Feeding Strategies

Feeding difficulties can occur for a variety of reasons. So it’s important for caregivers to deliver support that properly aligns with a child’s strengths, abilities and needs in order to promote the safest, most comfortable and positive mealtimes.  

A child’s feeding skills are directly related to their entire body’s physical and intellectual development. When a condition, illness or disability is present, feeding skills may be impaired. Many children who have been adopted have varying disabilities, special health care needs or feeding difficulties. Therefore, they require a different set of feeding strategies.

Common Feeding Strategies 

There are many strategies that can assist caregivers with supporting a child’s individual feeding needs. It’s always best to seek out specialized support from a trained feeding specialist, such as a speech-language pathologist or occupational therapist, when questions or challenges arise.

However, there are some basic actions that often work well for many babies and children. Listed below are some of the top general strategies for supporting a baby and child’s feeding development, organized into four groups:  

1. Feeding Timing 

2. Equipment 

3. Positioning 

4. Other Ways to Help 

Feeding Timing  

• Limit feeding times. Try limiting feedings and mealtimes to 30 minutes or less at a time. The longer a baby or child is asked to participate in a feeding or meal, the greater the chance he will begin burning more calories than he takes in orally.   
• Look for feeding cues. Try feeding babies and children based on their feeding cues. This means looking for signs that they are ready to eat and ready for a break or to be finished.  
• Look for hunger cues. Children may indicate they are hungry by bringing their hands to their mouth, sucking on their fingers or toys, opening their mouth, licking their lips, turning their head toward others and food sources, stretching, wiggling and showing increased physical movements, cooing and smiling at food sources, looking at and/or reaching for food, using specific sounds or words to request food, or fussing and crying.  
• Watch for other signs. Children may indicate they need a break or are finished eating by not sucking for lengthier periods of time or altogether, closing their mouth, turning their head away from others and food sources, eye rubbing, yawning, falling asleep during feedings, having a limp body, splaying their hands and legs, pushing food away using their hands, or fussing and crying.
• Respect a child’s desires. Crying, fussing and turning red or darker in color are late signs that a child is hungry or becoming upset that his cues to stop are not being understood or honored. Catching a child before these signs begin is strongly encouraged since all children feed best when they are calm and alert. Respecting a child’s desires leads to more positive mealtime experiences. 
• Change a schedule. Try slightly changing the feeding schedule. For example, offer smaller, more frequent feedings or larger, less frequent feedings. Watching for a baby’s cues will be crucial!  
• Keep the pace. Try pacing babies and children at feedings and mealtimes. Pacing helps babies to find sucking rhythms, reduces coughing and aspiration, minimizes the occurrence of liquid leakage and spitting up, allows for rest breaks and builds endurance. Pacing helps older children learn how to safely eat a meal at an appropriate pace, thoroughly chew and swallow food, and reduce the risk of choking. Always use a rate of feeding that matches the rate a baby and child can safely and comfortably handle.  

Your job as a parent is not to make your child’s way smooth, but rather to help her develop inner resources so she can cope.

Ellyn Satter, MS, RD, LCSW, BCD

Equipment  

• Use the right equipment. Try using feeding equipment that matches the individual needs of a baby and child. For example, use slower flow nipples and bottle systems for a baby who has a hard time with faster flows; specialty bottles and nipples for a child who has difficulty sucking or swallowing; softer nipples for a baby with a weaker suck; or smaller child-size spoons and cups that match the size of a child’s mouth and hands and allow for more successful eating and self-feeding.  
• Offer extra support. Try using a chair or seat that provides optimal positioning and support for a child, and offer extra physical support for their body when needed. This support could include rolled-up towels or blankets, pillows, foam and stuffed animals (for a child’s body), or boxes, suitcases, benches, stools, containers, books, wood, etc. (for their feet).   
• Provide the right foods and liquids. Try offering babies and children suitable foods and liquids for biting, chewing and swallowing, and appropriately sized food bites and sip sizes that reduce the risk of choking.  
• Offer “soothing” toys. Try offering a baby a pacifier or a teething/sensory toy before and after feedings for soothing, organizing and building oral awareness.  

Positioning  

• Get into position. Always follow the key elements of positioning for all babies and children.  
• Elevate! Always feed babies and children in an upright position that is at least at a 30- to 45-degree angle. Do not feed them lying down on their back or without any elevation as this can lead to choking, spitting up and other serious medical issues.  
• Maintain an upright position. Try keeping babies and children upright for at least 15 to 45 minutes after all feedings to keep foods and liquids in their stomach. You can do this by holding them, having them stay seated in their chairs or by using a carefully constructed wedge or rolled-up blanket or towel that offers adequate elevation.  
• Keep things safe. Sit at eye level with a child while feeding them, as this helps them maintain proper alignment for safely eating and drinking. 

Other Ways to Help 

• Make changes slowly. When making changes to how you are feeding a baby or child, start by changing one element at a time. Too many changes all at once can be stressful and can make it hard to know which changes worked well and which did not.  
• Make assessments. Stop feeding a baby or child who is coughing, choking or gasping for air. These are signs that something about the feeding process is not working and needs to be assessed and addressed before moving forward.   
• Don’t force your child. Avoid forcing a baby or child to eat. Calm them as much as possible before offering feedings and mealtimes, and respect the cues they are showing. 
• Encourage independence. Encourage babies and children to practice feeding themselves, when possible, to build foundational skills. This might look like gently helping a baby hold their bottle with you during a feeding, or offering a young child utensils and cups to practice with at each meal. Eating with a child is a terrific way for them to see how others eat and drink.  

Just as every child is a unique individual, so too are the feeding supports they may require around mealtimes. Additionally, even though some children have the same condition or disability, they are still very different and may have varying needs or capabilities. It is critical to look at each child independently across all areas of development to best understand their particular abilities and needs and the precise equipment required to support their growth and development. This might include using the strategies shared above and seeking additional help from a community expert.  

For more details on feeding best practices, download Holt International’s Feeding & Positioning Manual: Guidelines for Working With Babies and Children and reference our Feeding and Interaction Cues Handout (Appendix 9L2).