Many children with feeding difficulty have aversive feeding behaviors or learned refusal patterns around the act of eating or feeding. I often tell my students that if a child doesn’t want to eat, you can’t make them. By the time children come to our feeding team, many caregivers have tried multiple ways to get there kids to eat. Usually they have tried force feeding and/or letting the child get very hungry. Neither of these alone will fix a feeding problem which are typically multifactorial in nature.
Children refuse foods in many different ways. Here is a list of some of the most common aversive feeding behaviors:
- Poor mouth opening for the spoon.
- Refusing foods by turning away, blocking the spoon, covering their mouth.
- Irritability and tantrums during feeding attempts, saying “no”.
- Expelling foods.
- Drinking instead of eating.
- Using delay tactics to stall the next bite.
- Refusal to sit in a highchair or at the table.
- Accepting only specific foods by type, texture, or brand.
For this post, I am going to concentrate on the first one, poor mouth opening for the spoon. This is very common with our food refusers. These are the kids that look like they are accepting the bite and then more than half of the puree comes off the spoon on the way into the mouth. I have also noticed that when caregivers are feeding a child who is hard to feed, they develop maladaptive feeding techniques such as dumping the food into the mouth, scraping the spoon off the upper gums, or loading the spoon (because they may only get a few bites) and shoving what they can into the oral cavity.
Let me tell you about a little guy I used to work with. I can remember him sitting in the highchair one day and we were working on acceptance of the dry spoon. Sometimes we call this “spoon game”. The idea is that we want to start where the child can be successful and for many kids that is without food. We are going to work on shaping behavior toward oral feeding and one of the starting places is having a child accept the spoon.
And I mean acceptance of the whole spoon– the goal is
- mouth opens with tongue down on the floor of the mouth
- therapist places spoon on child’s tongue with slight pressure
- child closes lips
- spoon comes out
During this particular therapy session, the child who I will call Charlie was sitting in the highchair. He was a little under the age of 2. I presented the spoon with a verbal cue to “open” and Charlie would respond by opening his mouth a crack, enough to let the tip of the spoon through his lips but not into his mouth. I tried multiple times with toy reward, verbal cueing, and visually showing him but Charlie continued opening his mouth only a crack. After a short period, we let him get down from the highchair, while I talked with his mother. Wouldn’t you know Charlie walked right up to me, tapped my leg, looked at me and opened his mouth as wide as he could. Then walked away pleased with himself.
I am happy to report that after feeding therapy, Charlie is now a good eater and is eating table foods well and has never looked back. Those days of poor mouth opening are long behind him.
So why do I persist on getting full acceptance of the spoon?
For several reasons:
- To successfully eat from a spoon you must be able to accept the spoon in your mouth. I have dubbed this teaching “spoon technique”. For some of our kids the decreased mouth opening is a behavioral response not a physical one.
- If we can establish acceptance of the spoon, it opens up the ability to work on many things: decreasing a humped or retracted tongue, lateral placement of the puree as a pre-chewing exercise, introducing new flavors and textures, and lip closure.
So how do we get mouth opening?
- Child should be positioned in a highchair or supported seat.
- Start with a dry or empty maroon or infant size flat spoon.
- Caregiver or therapist feeds the child, present the spoon and say “open”
- If the child does not open wide enough, I might say “big open’ and I model an open mouth posture, sometimes I add a sound cue “ah”.
- If the child still is not opening, then I use the spoon on the upper lip and tap upwards on the lip while I provide jaw stability with my other hand. Most kids will open with this technique.
- Then I place the spoon on their tongue with slight pressure before coming out of the mouth with the child’s lip closure.
- I also consistently use reinforcement (toys, verbal praise,etc) when the child opens so they are motivated to do it again.
Usually, I will not move onto to purees until I get good consistent opening for the dry spoon. The exception is some kids open better if there is something on the spoon so I might use a dip spoon in water, juice, or a thin puree. If using food, I stay at a dip level until we have consistent spoon technique of good opening.
Home practice: I teach parents to use this technique and I ask them to practice a certain number of times each day at home. Then at the next session, I ask the parents to feed and to show me how it is going. If it is going well, we move up to dips or small bite volumes of smooth puree.
shreya dayal says
My son was a re-flux baby but I thought he has outgrown it as he grew older (17 months now). I am told by the medical practitioner (not my pediatrician) that my son is still suffering from re-flux just that he has learnt to hide the symptoms. I understand this therapy takes time but wouldn’t it be nice if there was a provision to have the therapist come home and practice their techniques, instead of taking my son to the therapy center.
At this stage we have figured out that, my son does not need any special treatment that could only be done at the Therapy Center. So if there are any services where the Therapist can come for home visits that would ideal. I also feel that this kind of Therapy if done regularly can help the child quickly as opposed to doing the therapy once a week.
I live in Richmond, VA and to have anyone come home and come daily would really help me speed up my son’s behavior towards food. Any pointers shall be very helpful.
Krisi Brackett says
I am sorry that I missed your comment. How is your son doing? You mention he has reflux but not his feeding issues? I don’t know of any locally based feeding therapy that comes to your house daily. As a feeding therapist, I feel one of my jobs is to teach you the parent how to carry out the techniques used in therapy. That way you will feel confident about feeding your child and the child will get to practice every day.
Depending, on your child’s feeding issues, there are intensive or “day treatment” programs that you can take your child too that will work with your child during the day, every day, for a number of weeks. There is one in Richmond but the program would have to determine if your child is a candidate for their program.
feel free to email me back , Krisi
My son is 3yrs and he is the same. No food is allowed near his mouth at all till now I dont know if he likes any food, he also used to have re flux and not sure if he still has it. Pls share ur experinence and if anything worked for you in feeding. Pls do share
Have you had any improvement? I am in the same boat with my 2 year old and the want us to get tests for everything trying to find the root of the problem.
Can you share how your son id doing now with his eating issues I have a 3 year old with same issues as your any info will be of great help. Thanks
Hi, question I have is if you are a parent doing as you have stated above would you stop giving solids altogether and focus more on getting the child to accept the spoon? Will that not inevitably mean that they could forget the swallow reflex in the period that it takes for the child to accept the spoon into their mouth, and how long does it (as an average) take for a child to accept the spoon and then reaccept the spoon with some purree on it?
We are stuck see in this cycle of services unable/unwilling to help as they aren’t sure it’s safe without having enough solids/liquids going in to do a vp. We just have the advice to positively reinforce, no real techniques or explaination. I learnt alot on this article.
I tried this and it worked fine at first but it’s not working now.
Anamaria Bostan says
What if the child opens the mouth for the dry spoon , but refuses spoon dipped in purée? How doesnone convince a child that is 11 months old to open his mouth?
Hi that was a nice technique, but seriously it’s not working with my toddler!!
The moment I keep the spoon near his mouth and start tapping he would have already finished opening and closing his mouth.
If I try to give support to his jaw with my hand he would withdraw and move back.
Pleas help me its been a great task feeding him.
Hi..I don’t know what to say about feeding habit of my baby….he is 22 month old.but till now he don’t know how to eat…he don’t close his lips over spoon.he can’t even drink from cup as he keeps his lip open till d time cup touches his mouth…he will only close his lips only when I remove the spoon or cup from his mouth..
He has feeding problem from very beginning…as suggested by doc we had to start solid at 5 month as he was quite underweight…he was never interested in food.The moment he saw food,he would immediately turn his head away.so we had to force feed him that time by pouring down food in his mouth…We thought this habit will change once he start showing interest in food..but this has never happened…Till now he is not interested in any type of solid food.And he is also delayed in speech…
I need some serious advice how to improve his feeding habit..i can’t go to any speech therapist as no one is available here…
After I read your post, saying ditto would also be an understatement. My son is 20 months old and is exactly (word to word) same.
I am at my wits end and literally break down every single night not being able to understand what to do… I literally have tried every trick in the book..
Please please help me out if you got any success in your child’s eating pattern, accepting the spoon, opening the mouth, eating solids, chewing, and not being so damn averse to all sorts of food.
I really need some help..
I would really be very grateful..
Thanks so much in advance.
Hi Niha and Ruchika
Hope you both doing well with you kids. I read your post and found that this is exactly my case now. My 16 months don’t know how to open his mouth for spoon and turn his head if provided food. I really don’t know how to improve the situation. Can you please suggest some ideas from your experience.
Thanks in advance
Hello what is my 2 year old knows how to open his mouth but doesn’t want to because he refuses to eat.
Good post will try to implement it
My 19 month old used to eat thrice a day and now since a month suddenly stopped opening his mouth. He fusses at meal times. The only reason he sits for a few bites is because his favourite jingle is on iPad. Today in the morning he just ate a few rice crispies before going to school and half his milk. What to do? Shall I change his food?
7 month old on tube feeding and top up breast feeding. Told to start introducing puréed food. Get it in his mouth, but he just spits it out. He can swallow when breast feeding. He is not gaining enough weight even with prescription formula additive to my breast milk with tube. Need to get him eating and off tube feeding. Help! And yes, we see a paediatrician regularly. Also have nursing team visit regularly. No one can provide answers as to why all this is happening.
Krisi Brackett says
Feeding problems can be challenging and difficult to treat. I would suggest an evaluation with a speech pathologist or occupational therapist that specializes in feeding or a feeding team.
This is a very good article and I intend to practice this at home for my son (1yr). He shows all the 8 signs mentioned in your post above. Could you please help us in addressing the other 7 behaviors too? My wife is getting into a mode of depression because of my son’s non-eating behaviors and I can only do so much to improve the conditions. It would be really helpful if you can guide us here!
Thanks a lot in advance,
Leidy Merlos says
I have a 13 months old who’s already on feeding therapy but I feel it’s not working. He still won’t open his mouth to be fed. He sees a spoon then screams and turns his head away. He also has sensitive issues when he touches purees or something wet it makes him gag. If I feed him anything with a spoon he will puck. Even breast milk. I am lost and VERY frustrated.
Ankita Saikia says
Hi. I am from Bangalore India with my 10 months old daughter with all the aversal behaviours. Can I have a skype appointment or gtalk appointment with you. Ankita
Hello , my son is 7 month old and is doing the same behavior of not opening his mouth . He opens his mouth for any other object besides the spoon . We have tried the dry spoon and he plays with the spoon and try to put it in the mouth is fine . But every time I try to add purée and feed with the spoon he keeps his mouth shut .i have tried to add the purée with spoon in the mouth ( closed lips ) so he sips the purée but this is very rare too …. it just depends on the mood . What excercise can I do to help him open his mouth to eat ? Please help .i use the baby sit and he sits up ( weakly )… we are still working on his back to be stronge … but he sits supported fine
I have the exactly same problem with my 7 month old. How did you overcome this problem, please share your experience.
It would be really helpful.
I have the exact same issue and my daughter is 7 months. How did you all resolve the issue or get around it.
Jennifer Salo says
My son is almost 16 & is refusing to eat with a spoon & open his mouth. He has selective mutism & anxiety so he goes threw many changes. But now he only wants to eat ice cream, yogurt, jello, pudding, but does it with his hands & is dropping weight . I took him to the hospital but they said they couldn’t do anything that it was behavioral. I don’t no what to do
After reading this I immediately think to myself this is exactly what the issue my 13 month is facing. My husband and I have seen 8 different specialist, had an Early Intervention session and continue to worry about our daughters feeding problem. She is failure to thrive and we have tried everything possible. Doctors have given us zero hope and given up on trying to help my daughter. This has put a huge amount of stress on the whole family grandparents included. Time is limited, my daughter continues to lose weight and it’s impacting her growth/development and overall well being. She opens her mouth only a little tongue raised and spits purée out . I have to feed her the same bite sometimes 10x before she gets it all. I use the moroon spoon we were given by one of the SLP. I have tried using props, toys, videos, showing her how its done, rewarding her, force feeding her, but NOTHING and I mean NOTHING has worked. I’m going to try the dry spoon technique and see what happens. We’re so desperate for real knowledge and experience. We feel that doctors and specialists have let us down. We have heard “good luck” so many times but luck isn’t it, we need HELP. thank you for your post. I really hope it works even a little.
Michelle Maddox says
My 1 year old started this behaviour over a month ago during a cold then the behaviour has continued. Before she would always accept the spoon without a problem and open her mouth wide. I hate meal times it give me anxiety which I dont show to her but can take over an hour to get her to eat a very small amount. I give her foods she can feed herself now but this can often be very hit and miss. Is there another technique you can tell me about as obiously she already knows how to eat from a spoon and the fact she isnt is behavioural so I’m not sure what using a spoon to practice with will achieve? Thanks
My son is 4 and has had feeding challenges for a while specifically around chewing. We have managed to expand his diet but it’s still limited to yogurt and 3 other foods like mashed potatoes with finely mashed chicken and meatloaf or mashed spaghetti rings. He swallows everything without chewing but will gladly chew toys. We cldnt get feeding therapy covered by our insurance so I’ve been trying to resolve this by sourcing info online and showing him how to chew unsuccessfully!! Any advice would be appreciated.
Jason Dean says
My 22-month-old was 6 weeks early and so from the weening stage we did whatever we could to get him to eat as he was at a very low weight, which is now watching things on an iPad/tele (these are strictly educational shows and have clearly helped him develop his speech, counting and listening and this is the only time he has television access). The problems we now have are –
If a show or video comes on that he isn’t a fan of he’ll completely refuse a spoon regardless of what’s on it, often turning his head away and blocking his mouth with his arm.
He will only eat if something visual is available to watch (this means phones are out when we’re at friends’ houses etc). He’ll eat sandwiches – occasionally – in the car/buggie without any stimulant and will shovel in raisins, rusks and snacks like there’s no tomorrow, again without the iPad. But eating a meal-sized sandwich is rare.
On top of this, he will only open his mouth the tiniest bit. When he plays with a tea set it’s as wide as you like, but put him in the high chair and try to feed him and it’s only ever slightly open. We know he likes certain meals as he leans towards the bowl but he just won’t open up properly.
When he was younger, he’d snack on cucumber sticks, melon and lots, but almost overnight he decided he didn’t like holding anything with a wet texture, so no picking up pasta or cucumber etc.
So, how do we get him back to snacking on things of all textures to then get him to a point where he’ll feed himself a small meal? He loves being in the bath and playing with bubbles so it’s not like he hates everything wet.
How do we get him to open his mouth nice and wide?
How do we encourage him to start spoon feeding himself (hopefully this will help him see that he needs to open up.
My child is two and he won’t open his mouth at all. At an early age he use to eat and he had some gag issue and threw up for a bit then shut down and now only his bottle. He won’t have a dry spoon pass his lip and as he see the spoon it’s a fight. He constantly teething but he would put any other hard stuff in his mouth just don’t want a spoon in
Looking for assistance with 8 month old who refuses solids. She will chew on bread- pizza crust, baguette and tether crackers independently. She seals her mouth when a spoon is present. She will place her hands over her mouth, turn away and blow out (raspberries).
I have gone thorugh your articles on
“An interview with Clare Llewellyn, PhD, and Hayley Syrad, PhD, authors of An Appetite for Life: How to Feed Your Child from the Start”
“Aversive Feeding Behavior: Getting full mouth opening for the spoon and why it’s worth the trouble”
I am from Toronto, Canada, my daughter is having a very similar problem with accepting spoon and solid food.
She was on breastfeeding since birth and at 3 months we tried formulae using bottle but she would dislike bottle. She had from bottle very rarely.
Starting 5.5 months we tried Gerber rice cereal mixed with breast milk, using spoon. Initially we made it watery and she was kind of taking it, once a day.
Once she was 6 months, we thickened the consistency of the mix, started using formulae and cereal and twice a day. Her spoon refusal started.
We have also tried different mashed vegetables, but every feeding is a challenge.
Now at 8.5 months, she still refuses spoon, but would at times take the initial 3-4 spoons, and refuse thereafter.
A squeezed bottle works better for her, which needs more watery and mashed food and her total daily intake is still not up to even a 6 month old.
We visited the pediatrican in February 2020 just for the feeding issue and he has referred us to a therapist (no details shared with us until the appointment is done)
Due to the COVID-19, lot of places are closed and the whole of March 2020 has passed.
We are using munchkin spoon.
Can you suggest where to get the flat spoon – I did not find in Amazon.ca
I think we need a therapist urgently to guide/train us how to feed her.
Did you ever get to see a therapist? My son is this way too
Our girl is now 9 months old, and has been having troubles with swallowing food.
She was drinking milk all along, and seems to have issues with swallowing food. She sometimes takes small bits of fruits and put them into her mouth, and swallows, them. But other items such as puffed rice, she won’t swallow.
We tried putting mashed food such as mashed fruit in her mouth, but she gets the food onto her tongue, and lets it stay there. For sometime she will try to keep the food there and not let it fall out, but eventually when enough saliva settles in, the food slips out.
Is she having any issues with a tongue tie? How do we figure out? How do we get her to do the action of swallowing food consistently?
I am Toronto as well, have the exactly same problem with my 7 month old. Did you overcome this problem, please share your experience.
It would be really helpful.
Hi. My 16 months baby has suddenly completely stopped spoon feeding in a day. She clamps her mouth shut and moves her face left and right to avoid spoon. Please help me in this matter because my baby does not even take formula or any milk. Spoon feeding was only source of giving her proper food. She was feeding fine before this.
Hi Ya I am having real difficulty with my 13 month old baby. She has never been a great eater but I’ve just plodded on for all this time. Typical mealtime is her sometimes willingly sitting in the highchair, when she is sat in the highchair and sees the spoon she will turn her head and refuse, most often moaning to indicate that she doesn’t want it. If I put a toy/object on her tray for her to mess with so she is preoccupied she will open her mouth to eat the food. Mealtimes are horrible and I dread them. Have you any advise on what I can do??
I have 15 month old twin boys . My twin B is not eating at all. He refuses to open his mouth and pushes away the food . If I force feed him he will gag and spit it out. I read this article today and will try the spoon training technique. I hope it helps. I was wondering if you have any other ideas to help me to get him to eat? He only wants a bottle won’t take any cups at all either
Thank you for your time
Thanks alot. Charlie’s eating is almost like my son’s . Will practice what I have learnt here.
This article was very informative ..thank you!
I have a 15 month old toddler who is on gtube ( born 3 months premature and had to have TEF repair surgery) and we are struggling to transition her to oral feeds. She does not open her mouth for the spoon ( we are trying purees) and doesn’t seem interested to eat orally. We have tried working w multiple speech therapists and we havent been able to make progress.
We are based in Houston, Texas. So we wanted to check if we can consult w you online?
I would also appreciate if you could share any recommendations for a local speech therapist who specializes in pediatric feeding issues.
Hi! Our daughter is 10 months old and our pediatrician stresses solid food eating to an extreme. It has caused a lot of anxiety in our household, because our baby is very stubborn. We try and try to get her to eat things, but it is very hit and miss. Some days are fine, but most are very tough. I am afraid I am giving her a negative stigma towards eating. She often turns away and refuses without having tried anything. She is currently teething, but this has been going on for awhile. My husband is a picky eater so we are very nervous for her future. Sometimes, she will open her mouth and as the spoon gets closer, she turns away. We don’t know what to do to get her to be a great eater. None of our other friends have had an issue like this with their child. Any advice would be greatly appreciated. Thanks.
Ellen Frimpomaa says
helo am Ellen and my baby is 5months old i have started her on porridge but she doe tnot open her month for food but once the food get into her mouth she will swallow it , my worry is why she is not opening her mouth for food, please help me, i dont want to force the food into her her moth too. tanx
Hi. My little girl Ada is 9 months. She is a breastfed baby and won’t eat food, we struggle to get a teaspoon a day. Any help or tips much appreciated, we have spent £££s on feeding trays, bottles and spoons. All don’t work ….
Can you share how your son is doing now with his eating issues I have a 3 year old with same issues as yours …. any info will be of great help. Thanks
Mana from Nepal says
I have a grandson of 20 months. He started refusing the spoon a month ago. Members of the family tried several ways. Doctors suggest not to force feed. He likes drinking milk and fruit juice, opens his mouth to those. But for other foods he doesn’t let us do that. Now what I am doing is a) with his favorite song singing putting him quietly on high chair, b) playing with him with his favorite toys for a while, c) opening TV at a distance for nursery song, d) slowly giving him the drink, e) having two glasses one with drink and the other with a thick liqid solid, then altering the food, f) sometimes he refuses, then again giving him the drink. Doing so has worked. I try this 4 times a day. If he doesn’t accept one time, that doesn’t worry me. If I can continue this I will be more than happy. Let’s see.
Carol Ann says
Hi, my so. Is 2 years old in April and is refusing to eat solid foods. He will only accept puréed foods. Also, when eating the puréed foods he only opens his mouth particularly and pushes out the spoon with his tongue.
His weight was checked today and he has gone from normal range to below -3.
I don’t know what to do to help him. Please assist if you can. Thank you.
Shannon Nookemus says
I am having some of these issues with my 7 month old. Is there a video that you can share with me?
How many times a day would you recommend doing the dry spoon technique? Does he need to be in a high chair while doing this technique? Would it be ok to give him a spoon to play with at playtime?
My LG is 28 months and still won’t open her month fully should I be worried
Please can you advise if we can have sessions for my child who is 2?
Were about are you based i am in Durban south africa.
Elaine Egbert says
I am a grandmother where I watch my grandson during the day while both parents work. He was a severe IUGR when born and had a bottle aversion. He does take the bottle but not consistently so also has a feeding tube. He is going on 10 month now and the nutritionist wants us to start solids. Does not like certain textures but does well w purées. Will not open his mouth for food but rather does not refuse it when u sneak it in. Going to try the dry spoon method u mentioned. Will play w the spoon on his own. I guess what I am asking is am I doing more harm sneaking food in his mouth? Should I wait till he opens his mouth? Parents and I are just so frustrated w this feeding aversion, there other children had no problem w wanting to eat. Your advice would be greatly appreciated for I don’t feel anyone is Takeing his aversion seriously since he does put the spoon in his mouth and bottle at times. I just don’t want him to get too far behind. Appreciate any advice u have to offer. Thank you concerned grandma.