No meal with Isla would be complete without one cool shot of adrenaline, poured especially for me.

It’s served straight up my spine, numbness across the chest, heart pumping through the ears, fingers tingling.

She offers it in the kitchen, when my back is turned away from her. I’m facing the counter, slicing and dicing her serving of whatever’s on the menu. I hear her gentle coughing, then a sharp gag, then a moment of silence that lasts an odd second too long. The instant I whip around to face her—those cherub cheeks flushed red, her eyes uncertain, more silence—the adrenaline shoots right through me with a lone thought,

She’s choking! Oh my god! This time, she’s really choking!

Though I’ve thought this a couple dozen times, it still rips through me like a triple espresso on an empty stomach.

I rip her tray from her chair, fumble unbuckling the belt (did I mention the numbness?), and grab her by her tiny torso never knowing exactly what to do next. It’s usually in that moment that she opens her little mouth, releasing dozens of little pieces of the un-chewed food I’d been serving her over the last ten minutes.

She’s not gasping for breath, losing oxygen to the brain, about to pass out …. she’s simply given in to the fact that there’s no room in her mouth to chew.

When I realize she’s fine, I get a small taste of relief and then a large side order of anger. “Isla! Why do you do this? Don’t shovel so much in your mouth at once!” For dessert, we share a small dish of disbelief. Me, not understanding what’s possessing my little daughter to hoard every morsel she sees. Her, wondering why soft, sweet cooing mommy sometimes suddenly turns so loud and sharp.

I’m always wide awake after a meal like that.

WIDE awake. Ready to run a race, dash off a hundred thank you cards, redesign the living room, write a family financial plan for the new year. No need to seek life-affirming thrills on the top of a ski mountain, on the backseat of a motorcycle, in a 100 foot plunge off a trestle bridge. I’m now get shots of my adrenaline right in my own kitchen.


The last time this choking fake out happened, I had had enough and did what any young mother mother of a young child would do: I signed up for a class on infant CPR. (No. That’s still on the To-Do list.) I took my problem to the Internet and start googling the heck of out of it… ‘infant stuffing mouth,’ ‘infant choking,’ ‘infant feeding problems,’

That’s when I discovered that there are actually experts in what I call the ‘mechanical side of feeding.’ They’re usually occupational therapists and speech pathologists who specialize in pediatric feeding difficulties. Who knew?!

Q & A: Alisha Grogan

Meet one such expert, Alisha Grogan, MOTR/L a pediatric occupational therapist and mother of two young boys based in the Pittsburgh area.

Alisha Grogan feeding therapist

Alisha and her blog, Your Kid’s Table, talked me through my most recent fear of feeding Isla—and then, since I’m full of fears, we chatted some more… Here, find great tips for feeding a toddler or younger. Since this post is long, I added some nifty headings to make it easier to skim through and find what you’re looking for…

Choking

Amelia: At 13 months, Isla’s a speed eater, two-fisting handfuls of food into her mouth faster than I can replace them on the tray. Of course, I’m terrified she’s going to choke. I don’t have patience for the obvious solution—to put just one piece in front of her at time, so I’m wondering 1) if you have any ideas for slowing her down, and 2) what’s her problem (clearly, she’s anticipating a famine)? 

Alisha: Not to worry! Actually, this kind of feeding behavior is normal for kids until 16 to 17 months. Up until then, they’re really still developing a sense of the boundaries of their mouth. Normally, you put food on your tongue, the tongue moves it to the molars, it goes back and forth until it becomes a bolus (or a ball of food that’s been through the chewing process), then you swallow. A child is still learning this process and if they can’t feel the pieces of food in their mouth, they will stuff more and more in there until it stretches the sides of their cheeks and they can. They don’t yet understand the idea that they can choke.

The good news: she will eventually grow out of it. That said, there are still a few things you can do to help her learn to slow down. First, you can literally ask her to: cognitively, she might not understand you, but she will in time. Gently pull her arm back from her mouth as you say it to help her make the connection. (She might be a little fussy about this, but will get better.) Second, you can distract her from the food (by singing, clapping, or whatever she likes) to get her to take a break. Let her get back to eating once she’s chewed what’s in her mouth. Lastly, when you brush her teeth, you can make sure you’re brushing her gums really well in the back, and the insides of her cheeks, around the edges and the top. That will improve her oral discrimination, too. A vibrating toothbrush can also help, which I talk about on my blog in a post about a child with some sensory challenges.

Just be cautious: your number one goal should always be to have a positive association with food and meal time. Keep this in mind as you’re working with her to slow down.

Also, while I don’t think this is what’s going on with your child, there ARE children with tactile discrimination problems—there’s a spectrum. Some children who are born premature or have autism might struggle with this and an occupational therapist can help. Also, there are easy ways to improve any child’s sensory skills, which can also be found on my blog.

Drinking

Amelia: Such good advice! Thank you! Okay, my next point of confusion at meals: giving drinks alongside food–are you for or against this? My husband always serves up a beverage with meals ‘to help her wash it down.’ I’m always taking it away (when he’s not looking, of course). Two reasons; I’m worried she’ll fill up on fluids and not have enough room for food (ie real nutrition); plus, I’m worried that mixing the fluids and the solids will cause her to choke, not prevent it. Thoughts?

Alisha: Overall it’s a good idea! Congratulations to your husband on that one. I actually use this as a strategy to help kids learn to swallow. If a child can’t stand the texture of applesauce, or anything pureed, for instance, I will use the drink as a tool to help them. They take a taste, then a drink to help wash it down. The idea is that if you add a little liquid to the mouth, it can be easier to swallow because it’s easier to swallow liquid than a solid. In general, if kids have hard time swallowing or chewing solids, following each bite with a drink to help wash it down and rinse everything from their mouth is a good, helpful thing. Overall, we want them to have great ability to eat and drink at the same time.

That said, it really does depend on the child. If your child is choosing the drink only, then no, it is not a good idea to give it to them with meals. Some children will choose to drink an entire cup of milk, for example, and then not eat their food. If this is your child, I’d give a little bit of water—opposed to milk, which is much more filling—and that’s all.

Mastering forks & spoons

Amelia: At what age are kids ready to use a fork and spoon? At 13 months, my daughter has no interest in using them for anything but banging or making food mosaics on her face and tray. Should I try harder to teach her to use them or leave it alone?

Alisha: I would expect them to be independent with a fork and spoon by 2 years old. There’s a really wide range, however. As general guidelines, I would recommend starting a child at 9 or 10 months with a spoon. If they are throwing it… then take it away. You can re-introduce it again in a week or two. Really, a child is capable of feeding themselves with a spoon by one year—I wouldn’t expect them to or need them to at this age, but the point is that they do have the ability to do it and you should certainly give them an opportunity to try by this time.

Around 14 months, they should be they should be partially feeding themselves and you should be partially feeding them. At 16 to 18 months, they should be poking foods with a fork. I think it’s totally acceptable if they are still finger feeding themselves at this point, too. If they are eating chicken fingers, for example, they can use use their hands. But if they want spaghetti, they would be able to use a fork if they wanted to.

Isla, why not try the other hand?

Amelia: Okay, we’ll work on that one. This is definitely a case of ME, not Isla, who is having trouble learning something. (I need to learn not to cringe at the mess she makes and to give her more opportunity to try. Along with this, I’m dizzied by the array of spoons, forks and sporks at buybuyBaby: what should I be looking for?

Alisha: You want spoons with a deeper bowl, so that the food they scoop up stays put. You also want a shorter, thicker handle, which is easier for them to grasp and manipulate with their wrist since they need to scoop then turn towards their mouth. (These are different from feeding spoons, which have a shallow bowls and longer, narrower handles.)

Sippy cups

Amelia: Next up: sippy cups. My pediatrician advised us to skip them and go straight from a bottle to a straw. What’s up with that?

Alisha: With a sippy cup, you use the same suck pattern as with a bottle: for both, they put their little tongue under the nipple or spout and move it back and forth to drink. You’re not challenging them or advancing at all. With the straw cup, they use a different suck pattern–one that helps to develop speech sounds. A straw cup is more developmentally advanced than a sippy cup. The other issue is if they use a sippy cup for a long period of time, it can actually make their teeth push out. It’d have to be for a long time, but it is a potential risk.

Amelia: Oh wow! This is so interesting… you’re actually helping them develop their mouth in preparation to speak?

Alisha: Yes! Using a straw helps strengthen the muscles in the mouth that are used for speech. To drink from a straw, you use your lips—your tongue isn’t involved at all.

On another note, drinking from a straw is also really great sensory stimulation. The actual sucking sensation brings a soothing, calming, organizing stimulus to their systems. This is especially helpful for kids with sensory issues, since they are all over the place. Generally speaking, sucking on a straw brings balance to a kid’s system. It can also be alerting, too, especially if it is a cool drink.

Straws

Amelia: One of my favorite posts (thus far!) on your blog explains how to teach your little one to drink from a straw. Thank you for posting this because I went through a time when I asked every mom I saw with a toddler drinking from a straw HOW they taught them, and no one could really explain it. Your post includes a great step-by-step method. 

Alisha: You can usually teach them with a regular straw first. That’s because the no-leak cups with a built-in straw have a valve which requires a strong suck in order to get any liquid out of them. Some kids pick it up it up right away—one of my sons, for instance, amazed me by getting it at five months—and some kids need more time.

If your child is choking or coughing a lot of with a straw you might need to back off a bit. A straw brings a lot more liquid into the mouth and drops it further back on the tongue, so it can be challenging at first.

Snacking

Amelia: Lastly, as an occupational therapist, what’s the biggest mistake you see parents make when it comes to feeding? 

Alisha: The thing that I see the most often, and what really makes me crazy, is when people ask me, “Why won’t my kids eat?” Usually, the answer is “because you’re giving them snacks all day!”

Many people make the mistake of letting their kids graze all day long. Handing them a couple of pretzels here, a cup of Cheerios there. And I’m not saying that I’ve never done it. However, I save it for exceptions, just to pacify them in extreme situations. It can ruin the appetite and it’s also a safety issue, especially a choking hazard, for children under the age of 5.

Snacks should be more substantial than this and they should be worked into the routine. For instance, kids should eat every 2.5 to 3 hours from the start of one meal to the start of the next with just water in between. (This is under my ‘basic strategies‘ on my blog.)  I know everyone is crazy busy and this can be tough but I think having structure around your meal patterns is very important.

I believe that eating should be an event. It’s family time, it’s social time, whether your kids are with you, grandparents, or whomever. I think eating and meal time should be given the respect that it deserves by having kids sit down at a table to do it. You want to show them that meal time is an important part of life and not something we are just doing it passively.

Amelia: Oh, Alisha! That’s really wonderful! In addition to making sitting down at a table to help make meals important, I love the idea of ‘not eating passively.’ Teaching kids (and adults!) to be more deliberate when it comes to choosing foods and nourishing themselves—especially with the food-is-everywhere environment we live in—is definitely worthwhile! 


Thanks to Alisha Grogan for ALL the great tips and advice. If you want to learn more about how to help your child be a better eater, you can find additional articles on the website Your Kids Table. You can also find Alisha on FacebookTwitter, and Pinterest. Enjoy!