Addressing potential pitfalls with a learning-to-eat infant

Feeding 411: part 1 – gagging, grabbing the spoon, and getting out of the chair

Editor's Note: With new tastes to explore, new tools to try, and a new level of social interaction, learning to eat table foods is a time of adventure for infants. Guiding a child through these experiences, however, can be a complex process for parents as they try to balance nutritional needs and monitor development of chewing, swallowing and spoon/fork/cup skills, while safely encouraging children to become able to feed themselves and enjoy mealtime with family. In the information below Betsy Clawson, Children's Feeding Program Behavioral Coordinator, shares common "pitfalls" for new feeders, ideas for ways to steer clear of potential problems, and warning signs of causes for concern. We plan to add information to this "Feeding 411" section of Tid*Bits regularly. Please contact us with your questions and areas of interest related to children's feeding behaviors. We hope to feature your suggestions for topic ideas on future postings on this page.

Gagging

It is typical for children to experience some gagging as they are learning to eat. Since they most likely do not have enough teeth to chew food really well, the gagging reflex helps protect them from choking on bites that are too large. Often toddlers become used to the smooth pureed foods they are initially given, and when they move to mixed textures they become confused and are not always sure whether to swallow the food whole or chew. They often try to swallow it like the smooth food but then are not sure what to do with the lumps.

Children may also gag if they eat too quickly, have too much food in their mouth, or if they don't like the taste or texture of what they are eating. While the tendency to gag does not totally disappear, it usually does improve as the child gets older. Gagging should not be a major concern if it happens only occasionally, seems related to certain tastes/textures, or if it seems to lessen with repeated exposure to the food. However the following may be causes for concern and something to consider mentioning to a child's primary care provider:

• Child gags frequently – daily to several times a day
• Child's gagging always leads to throwing up
• Child is not gaining weight or is losing weight
• Child throws up food from previous meal
• Child does not seem to be improving over time and/or is not progressing to textures and table foods relative to other children his or her age. (For a guide for an introduction of foods, click here.)

Toddlers can also have an exaggerated gagging reflex. When this is the case, sights or smells can cause severe gagging and/or throwing up and putting fingers, hands or teething toys near or just in the front of the mouth may cause gagging as well. Children with these issues are sometimes not able to progress to table foods and can become anxious about eating because of fear of gagging. These types of concerns are important to discuss with a child's primary care provider. If gagging interferes with a child's ability to meet feeding milestones, it may be necessary to seek help from a specialist.

Remember to always watch your child closely when trying new foods. Any object that is 1" in diameter can plug your child's throat and objects smaller than that can be inhaled. For more information on mealtime choking hazards, click here.

Grabbing the spoon

Children may become interested in spoon feeding themselves as early as 8-9 months but typically it will be several months before they master this skill. When a baby starts reaching for the spoon, it can take much effort on the parent's part to get the spoon to the child's mouth. To help an "eager feeder" transition to spoon feeding - and minimize frustration for all involved - try:

• Giving the child a spoon to play with, supervised at mealtime, to help learn how to hold it.
• Letting the child dip a spoon into food and practice bringing it to the mouth while you continue to feed him or her.
• Loading their spoon for them and then letting them bring it to their mouth. Young children are usually more accepting of help from their forearm and/or elbow than you grabbing their hand.
• Alternating bites from "your spoon" and "his/her spoon."
• Allowing self-feeding at the beginning of the meal when the child is hungry and motivated. Then feed the rest when they lose interest and start doing more playing than eating.

Getting out of the chair

If a child does become upset during mealtimes, it is important to try to help them calm down, even slightly, before taking them out of the chair. Ending on a positive note helps ensure your child will be more willing at the next mealtime. Sometimes distraction can divert their attention from whatever was upsetting. Also continue to feed your child only when he or she is in a high chair or sitting down at the table. Stand-up eaters can become all-day snackers who are picky at mealtime because they are not hungry.