How to tell if your child has a feeding problem—and what to do next

Feeding your child is critical, sure, but it’s not always simple. There are many complexities that go into feeding babies and toddlers, whether breastfeeding or bottle-feeding, starting solids or expanding their food exposures.

When your little one experiences feeding challenges, it can be distressing. You may have more stress after hearing about a recent study claiming that infants with feeding problems were more likely to have developmental delays later in childhood.

“Feeding difficulties may be the first indication of a developmental delay, but the delay was already present, just undiscovered,” Amy Peterson, an Idaho-based feeding and lactation consultant with Evenflo Feeding, tells Motherly. “Feeding problems can be an indicator of developmental delays. This is true. But feeding problems do not cause delays.”

Knowing that, let’s take a dive into feeding issues so you know what you may or may not be dealing with.

Common feeding problems in babies and infants

Feeding problems in children can be classified in one of three ways:

• Structural 
• Neurodevelopmental
• Behavioral

A tongue tie is an example of a structural issue, whereas trouble swallowing could be neurodevelopmental. Refusal to eat could be behavioral. It’s worth noting there can be overlap between those categories.

Some signs of possible feeding issues in babies and toddlers may include: 

• Eating only certain foods
• Avoiding or eliminating food groups
• Pushing food away or refusing to eat
• Choking or gagging
• Coughing 
• Drooling 
• Holding food in the mouth 
• Chewing difficulty
• Not progressing from initial purees to more textured and eventually age-appropriate diet

In older babies and toddlers, not progressing through textures warrants seeking help, Peterson points out. More subtle signs are a lack of lip closure around a feeding utensil, the inability to sit with appropriate posture and lack of hand-to-mouth coordination.

Additional signs of feeding issues specific to younger babies include:

• Arching their back during a feeding session
• Stiffening during a feeding session
• Crying during a feeding session
• Falling asleep during a feeding session
• Difficulty with both breast and bottle-feeding; or baby won’t eat
• Not progressing from breast or bottle to solids
• Taking a long time to eat
• Becoming congested
• Spitting up or throwing up
• Not gaining weight

“For a parent, the first sign of a feeding issue is a baby who is not gaining weight or is gaining too slowly,” Peterson says. Health care pros dub that “failure to thrive,” which means the child consistently does not gain weight.

“More subtle signs of a feeding difficulty include arrhythmic feeding with breast or bottle, arms that hang to the sides or flail during feeding, and difficulty timing swallowing and breathing,” Peterson adds.

Feeding problems may be linked to developmental delays

In the Journal of Pediatrics study, researchers surveyed mothers of 3,597 children about gagging, crying during meals or pushing food away. Then they assessed whether the children went on to have developmental delays at 18, 24 and 30 months.

After crunching all the data, they found that most kids didn’t have significant feeding issues between 18 and 30 months. But 21% had high feeding problems at either one or two points in time.

Feeding problems were increasingly linked with a score that showed risk for developmental delays.

The study authors explain that infants with frequent feeding problems—especially those that continue into their third year of life—may be considered at-risk for developmental delays. They could benefit from more targeted screening (and perhaps intervention) when they’re younger.

The reality (and causes) of feeding challenges

There is research suggesting that children with pediatric feeding challenges do go on to have developmental delays, says Lori Caplan-Colon, owner at Montclair Speech Therapy in New Jersey, which also offers swallowing and feeding therapy.

If feeding problems are a result of sensory challenges, that can show up in other areas, such as in how the child plays and engages with their environment. That can lead to delays if there are limited opportunities for exploration, she says.

“If feeding challenges are medically based, complications from those challenges [including any side effects, additional medical appointments, prolonged hospitalization] can hinder development,” Caplan-Colon adds.

If a child isn’t making progress with diet due to limitations with oral skills to manipulate foods, it may also manifest in the speech or language area. “Weakness or reduced coordination of oral structures will affect feeding as well as speech,” she tells Motherly.

Peterson says she doesn’t see kids with feeding issues necessarily go on to have delays. “Feeding difficulties can be associated with so many things, including a mismatch between parenting style and baby temperament. Or something as simple as using the wrong bottle, spoon or cup,” she says.

On the other hand, feeding difficulties can be caused by tongue tie, food sensitivities, speech/articulation problems, sensory issues, anxiety, obsessive-compulsive disorder, and more. These are not considered delays, but they are diagnoses that will benefit from working alongside a professional, she adds.

A note on “normal” feeding

Now that we know what may signal a red flag, it may be just as important to find out what’s “normal.”

If your baby is spitting up a lot, but still gaining weight? Likely normal. If your kid starts to prefer certain foods over others, that’s pretty common, Caplan-Colon notes. Also, if feeding time is messy, that’s common, Peterson says.

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When to see a doctor

If you suspect your child might have a feeding problem, your first step should be to talk about any issues you’re seeing with your child’s pediatrician, and lactation consultant may be helpful, too. They’ll likely refer you to a feeding specialist.

“What I do not want is for parents to feel overwhelmed or helpless when it comes to their child’s potential pediatric feeding challenges,” Caplan-Colon says. “Parental instinct is strong and it’s important to seek help early to avoid exacerbation of the challenges,” she says.

During a consultation, the health care professional will likely get a full medical history, examine the child’s mouth, and may ask to see them drink or eat in order to diagnose an issue. If there’s a problem, they can come up with a care plan.

Feeding solutions and treatment

If your baby or toddler does have an issue, there are feeding therapy solutions—most likely in the form of outpatient visits.

At home, Caplan-Colon says making meals fun has “huge value” in both home and in feeding therapy sessions.

“Children may refuse to ‘eat’ the broccoli, but perhaps, they will begin to interact with the broccoli and begin to make stamps when dipping broccoli in a dip,” she explains.

“When it comes to gagging, we want to encourage our littles to work out that gag reflex so exploration of non-food items can be utilized,” Caplan-Colon says. “Many companies have designed a variety of tools to target the ‘normalization’ or ‘desensitization’ of a gag response.”

Getting support

“Developmental delays cannot be prevented,” Peterson emphasizes. “They can be addressed, though, so the child can reach their full potential.”

If your child exhibits any signs of a feeding issue, it doesn’t mean your child definitely has a problem—or that they will have other developmental delays. If they have been diagnosed with a feeding issue (or delay), there are plenty of professionals ready to help, mama. 

“I don’t want parents to worry that a feeding difficulty equates with a developmental delay,” Peterson says. On the other hand, resolving a feeding issue is not guaranteed to prevent future problems, either, she adds.

“Parenting is messy. Love your baby, do your best, get help when you need to.”

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