Skill & Ability

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Evaluation & Treatment: Feeding Skill Domain

Authored by: Suzanne Evans Morris, PhD, Erika Gisel, PhD, OTR, erg, and Feeding Matters

Many people think that eating and drinking develop easily in every baby, but they do not. Learning to eat skillfully and comfortably is rooted in the development of sensory and movement skills that make it possible for an infant or child to suck, swallow, bite, and chew. Feeding skills and abilities include the social, communication, and interactive skills that integrate with mealtime skills.

Feeding is complex and involves many different parts of the body, as well as the mind and emotions. It is based on a combination and coordination of skills, requiring body movement, sensory processing, oral feeding, self-feeding, mealtimes, and communication. It is like a giant jigsaw puzzle in which each piece is important. When one or more pieces of the feeding puzzle are missing, out of order, or unclear, the child can have difficulty eating and drinking.

When You Should Be Concerned

Below is a sample of warning signs associated with pediatric feeding disorder. For a more comprehensive list based on your child’s age, please visit our Infant and Child Feeding Questionnaire© page.

  • Coughing, choking, gagging, or vomiting while eating and drinking
  • Difficulties with a variety of tastes or texture, which may reflect sensory processing issues
  • Pocketing of food between the cheeks and/or gums
  • Gurgly, hoarse, or breathy voice quality
  • Fatigue or difficulty coordinating sucking or chewing with swallowing and breathing
  • Arching, stiffening of the body, or refusing to eat during mealtimes

Who Can Help Assess and Treat

Helping an infant or child to learn to eat and drink is based on the careful integration of skills taught by multiple disciplines. The three most common pediatric feeding skill and ability specialists are speech-language pathologists, occupational therapists, and physical therapists. They understand how different parts of the body work, and they help children develop feeding skills to the best of their abilities. Each specialist has expertise in one area; many have participated in advanced courses and training programs that provide them with an understanding of how to combine observations and treatment ideas in collaboration with other professionals. The vast majority of these providers have master’s degrees, and many hold doctoral degrees and have postgraduate training.

Speech Language Pathologists Occupational Therapists Physical Therapists

Hover over each specialist to learn more about how they relate to feeding disorders.

What They Do

Speech Language Pathologists

  • Collaborate or assist with swallow studies because of their specialized training in assessing a child’s ability to swallow safely and efficiently
  • Improve skilled movement of the mouth that leads to safe and efficient eating and drinking
  • Provide strategies for improving coordination and overall muscle tone with a child’s oral/facial muscles and improving articulation
  • Offer a great deal of guidance that helps parents create satisfying individual and family mealtimes for their children
  • Determine if oral-motor and/or oral-sensory problems are contributing to a child's feeding struggle

Occupational Therapist

  • Help develop overall movement coordination skills that support feeding development
  • Focus on fine motor skills to develop coordination of more precise movements between the eyes, shoulders, arms, and hands
  • Propose strategies for improving sensory processing that incorporate all of a child’s senses in an organized way during eating
  • Facilitate the development of self-feeding skills
  • Help children increase their comfort level when eating a wide variety of different food textures

Physical Therapist

  • Help a child develop better control of his or her body as a whole
  • Strengthen head and trunk control to provide the foundation for specific movements of the mouth, chest, and abdomen used for breathing, eating, and swallowing

This model addresses all aspects of pediatric feeding disorder. Click the model to learn more.