Food Oral Disorders: Complete Speech Therapy Guide
When eating becomes a struggle: understanding and supporting children with food oral disorders, from selectivity to sensory issues.
Food oral disorders affect many children and represent a major source of concern for parents. Food refusals, extreme selectivity, difficulties transitioning to solid foods... These situations can have consequences on growth, development, and family dynamics. The speech therapist, a specialist in the oro-facial sphere, plays a central role in the assessment and management of these disorders.
🍽️ Understanding food oral disorders
Food oral disorders refer to all the functions assigned to the mouth in the context of eating: sucking, chewing, swallowing, as well as sensory aspects and the pleasure of eating. It develops progressively from intrauterine life and continues to evolve throughout childhood.
The two types of oral skills
Primary oral skills
Infant sucking-swallowing, reflexive and automatic, exclusive liquid feeding
Secondary oral skills
Chewing-swallowing, voluntary and learned, food diversification and solids
Transition
Gradual transition between 4-6 months and 2 years, sensitive period to disturbances
💡 Verbal and food oral skills
Food oral skills and verbal oral skills share the same anatomical structures and develop in parallel. A disorder in one can impact the other. This is why the speech therapist is the reference professional for both dimensions of oral skills.
📈 Normal development of oral skills
Knowing the stages of normal development allows for the identification of deviations and the adaptation of management. Here are the main stages of acquiring food oral skills:
- In utero: Sucking-swallowing of amniotic fluid from 12-15 weeks, first taste experiences
- 0-4 months: Exclusive liquid feeding, sucking-swallowing reflex, anterior gag reflex
- 4-6 months: Beginning of diversification, smooth textures, spoon, reduction of gag reflex
- 6-9 months: Mashed then crushed textures, beginning of chewing, grasping food
- 9-12 months: Small melting pieces, increasing autonomy, diversification of tastes
- 12-24 months: Increasingly effective chewing, adapted family meals
- 2-6 years: Physiological food neophobia, refinement of preferences
⚠️ Food neophobia
Between 2 and 6 years, most children go through a phase of food neophobia: they refuse to taste new foods. This phenomenon is normal and adaptive. It should not be confused with an oral disorder. Patience and repeated exposure without pressure usually help to overcome it.
🔍 Different oral disorders
Food oral disorders encompass various realities, ranging from simple selectivity to severe disorders affecting growth.
Sensorial dysoral disorders
Hypersensitivity or hyposensitivity to tactile, taste, olfactory stimuli
Food refusal
Active opposition to meals, avoidance behaviors, conflictual meals
Extreme selectivity
Very restricted food repertoire, refusal of entire categories of foods
Risk factors
- Medical factors: Prematurity, gastroesophageal reflux, allergies, ENT pathologies
- Sensory factors: Oral tactile hypersensitivity, sensory processing disorders
- Motor factors: Coordination disorders, hypotonia, neurological disorders
- Psychological factors: Anxiety, negative experiences around food
- Environmental factors: Prolonged artificial nutrition, hospitalizations
🛠️ Fun tools for oral skills
The COCO app offers breath and attention games suitable for young children, complementing work on oral skills.
Discover COCO →📋 Speech therapy assessment
The assessment of food oral skills must be comprehensive and take into account the sensory, motor, behavioral, and environmental dimensions of the disorder.
Components of the assessment
- Detailed anamnesis: Eating history, development, medical history, meal context
- Meal observation: Behavior, interactions, accepted textures, signs of difficulty
- Examination of the oro-facial sphere: Anatomy, tone, praxis, sensitivity, reflexes
- Sensory evaluation: Reactivity to tactile, taste, olfactory stimuli
- Parental questionnaires: Food inventory, parental stress, quality of life
💡 Meal observation
Observing a meal in a real situation (ideally at home or on video) is valuable for understanding interactions and behaviors. It helps identify vicious circles and propose concrete adjustments.
🎯 Rehabilitative management
The rehabilitation of oral disorders aims to broaden the food repertoire, improve motor and sensory skills, and restore the pleasure of eating in a serene context.
Areas of focus
Sensory work
Progressive desensitization, multi-sensory exploration, play with food
Motor work
Oral-facial praxies, chewing, coordination of sucking-swallowing-breathing
Behavioral work
Reduction of anxiety, positive reinforcement, structuring of meals
Intervention principles
- Respect the child's pace and avoid any form of coercion
- Create a playful and relaxed context around food exploration
- Proceed in small steps with gradual generalization
- Actively involve parents in the therapeutic process
- Collaborate with other involved professionals
👨👩👧 Parental guidance
Parents are the primary agents of change. Parental guidance is at the heart of managing oral disorders.
Advice for parents
- Never force the child to eat, avoid conflicts around meals
- Regularly offer without pressure, accept refusals without negative comments
- Eat as a family, model enjoyment of food
- Involve the child in meal preparation and shopping
- Present foods in an attractive and playful manner
- Value progress, even minor ones
⚠️ Breaking the vicious cycle
Parental stress and pressure around meals can perpetuate and worsen oral disorders. Helping parents let go and regain a calm attitude is often the first step towards improvement.
🤝 Multidisciplinary approach
Oral disorders often require a multidisciplinary approach involving several professionals depending on the situation:
- Pediatrician / Pediatric gastroenterologist: Medical assessment, growth monitoring, treatment of GERD
- Dietitian: Nutritional balance, supplementation if necessary
- Psychologist: Anxiety, family dynamics, parental support
- Occupational therapist / Psychomotor therapist: Global sensory disorders, positioning
- ENT: Swallowing disorders, anatomical problems
🎯 Conclusion
Food oral disorders are common and can have significant repercussions on health, development, and family life. Early and appropriate speech therapy management, combined with quality parental guidance, usually leads to significant improvement.
The approach should respect the child's pace, focus on pleasure and play, and be embedded in a positive family dynamic. A multidisciplinary collaboration is often necessary for complex situations.
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