in turn feeling anxious and stressed. I talk about re-defining what it means to “try” a food, to include touching new foods, bringing it to the mouth, smelling or licking foods, handing food to mom and dad. Often by reducing the pressure to put food in the mouth, chew and swallow, kids are more apt to actually do so. This little girl has probably already learned that food is scary with her experience with reflux, gagging, and possibly choking that we need to make meals as rewarding and stress-free as possible. I would also encourage mom to always have the food that the baby is eating on everyone else’s plate too. Also, to reduce the number of pieces of food on the little girl’s tray. Rather than giving 5 pieces, try only 1 to reduce the demand. Good foods to try would be cubes of baked sweet potato or butternut squash or stewed pears. They are very soft and mash well without good chewing skills.

You may have already reviewed this page on our web site, but this is the link for typical feeding skills of a 12-18 month old.