Food orality: understanding and supporting eating disorders

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Oral Feeding: Understanding and Supporting Eating Disorders

Oral feeding disorders (OFD) affect 25 to 45% of children with typical development and up to 80% of children with disabilities. They manifest as feeding difficulties: refusal of certain foods, hyperselectivity, chewing or swallowing difficulties. This comprehensive guide presents the mechanisms, warning signs, and support strategies.

🍽️ Download our oral feeding tools

Texture Chart
Oral-Facial Praxis
Meal Supports

What is oral feeding?

Oral feeding refers to all the functions assigned to the mouth in the area of nutrition: sucking, chewing, swallowing, but also taste pleasure and the psycho-affective relationship with food. It is a complex function that involves sensory, motor, cognitive and emotional skills.

Oral feeding disorders (OFD) include all feeding difficulties that are not explained by an organic disease. They can manifest in very diverse ways: from the child who categorically refuses anything that is not pureed to the one who only eats white foods, including the one who gags at the slightest piece.

Normal oral feeding development

Oral feeding develops very early, from fetal life: the baby swallows amniotic fluid and sucks their thumb. This primary oral feeding prepares the necessary skills after birth.

Age	Feeding Development Stages
Birth	Sucking reflex, exclusive liquid feeding (milk)
4-6 months	Beginning of diversification, smooth textures (purees)
6-8 months	Thicker textures, beginning of soft pieces
8-12 months	Lateral chewing, finger foods, beginning of autonomy
12-18 months	Varied feeding, mixed textures
18-24 months	Near-normal feeding, eats like the family
2-6 years	Normal period of food neophobia (rejection of new foods)

Types of oral feeding disorders

Sensory disorders

Oral hypersensitivity: exaggerated reactions to textures, temperatures, tastes
Hyposensitivity: seeking strong sensations, very spicy or crunchy foods
Tactile defensiveness: refusal of certain textures in mouth or on hands
Hyperselectivity: very restricted food repertoire

Motor disorders (motor dysoralia)

Chewing difficulties: doesn't chew, swallows everything whole or keeps in mouth
Swallowing difficulties: aspiration, blockages
Oral-facial praxis disorders: ineffective tongue/lip movements

Behavioral disorders

Severe food neophobia: refusal of any new food
Avoidance behaviors: turns head away, pushes away, cries
Conflicted meals: power struggles, systematic refusal

Causes and risk factors

OFDs 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 feeding, excessive pressure

⚠️ At-risk populations

OFDs are particularly common in former premature babies (tube feeding), children with ASD (frequent hyperselectivity), children with disabilities (motor disorders), and children who experienced early hospitalizations with negative oral experiences.

Warning signs

In infants

Difficult, long or insufficient feedings
Significant reflux, frequent vomiting
Refusal to transition to spoon feeding
Blockage during 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 sight or touch of certain foods
Very long meals (>45 minutes) or very short ones (nibbling)
Excessive sorting on the plate, rigid ritualization
Eats only smooth textures beyond 2 years
Systematic conflicts around meals

Assessment and management

OFD management is multidisciplinary:

Pediatrician: rule out medical cause, monitor growth
Speech-language pathologist: assess and rehabilitate oral feeding disorders
Occupational therapist: sensory disorders, meal positioning
Psychologist: anxiety component, eating behavior disorders
Dietitian: nutritional balance despite restrictions

The speech-language pathologist evaluates sensorimotor skills (sucking, chewing, swallowing, sensitivity), observes a meal, and gathers the child's feeding history.

Intervention strategies

🌡️ Progressive desensitization

Expose the child very gradually to new or feared foods, following the steps: tolerate nearby → touch → bring to mouth → lick → taste → eat. Each step is valued. Never force.

🎮 Playful and sensory approach

Play with food (outside meals): touch, knead, smell without obligation to taste. Sensory manipulation activities (play dough, sand, messy play) to reduce overall tactile defensiveness.

🍽️ Peaceful meal environment

Calm meals, without screens, with family. No pressure to eat. Offer without forcing. Serve small quantities. Avoid comments about what the child eats or doesn't eat.

📈 Texture progression

Follow a logical progression: liquid → smooth → ground → soft pieces → firm pieces → mixed. Respect the child's pace. Work on chewing in parallel through praxis exercises.

💪 Working on oral-facial motor skills

Oral-facial praxis exercises: tongue, lip, cheek movements. Chewing exercises (biting and chewing appropriate objects). Oral sensory stimulations.

Our downloadable tools

📊 Food texture chart

Texture classification with food examples for each category. Guide for diversification progression.

Download

👅 Oral-facial praxis exercises

Illustrated exercises to work on mouth, tongue, lip movements. Useful for chewing and articulation.

Download

🍽️ Meal supports

Visual supports to structure meals: sequences, choices, positive reinforcement. Helps reduce meal-related anxiety.

Download

📋 Food diary

Tool for tracking meals and progress. To note accepted foods, refused foods, and new foods tested.

Download

Frequently asked questions

📌 My child only eats pasta and bread, should I be worried?

Some 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 generates significant distress. Consult if the situation doesn't improve or worsens.

📌 Should you force a child to eat?

No. Forcing is counterproductive: it increases anxiety and reinforces refusal. The recommended approach is to offer without forcing, regularly expose the child to foods (even if they refuse them), and create a peaceful meal environment. Constraint worsens oral feeding disorders.

📌 My child gags with pieces, is this normal?

Occasional gagging is normal when learning new textures. It becomes concerning if it's systematic, very intense (vomiting), or persists beyond 2-3 years. It may indicate oral hypersensitivity that requires management.

📌 Who should I consult for oral feeding disorders?

Initially, the pediatrician to rule out a medical cause. Then a speech-language pathologist specialized in oral feeding for assessment and rehabilitation. Depending on the case, an occupational therapist (sensory disorders), a psychologist (anxiety, eating disorders) or a dietitian may complement the management.