Answers to parents’ biggest questions about feeding and swallowing concerns

Baby transitions from bottle to solid foods

Most kids have experienced challenges with food at some point, whether that means eschewing veggies or refusing anything but chicken nuggets and pizza. But for children with airway disorders and other conditions that affect chewing or swallowing, mealtime isn’t just frustrating. It can be uncomfortable — and even dangerous.

If your child is experiencing difficulty drinking or eating, or is aspirating, your first step should be to make an appointment for a clinical evaluation, says Kathryn Davidson, a speech-language pathologist in the Feeding and Swallowing Program at Boston Children’s Hospital. Depending on the results, your child’s clinician will likely recommend certain strategies to make mealtime more palatable. Here, Davidson answers some questions for parents of kids with feeding and swallowing challenges.

Q. Why is my child struggling to progress with solid foods?

A. There are many reasons why a child may struggle to transition from bottle- or breast-feeding to purees and chewable solids. Often, this can be the result of delayed oral motor skills (such as immature chewing or tongue movements) or sensory-based feeding difficulties (such as gagging). These kids may benefit from additional practice with foods that break down easily when they mix with saliva (such as teething wafers) or tools that provide opportunities for chewing and exposure to new flavors and textures in a more controlled manner (such as a silicone safe feeder).

Other times, children may struggle to progress with solid foods due to underlying gastrointestinal issues or anatomical differences. Many babies outgrow these difficulties as they mature and continue to develop, but some babies require more support to help them eat age-appropriate foods. You should discuss this with your child’s pediatrician to determine whether a feeding evaluation may be helpful.

Q. How can I make mealtimes easier for my child?

A. Mealtimes can provide the opportunity for family bonding and shared enjoyment during our busy schedules. However, for children with feeding or swallowing difficulties, mealtimes can be stressful for the entire family. There are several strategies that may be helpful for making this a more relaxed and positive experience.

First, ensuring that your child has a structured mealtime schedule makes meals more predictable for them and also helps ensure that they are hungry. When children are allowed to graze throughout the day, they are often not hungry and might prefer other activities to eating. You can also include your child in mealtime preparation so that they can begin to touch and smell new foods in a low-pressure manner. Children frequently feel more comfortable interacting with or eating foods that they helped make. This can be a good strategy for including children who are tube-fed and not yet ready to eat by mouth, as well.

During the meal itself, provide one or two foods that you know your child can eat without difficulty, as well as one or two new foods that your family is eating. Encourage your child to explore this new food but don’t pressure them to eat it before they are ready. Some families find that having a separate “learning plate” is helpful for their children when they refuse new foods near their preferred foods. This allows the child to place foods that they are not yet ready to taste on a separate plate in front of them, which over time may make it easier for them to eat. Additionally, if your child is a picky eater, you can try to make new foods that are similar in appearance or flavor to their preferred foods. For example, if your child eats French fries, you could try sweet potato fries with the same sauces or dips.

Q. Why does my child cough when drinking?

A. Sometimes your child may cough when they drink too fast. Try offering a slower flow rate: If you’re bottle-feeding, use a slower-flow nipple, for example. If your child drinks from a cup, try using a straw to slow the flow rate. Some kids will also cough when they are learning a new skill, such as transitioning from the bottle to a straw or cup. Offering smoothies, which are thicker, can be helpful for slowing them down until they are more experienced.

Other times, coughing can be a sign that your child is having swallowing difficulties. You should discuss this with your child’s pediatrician if the coughing occurs frequently, if your child is often sick with respiratory illnesses or if your child has medical issues that might make it more difficult to swallow (for example, airway issues like laryngomalacia or neurological issues like cerebral palsy). The doctor may recommend a barium swallow or other test to determine the safest foods and liquids for your child.

Q. What can I expect from a visit with a feeding therapist?

A. When your child is experiencing feeding or swallowing difficulties, a clinical feeding evaluation can be a useful way to figure out why your child is struggling and how you can help them progress. During this visit, you will meet with a speech-language pathologist who has special training in feeding and swallowing. You should bring some foods and drinks that your child likes, as well as things that your child is having a hard time with.

The clinician will evaluate your child’s chewing skills, tongue movements, self-feeding abilities and sensory responses. They will also assess for any overt signs of swallowing difficulties and may recommend a swallow study if they feel it is necessary. They may try new foods or special bottles or cups during the visit to help make it easier for your child to eat or drink, and they will provide you with a plan of strategies to try at home as well.

Learn more about the Feeding and Swallowing Program.

Feeding and swallowing expert


Kathryn Davidson, MS, CCC, is a speech language pathologist in the Feeding and Swallowing Program and Center for Airway Disorders at Boston Children’s Hospital.