What it means:
Helping babies and children build the muscle strength and coordination needed to suck, chew, swallow, and manage different food textures safely.

When it’s needed:
If your child has difficulty chewing, struggles to move food around the mouth, drools excessively, or tires quickly during meals.

Major Milestone:
By 12 months, most babies should be able to bite and chew soft foods and drink from a cup with some assistance.

Quick Tip:
Offer safe chewy foods like soft breads or teething crackers to naturally strengthen jaw muscles during snack time.

What it means:
Helping children eat and drink safely without food or liquids “going down the wrong pipe” (into the lungs), which can lead to coughing, choking, or pneumonia.

When it’s needed:
If your child frequently coughs or sounds congested during eating, has recurring respiratory illnesses, and/or has a medical condition that puts them at risk for aspiration (such as prematurity, genetic conditions, neurological issues, or airway issues).

Major Milestone:
Most babies that aspirate will improve with growth and maturation. In the meantime, talk to your physician and feeding therapist about the safest plan to prevent pulmonary issues.

Quick Tip:
If your baby is coughing during breastfeeding, try a reclined position so that gravity isn’t pulling the milk into the back of baby’s throat. For bottle feeding, try holding the baby in an elevated sidelying position, using a slower flow nipple, and paced bottle feeds.

What it means:
Helping manage feeding difficulties related to reflux, where stomach contents move back up into the esophagus, causing discomfort or feeding aversion.

When it’s needed:
If your child arches during feeds, refuses to eat, vomits frequently, cries during or after meals, or struggles to gain weight.

Major Milestone:
Most babies outgrow mild reflux by 12–18 months, but some need therapy and medical management if it affects feeding and growth.

Quick Tip:
Keep your child upright for 20–30 minutes after meals and offer smaller, more frequent feedings to help reduce reflux symptoms.

What it means:
Introducing your baby to foods beyond breastmilk or formula, helping them learn how to taste, chew, and swallow safely while exploring different textures and flavors.

When it’s needed:
Most babies are ready to start solids around 6 months, when they can sit with little support, show interest in food, and have good trunk and head control.

Major Milestone:
By 9-12 months, babies typically eat a variety of textures and are working on self-feeding with their hands.

Quick Tip:
Focus on offering a wide range of flavors and textures early — messy eating is part of learning and building important feeding skills!

What it means:
Supporting babies who spent time in the NICU as they develop safe and efficient feeding skills. This often includes babies born prematurely, those with medical complications, or those who required early interventions.

When it’s needed:
If your baby had difficulty feeding in the NICU, experienced breathing or swallowing issues, or needed special feeding supports like an NG or G-tube, NICU follow-up can help.

Major Milestone:
Not all premature babies are eating fully by mouth by their due date. Work with your doctor and feeding therapist to ensure feeding is safe and positive for long-term feeding success.

Quick Tip:
Early and consistent feeding therapy is crucial — even babies who seem to be doing "okay" at discharge often need extra support as they grow.

What it means:
When a baby who is expected to take a bottle — whether for full feeds, supplementation, or occasional use — refuses or struggles to feed from it.

When it’s needed:
If your baby consistently turns away, gets upset, chews the nipple, or drinks very little from the bottle, support may be needed to work through bottle refusal.

Major Milestone:
The goal is for your baby to feed comfortably and efficiently from both breast/chest and/or bottle as needed, without stress or struggle.

Quick Tip:
Babies can refuse the bottle for a variety of reasons, from a breastfeeding preference to an underlying medical condition. In collaboration with your baby’s doctor, an evaluation with a skilled feeding therapist can help determine the underlying cause for the refusals and steps to overcome them.

What it means:
If your child’s feeding therapist or physician is concerned that your child may be aspirating, they may refer them for imaging to visualize how the food or liquid moves through their throat.

When it’s needed:
If your child is showing overt signs of aspiration (like coughing, choking, red/watery eyes, throat clear, and/or congestion) or is showing symptoms of aspiration (like recurrent respiratory illnesses or pneumonias, poor weight gain, and/or unexplained feeding refusals).

Major Milestone:
Occasional coughing with eating or drinking can be normal, but if it is happening every day or multiple times a day, seek out advice from a feeding therapist and ask if a swallow study is indicated.

Quick Tip:
There are two types of swallow studies that can be completed in an outpatient hospital setting. A videofluoroscopic swallow study (VFSS) uses x-ray imaging to see how your child is swallowing. A flexible endoscopic evaluation of swallowing (FEES) uses a tiny camera through the nose to visualize the child’s swallow.

Sensory Feeding Difficulties
What it means:
Some children have strong sensory responses to food—like texture, temperature, taste, or smell—which can make eating stressful or overwhelming.

When it’s needed:
If your child avoids certain textures, only eats a very limited variety of foods, gags easily, or becomes upset around new foods, sensory challenges might be impacting mealtimes.

Major Milestone:
Picky eating can be normal beginning around 18-24 months, but shouldn’t result in growth challenges, a restricted diet of <20 foods, or refusals of entire food groups.

Quick Tip:
Start early with “no-pressure” exposure to a variety of foods, textures, and flavors. Encourage self-feeding with hands (babies can do this as early as 6 months with safe textures!).