Food Oralism: Understanding and Supporting Eating Disorders
The food oralism disorders (TOA) affect 25 to 45% of typically developing children and up to 80% of children with disabilities. They manifest as difficulties in eating: refusal of certain foods, hypersensitivity, difficulties in chewing or swallowing. This comprehensive guide presents the mechanisms, warning signs, and support strategies.
📋 In this article
What is food oralism?
Food oralism refers to all the functions assigned to the mouth in the field of eating: sucking, chewing, swallowing, but also the pleasure of taste and the psycho-affective relationship with food. It is a complex function that involves sensory, motor, cognitive, and emotional skills.
Food oralism disorders (TOA) encompass all difficulties related to eating that are not explained by an organic disease. They can manifest in very diverse ways: from a child who categorically refuses anything that is not pureed to one who only eats white foods, to one who gags at the slightest piece.
Normal development of oralism
Oralism develops very early, from fetal life: the baby swallows amniotic fluid and sucks its thumb. This primary oralism prepares the necessary skills after birth.
| Age | Stages of food development |
|---|---|
| Birth | Sucking reflex, exclusive liquid feeding (milk) |
| 4-6 months | Beginning of diversification, smooth textures (purees) |
| 6-8 months | Thicker textures, beginning of melting pieces |
| 8-12 months | Lateral chewing, finger foods, beginning of autonomy |
| 12-18 months | Varied diet, mixed textures |
| 18-24 months | Nearly normal diet, eats like the family |
| 2-6 years | Normal period of food neophobia (rejection of the new) |
Types of oralism disorders
Sensory disorders
- Oral hypersensitivity: exaggerated reactions to textures, temperatures, tastes
- Hyposensitivity: seeking strong sensations, very spicy or crunchy foods
- Tactile defense: refusal of certain textures in the mouth or on the hands
- Hypersensitivity: very restricted food repertoire
Motor disorders (motor oralism)
- Chewing difficulties: does not chew, swallows whole or keeps in mouth
- Swallowing difficulties: choking, blockages
- Bucco-facial praxies disorders: ineffective tongue/lip movements
Behavioral disorders
- Severe food neophobia: refusal of any new food
- Avoidance behaviors: turns head away, pushes away, cries
- Conflictual meals: power struggles, systematic refusal
Causes and risk factors
TOA are multifactorial. Several causes can combine:
| Origin | Examples |
|---|---|
| Medical | Prematurity, GERD (reflux), allergies, chronic diseases |
| Sensory | Hypersensitivity (common in ASD), sensory processing disorders |
| Motor | Hypotonia, neurological disorders, motor disabilities |
| Psycho-affective | Negative experiences (tube feeding, vomiting), anxiety |
| Environmental | Late diversification, monotonous diet, excessive pressure |
⚠️ At-risk populations
TOA are particularly common among former premature infants (tube feeding), children with ASD (frequent hypersensitivity), children with disabilities (motor disorders), and children who have experienced early hospitalizations with negative oral experiences.
Warning signs
In infants
- Feeding difficulties, long or insufficient
- Significant reflux, frequent vomiting
- Refusal of spoon feeding
- Blockage in diversification
- Weight curve that stagnates
In older children
- Very limited food repertoire (<20 accepted foods)
- Refusal of an entire category (vegetables, meats, textures...)
- Gagging or vomiting at the sight or touch of certain foods
- Very long meals (>45 minutes) or very short (snacking)
- Excessive sorting on the plate, rigid ritualization
- Eats only smooth textures beyond 2 years
- Systematic conflicts around meals
Assessment and management
The management of TOA is multidisciplinary:
- Pediatrician: rule out a medical cause, monitor growth
- Speech therapist: assess and rehabilitate oralism disorders
- Occupational therapist: sensory disorders, meal setup
- Psychologist: anxious component, eating behavior disorders
- Dietitian: nutritional balance despite restrictions
The speech therapist assesses the senso-motor skills (sucking, chewing, swallowing, sensitivity), observes a meal, and collects the child's feeding history.
Intervention strategies
🌡️ Gradual desensitization
Expose the child very gradually to new or feared foods, following the steps: tolerate next to → touch → bring to mouth → lick → taste → eat. Each step is valued. Never force.
🎮 Playful and sensory approach
Play with food (outside of meals): touch, knead, smell without obligation to taste. Sensory manipulation activities (play dough, sand, messy play) to reduce overall tactile defense.
🍽️ Calm meal environment
Calm meals, no screens, with family. No pressure to eat. Offer without forcing. Serve small quantities. Avoid comments on what the child eats or does not eat.
📈 Progression of textures
Follow a logical progression: liquid → smooth → pureed → melting pieces → firm pieces → mixed. Respect the child's pace. Work on chewing in parallel with praxies exercises.
💪 Work on bucco-facial motor skills
Bucco-facial praxies exercises: tongue, lip, cheek movements. Chewing exercises (biting and chewing suitable objects). Oral sensory stimulations.
Our downloadable tools
📊 Food texture chart
Classification of textures with examples of foods for each category. Guide for the progression of diversification.
Download👅 Bucco-facial praxies exercises
Illustrated exercises to work on mouth, tongue, lip movements. Useful for chewing and articulation.
Download🍽️ Meal supports
Visual supports to structure the meal: sequences, choices, positive reinforcement. Helps reduce anxiety around meals.
Download📋 Food diary
Tool for tracking meals and progress. To note accepted, refused foods, and new items tested.
DownloadFrequently asked questions
A certain selectivity is normal between 2 and 6 years (food neophobia). It becomes concerning if the repertoire is very restricted (<20 foods), if there is an impact on growth, or if it causes significant suffering. Consult if the situation does not improve or worsens.
No. Forcing is counterproductive: it increases anxiety and reinforces refusal. The recommended approach is to offer without forcing, to regularly expose the child to foods (even if they refuse), and to create a calm meal environment. Coercion worsens oralism disorders.
Occasional gagging is normal when learning new textures. It becomes concerning if it is systematic, very intense (vomiting), or persists beyond 2-3 years. It may indicate an oral hypersensitivity that requires management.
Initially, the pediatrician to rule out a medical cause. Then the speech therapist specialized in oralism for assessment and rehabilitation. Depending on the cases, an occupational therapist (sensory disorders), a psychologist (anxiety, eating disorders), or a dietitian may complement the management.
🍽️ Ready to support oralism disorders?
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Discover all tools →Article written by the DYNSEO team in collaboration with specialized speech therapists. Last updated: December 2024.
