Feeding support

At the Step by Step Feeding Clinic, we incorporate a developmental approach to feeding therapy that considers the motor, sensory, and emotional needs of each child. While we use positive reinforcement as a behavioral strategy to improve targeted behaviors, we do not provide true behavior-based feeding therapy.

Our approach is based on principles, including those described in Ellyn Satter’s Division of Responsibility and Fraker, Cox, Walbert, and Fishbein’s Food Chaining Method, which provides a framework for improving feeding skills.

Services are designed to provide parents with an understanding of the likely causes of their child’s feeding difficulties and the tools to support positive, enjoyable mealtimes. Intervention may also involve helping parents navigate medical assessments and recommendations, as well as occupational therapy to address sensory differences that impact mealtimes. Skill development is targeted through modification of foods, as well as their presentation at mealtimes, with the child as the primary feeder.

The goal of feeding therapy at Step by Step is to empower your child to transition to the next step of feeding in a safe and comfortable way. Our feeding therapy room resembles a kitchen, and we work together at a table with the child sitting in a high chair or Special Tomato chair adjusted to their size to provide adequate positioning for eating. Families should bring their own food from home. Parents and other family members (siblings, caregivers, grandparents) are included in the sessions as they are just as important to facilitating change as the child.

Early referrals can prevent years of mealtime battles - please call us today if your child is struggling with feeding!

Infant Feeding
Many families experience difficulty with breast- and/or bottle-feeding in the newborn period. At the Step by Step Feeding Clinic, our goal is to support you and your infant in establishing more efficient and enjoyable feedings.

Feeding difficulties in the newborn period may be due to:

Oral motor incoordination
Oral hypersensitivity (gagging on nipple or pacifier)
Tongue and/or lip ties
Difficulty with state regulation (too sleepy, lack of hunger cues, etc.)
Gastrointestinal difficulties (reflux, slow stomach emptying, milk sensitivities/allergies)

Resulting issues may include:

Parent/caregiver stress
Poor weight gain
Breastfeeding complications (maternal pain/discomfort, poor supply)
Bottle refusal

Older Infant and Toddler Feeding:
There are several feeding transitions in the first year of life and beyond. Many children struggle with these transitions and the impact on family mealtimes is significant.

Examples of these difficulties include:

Gagging/vomiting with spoon feedings
Difficulty tolerating textured foods (Stage 3 baby foods or mashed table foods)
Failure to transition to table foods
Difficulty chewing soft and/or hard textures
Excessive mouth stuffing or holding food for long periods of time
Difficulty eliminating bottle use/transitioning to a cup
Delayed self-feeding skills (utensil use, use of an open cup)
Negative mealtime behaviors (crying, tantrumming, throwing food, food refusals)
Stressful mealtimes for parents and child

Common underlying causes of feeding difficulties in infants/toddlers include:

oral hypersensitivity (grimacing, gagging, or expelling due to texture sensitivity)
tactile defensiveness (does not like to touch food or have messy hands and/or face during feeding)
gastrointestinal difficulties (reflux, constipation, slow stomach emptying, food allergies/sensitivities)
parent/child interaction challenges; mismatch of child's need to be independent and parent's need to feed their child (may be impacted by concerns with weight gain, parent expectations, or child's temperament)

Preschool-School Age Feeding:
Continued difficulties in children over the age of 3 are often described with the terms PICKY and PROBLEM feeders. For many of these children, the family dynamic and emotional regulation at meals are addressed first.

If your child demonstrates the following difficulties, support can be provided to help improve the quality of your family mealtimes:

Extremely limited food repertoire (less than 15 foods eaten consistently, refuses food groups)
Rigid mealtime behaviors (only eating certain brands of foods, foods must be prepared a certain way, etc.)
Texture aversions (refusals, gagging, vomiting)
Suddenly refuses a food they previously preferred and never eats it again
Mealtime anxiety (often becomes very upset, gags or retches at the sight/smell/taste of a new food)
Failure to participate in family meals (leaves the table, tantrums, etc.)
Difficulty participating in social activities involving food
Poor weight gain and/or nutrition concerns

Feeding support

Oral motor incoordination

Oral hypersensitivity (gagging on nipple or pacifier)

Tongue and/or lip ties

Difficulty with state regulation (too sleepy, lack of hunger cues, etc.)

Gastrointestinal difficulties (reflux, slow stomach emptying, milk sensitivities/allergies)

Resulting issues may include:

Parent/caregiver stress

Poor weight gain

Breastfeeding complications (maternal pain/discomfort, poor supply)

Bottle refusal

Older Infant and Toddler Feeding: There are several feeding transitions in the first year of life and beyond. Many children struggle with these transitions and the impact on family mealtimes is significant. Examples of these difficulties include:

​

Gagging/vomiting with spoon feedings

Difficulty tolerating textured foods (Stage 3 baby foods or mashed table foods)

Failure to transition to table foods

Difficulty chewing soft and/or hard textures

Excessive mouth stuffing or holding food for long periods of time

Difficulty eliminating bottle use/transitioning to a cup

Delayed self-feeding skills (utensil use, use of an open cup)

Negative mealtime behaviors (crying, tantrumming, throwing food, food refusals)

Stressful mealtimes for parents and child

Common underlying causes of feeding difficulties in infants/toddlers include:

​

oral hypersensitivity (grimacing, gagging, or expelling due to texture sensitivity)

tactile defensiveness (does not like to touch food or have messy hands and/or face during feeding)

gastrointestinal difficulties (reflux, constipation, slow stomach emptying, food allergies/sensitivities)

parent/child interaction challenges; mismatch of child's need to be independent and parent's need to feed their child (may be impacted by concerns with weight gain, parent expectations, or child's temperament)

​

Preschool-School Age Feeding: Continued difficulties in children over the age of 3 are often described with the terms PICKY and PROBLEM feeders. For many of these children, the family dynamic and emotional regulation at meals are addressed first.

Older Infant and Toddler Feeding:
There are several feeding transitions in the first year of life and beyond. Many children struggle with these transitions and the impact on family mealtimes is significant.

Examples of these difficulties include:

Preschool-School Age Feeding:
Continued difficulties in children over the age of 3 are often described with the terms PICKY and PROBLEM feeders. For many of these children, the family dynamic and emotional regulation at meals are addressed first.