Introducing our new monthly giving community: Food Every Day!

Be the reason a child eats — for just 50 cents a day.

When you join Food Every Day, you become the reason a child gets to grow up healthy and strong — and in many cases, the reason they get to stay with their family.

Families living in poverty work hard to keep food on the table — but too often, it’s still not enough. And when crises like job loss, illness or drought strike, the need becomes even more urgent. Parents struggle to provide even the most basic necessity for their children: food every day.

For a child facing hunger, food isn’t just a meal — it’s a lifeline.

When you provide Food Every Day, you will:

Make a Lasting Difference — By extending your impact beyond a one-time gift, no child will ever wonder where their next meal will come from.

See Your Impact — Get monthly text and email updates about children who are thriving because of you!

Stay Connected — Receive our print newsletter featuring heartwarming stories and photos from around the world.

Give with Ease — Automatic contributions make giving smooth, ensuring no child is left waiting and hungry.

As a member of FED, you ensure a child has the daily meals they need to grow, learn and dream. You will nourish their mind and body, help them catch up in their development — and bring their joyful giggles back!

You Can Help a Hungry Child

When you give Food Every Day, you not only help a child learn, play and grow — you help keep their family together.

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Learn more about Holt’s child nutrition program!

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Picky eating is an incredibly common and typical part of child development and is often noted by parents of children who have been adopted. In fact, it’s so common and often occurs multiple times across a child’s life, due to natural bursts in a child’s cognitive development.

When the brain grows in this area of development, it frequently makes trying new foods stressful and more challenging for a child’s body. This can also make mealtimes more difficult for caregivers. Often, children who are picky eaters will refuse to try new foods, they will refuse to eat familiar foods that they have previously enjoyed, and they will request or want to eat the same foods for long stretches of time. Children this age do have the skills to eat a wide range of food textures; however, they are more selective in their tastes due to their developing brains. 

My toddler is pretty particular about the brand of chicken nuggets I offer her for somebody who just ate a crayon.

Mark@TheCatWhisprer

Feeding is a sensory experience. Very often children will taste a food only after they have been given the opportunity to touch it first. Allowing children the chance to explore foods with their hands leads to greater comfort around foods and a stronger readiness to eat them. Remember: If solid food opportunities are postponed (beyond 6 months), or if a child is provided with few opportunities to practice eating foods and feeding themselves, it can make the process of eating much more difficult as well as impact oral-motor skill development. It’s important to remember that picky eating is typically a phase, and most children will move out of it. Children this age must often be exposed to a food 20 or more times before deciding to eat it, so eating new foods can take time and patience. 

What Is Problem Feeding (Extremely Picky Eating)? 

If a child is showing very strong preferences and is eating very little at meals, and this is happening over a prolonged period of time without improvement, caregivers should consider a referral to a feeding specialist to determine if something bigger is going on. Some diagnoses are more prone to extreme picky eating (also known as “problem eating”), such as autism spectrum disorders and children with sensitive sensory systems. 

Signs of Problem Feeding  

Your child:

• Eats fewer than four different foods or shows a steady reduction in the types of foods he will eat 

• Shows strong preferences for certain types of foods (only crunchy foods, warm foods, orange-colored foods, sweet foods, one brand of food, etc.) 

• Shows extreme upset when offered certain foods, especially new foods 

• Indicates strong preferences for eating foods in certain ways (same cup/bowl, foods must be separated and cannot touch, they must be whole and not cut, etc.).

Check out additional parenting resources!

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6 Tips for Supporting Picky Eaters  

1. Offer frequent exploration. Allow children the opportunity to explore foods (new and familiar) with their hands and utensils. Offer lots of opportunities for food exploration throughout each day. The more a child can touch, smell, see and experience a food, the more comfortable they will become tasting it! 

2. Encourage food interaction. Allow children who are picky eaters the opportunity to feed themselves. When children feel more in control at mealtimes, they are more open to eating foods. Also, offer children the chance to serve themselves food at meals. When children are able to interact with food in different ways (including serving it to themselves), they become more familiar with foods and more open to eventually eating them. 

3. Go slow, small and familiar. Offer small amounts of new foods at a time to avoid overwhelming a child. More food can be provided once the first serving is finished. Offer new foods alongside familiar foods the child already enjoys. This reduces stress by letting a child see how they have options, including something they already enjoy. 

4. Be consistent. Consistently offer a child many opportunities to become comfortable with foods at meals. Offer new foods often. When children are able to experience unfamiliar foods often, it reduces their stress and increases their interest and comfort in eating them. Just because a child refuses a food once or twice, does not mean they don’t like it. 

5. Eat together. Eat alongside a child. Children like doing what others are doing, so this is a great way to let them know that foods are safe and nourishing. Allow children the opportunity to eat alongside peers. Children learn a great deal from their peers. Group mealtimes are a wonderful chance for children who are picky eaters to expand what they will eat just by watching their friends. 

6. Learn outside of a mealtime. Have fun experiencing foods in ways other than eating. Look at pictures of foods, play with pretend food and talk about foods you see in your environment, such as at the local market or in the kitchen. 

You could make dinner for a toddler, or you could just cut out the middleman and throw away a plate of food and squirt ketchup on the dog.

Simon Holland

During this exciting time of life, children continue to show big bursts in development, including the types of food and drink they are interested in and capable of eating and drinking. As a child’s skills continue to mature, caregivers play a large role in supporting a child’s interest in enjoying a wider variety of foods. When met with questions or challenges surrounding a child’s interest in eating and drinking, it’s strongly encouraged to seek the support of an expert in your community, such as a feeding specialist or occupational therapist.  

For more details on feeding best practices, download Holt International’s Feeding & Positioning Manual: Guidelines for Working With Babies and Children.   

Receive Family & Adoptee Support

All parents encounter challenges as their children grow up. And sometimes, issues may arise that leave you uncertain as to how best to respond. But not every issue requires therapy or counseling. The Holt Family & Adoptee Support program is here to help during those times.

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Family mealtimes aren’t just about eating! They are about cultivating rich and thoughtful interactions that embed learning with loving. For many children who have been adopted, mealtimes with their adoptive families can mean new rituals and routines.  

7 Tips for Setting the Table for Successful Family Mealtimes  

Here are 7 tips that lend themselves to the creation of more meaningful meals in your home.  

• Set a regular schedule and routine. Develop regular and consistent family mealtimes. Try to limit grazing during the day, which can lead to reduced appetites for scheduled mealtimes. Also, offer mealtimes in the same locations in your home. Main meals are always served at the dinner table, for example, and snacks are served at a special snack table. Using consistent methods helps children know what is to be expected, which leads to reduced stress and increased success!  
• Eat together. Eat alongside your children! Children learn by watching others, and they enjoy doing what others are doing. So eating together is a great way to let them know that foods are safe and nourishing. It also allows children to know that nothing more exciting is happening in that moment, which can reduce distracted tendencies, anxieties or fears of missing out on other experiences. Even if you do not want to eat at the same time as your child, set aside the time to be present alongside them. Sip on a drink or have a small snack while they eat. Being an active participant alongside them can make mealtimes more enjoyable for everyone. 

• Teach by modeling. Children learn not only how to do things, but also what is expected of them by watching others. Mealtimes are a terrific place to show children what expectations you have for yourself as well as for them. Keeping this in mind, if you want a child to eat a specific food, you’ll need to eat it too! If a child sees that an adult dislikes something or refuses to partake in it, that behavior is what is learned. Additionally, if you want a child to sit for a meal or not look at electronic devices while eating, model these behaviors as well. Caregivers are the greatest of teachers!

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• Offer choices. Everyone loves feeling like they have the ability to control their situation, including our children. One way to do this at mealtimes is to offer a child specific choices. This might look like offering choices for what to eat for a snack, which drink to have or how many sweet potato fries go on their plate. It might also look like offering options for which cup or bib to use, which seat to sit in at the table or what music to play in the background. Keep the number of choices offered small (two to three maximum at a time), and avoid offering the “buffet approach.” Too many choices can become overwhelming for a child to choose from, and difficult to manage as the adult. 
• Make mealtimes not only about the food. Mealtimes are a wonderful chance to connect with one another, whether your child is younger or older. Instead of talking only about the food (“Take another bite!,” “How does it taste?,” “Do you want more?”), try talking about how the broccoli looks like a tiny tree or how delicious the meal smells. Share about your day, your favorite book or song, or what you’re excited to do afterward. Focus on the experience together during meals. Lastly, avoid external distractions, such as watching or using electronic devices, which can not only limit meaningful interactions, but also negatively impact a child’s ability to understand their hunger and satiation signals.
• Provide responsibilities. Just as children thrive on schedules and routines, many often enjoy or even prefer being offered specific responsibilities around mealtimes. Offer children different jobs, such as assisting with meal planning and/or grocery shopping, lending a hand with cooking and food preparation, setting the table, serving food to others and cleaning up after meals. Ensure these responsibilities are sensitive to the child’s age, development and capacity. For example, a young child may be able to assist with pouring items into bowls and washing veggies, while an older child may be able to partake in more complex preparation tasks. Children may choose to keep the same roles each day, or they may enjoy the opportunity to choose a different role over time.   
• Set appropriate expectations. Everyone is coming to a mealtime with different experiences, abilities and energy. For example, a young child might not yet be expected (or able) to sit for a meal longer than 15–20 minutes, or they may frequently reject new foods offered to them. Another child might be distracted more frequently, need ongoing assistance with self-feeding due to motor challenges or need fewer choices presented so that they don’t become overwhelmed. Knowing and adjusting expectations for each child is key to maintaining a more positive mealtime. 

So forget the stage! Dinner tables are what (figuratively) need to be set in order to have more successful mealtimes. As always, if you have questions or challenges surrounding mealtimes in your home, seek the support of an expert in your community, such as a feeding specialist or occupational therapist. 

For more details on feeding best practices, download Holt International’s Feeding and Positioning Manual: Guidelines for Working with Babies and Children.   

Receive Family & Adoptee Support

All parents encounter challenges as their children grow up. And sometimes, issues may arise that leave you uncertain as to how best to respond. But not every issue requires therapy or counseling. The Holt Family & Adoptee Support program is here to help during those times.

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A child’s feeding skills are directly related to their entire body’s physical and intellectual development. When a condition, illness or disability is present, feeding skills may be impaired. Many children who have been adopted have varying disabilities, special health care needs or feeding difficulties. Therefore, they require a different set of feeding strategies.

Common Feeding Strategies 

There are many strategies that can assist caregivers with supporting a child’s individual feeding needs. It’s always best to seek out specialized support from a trained feeding specialist, such as a speech-language pathologist or occupational therapist, when questions or challenges arise.

However, there are some basic actions that often work well for many babies and children. Listed below are some of the top general strategies for supporting a baby and child’s feeding development, organized into four groups:  

1. Feeding Timing 

2. Equipment 

3. Positioning 

4. Other Ways to Help 

Feeding Timing  

• Limit feeding times. Try limiting feedings and mealtimes to 30 minutes or less at a time. The longer a baby or child is asked to participate in a feeding or meal, the greater the chance he will begin burning more calories than he takes in orally.   
• Look for feeding cues. Try feeding babies and children based on their feeding cues. This means looking for signs that they are ready to eat and ready for a break or to be finished.  
• Look for hunger cues. Children may indicate they are hungry by bringing their hands to their mouth, sucking on their fingers or toys, opening their mouth, licking their lips, turning their head toward others and food sources, stretching, wiggling and showing increased physical movements, cooing and smiling at food sources, looking at and/or reaching for food, using specific sounds or words to request food, or fussing and crying.  
• Watch for other signs. Children may indicate they need a break or are finished eating by not sucking for lengthier periods of time or altogether, closing their mouth, turning their head away from others and food sources, eye rubbing, yawning, falling asleep during feedings, having a limp body, splaying their hands and legs, pushing food away using their hands, or fussing and crying.
• Respect a child’s desires. Crying, fussing and turning red or darker in color are late signs that a child is hungry or becoming upset that his cues to stop are not being understood or honored. Catching a child before these signs begin is strongly encouraged since all children feed best when they are calm and alert. Respecting a child’s desires leads to more positive mealtime experiences. 
• Change a schedule. Try slightly changing the feeding schedule. For example, offer smaller, more frequent feedings or larger, less frequent feedings. Watching for a baby’s cues will be crucial!  
• Keep the pace. Try pacing babies and children at feedings and mealtimes. Pacing helps babies to find sucking rhythms, reduces coughing and aspiration, minimizes the occurrence of liquid leakage and spitting up, allows for rest breaks and builds endurance. Pacing helps older children learn how to safely eat a meal at an appropriate pace, thoroughly chew and swallow food, and reduce the risk of choking. Always use a rate of feeding that matches the rate a baby and child can safely and comfortably handle.  

Your job as a parent is not to make your child’s way smooth, but rather to help her develop inner resources so she can cope.

Ellyn Satter, MS, RD, LCSW, BCD

Equipment  

• Use the right equipment. Try using feeding equipment that matches the individual needs of a baby and child. For example, use slower flow nipples and bottle systems for a baby who has a hard time with faster flows; specialty bottles and nipples for a child who has difficulty sucking or swallowing; softer nipples for a baby with a weaker suck; or smaller child-size spoons and cups that match the size of a child’s mouth and hands and allow for more successful eating and self-feeding.  
• Offer extra support. Try using a chair or seat that provides optimal positioning and support for a child, and offer extra physical support for their body when needed. This support could include rolled-up towels or blankets, pillows, foam and stuffed animals (for a child’s body), or boxes, suitcases, benches, stools, containers, books, wood, etc. (for their feet).   
• Provide the right foods and liquids. Try offering babies and children suitable foods and liquids for biting, chewing and swallowing, and appropriately sized food bites and sip sizes that reduce the risk of choking.  
• Offer “soothing” toys. Try offering a baby a pacifier or a teething/sensory toy before and after feedings for soothing, organizing and building oral awareness.  

Positioning  

• Get into position. Always follow the key elements of positioning for all babies and children.  
• Elevate! Always feed babies and children in an upright position that is at least at a 30- to 45-degree angle. Do not feed them lying down on their back or without any elevation as this can lead to choking, spitting up and other serious medical issues.  
• Maintain an upright position. Try keeping babies and children upright for at least 15 to 45 minutes after all feedings to keep foods and liquids in their stomach. You can do this by holding them, having them stay seated in their chairs or by using a carefully constructed wedge or rolled-up blanket or towel that offers adequate elevation.  
• Keep things safe. Sit at eye level with a child while feeding them, as this helps them maintain proper alignment for safely eating and drinking. 

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Other Ways to Help 

• Make changes slowly. When making changes to how you are feeding a baby or child, start by changing one element at a time. Too many changes all at once can be stressful and can make it hard to know which changes worked well and which did not.  
• Make assessments. Stop feeding a baby or child who is coughing, choking or gasping for air. These are signs that something about the feeding process is not working and needs to be assessed and addressed before moving forward.   
• Don’t force your child. Avoid forcing a baby or child to eat. Calm them as much as possible before offering feedings and mealtimes, and respect the cues they are showing. 
• Encourage independence. Encourage babies and children to practice feeding themselves, when possible, to build foundational skills. This might look like gently helping a baby hold their bottle with you during a feeding, or offering a young child utensils and cups to practice with at each meal. Eating with a child is a terrific way for them to see how others eat and drink.  

Just as every child is a unique individual, so too are the feeding supports they may require around mealtimes. Additionally, even though some children have the same condition or disability, they are still very different and may have varying needs or capabilities. It is critical to look at each child independently across all areas of development to best understand their particular abilities and needs and the precise equipment required to support their growth and development. This might include using the strategies shared above and seeking additional help from a community expert.  

For more details on feeding best practices, download Holt International’s Feeding & Positioning Manual: Guidelines for Working With Babies and Children and reference our Feeding and Interaction Cues Handout (Appendix 9L2).

Receive Family & Adoptee Support

All parents encounter challenges as their children grow up. And sometimes, issues may arise that leave you uncertain as to how best to respond. But not every issue requires therapy or counseling. The Holt Family & Adoptee Support program is here to help during those times.

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Feeding difficulties can arise at the start of a child’s life or they can develop over time. Whatever the reason, what’s most important is that caregivers know how to deliver care that supports a child’s ability to eat and drink safely and comfortably so they can grow and thrive.  

Conditions Commonly Associated With Feeding Challenges

A child’s feeding skills are directly related to their entire body’s physical and intellectual development. When a condition, illness or disability is present, feeding skills may be impaired. Many children who have been adopted have varying disabilities, special health care needs or feeding difficulties.  

Conditions or disabilities often connected with feeding difficulties include:  

• Autism spectrum disorders  
• Cardiac (heart) conditions  
• Cerebral palsy  
• Cleft lip and/or cleft palate  
• Deafness and hard of hearing  
• Down syndrome
• Fetal alcohol spectrum disorders and substance (drug) exposed children  
• Prematurity and low birth weight  
• Vision impairments 

What Are Feeding Difficulties? 

There are many different types of feeding difficulties that can arise for a child. Some of these occur at birth and persist for several weeks or months. Other challenges can occur later on in a child’s life and might be short or long-term. Below are 12 feeding difficulties babies and young children may experience.

1. The sleepy, hard-to-wake baby.

These babies fall asleep during feedings and they can be difficult to keep awake while feeding. They often do not let caregivers know when or even if they are hungry. Babies with fragile systems, especially those born early or exposed to substances, have extremely sensitive bodies. They will fall asleep as a way to protect themselves when challenged by stressful environments and situations. This can include babies with Down syndrome, heart problems (cardiac conditions), babies who are medically fragile, born early or babies exposed to substances in the womb. 

2. The fussy baby who is hard to calm.

These babies often fuss when they are being fed and when they are not being fed. They might appear hungry but then fuss when offered the bottle. Babies with fragile systems, especially medically complex babies or those born early or exposed to substances such as drugs or alcohol, will fuss as a way to communicate their discomfort and stress. It can be confusing for caregivers and very hard to understand why they are upset. These are the babies who can be incredibly difficult to soothe or babies who don’t stay calm for very long. This can include babies with cardiac problems (heart conditions), babies exposed to substances in the womb, babies who are medically fragile or born early, or babies with vision or hearing impairments or neurodevelopmental delays. 

3. The baby who has difficulty sucking.

These babies cannot suck strongly or efficiently or have a very disorganized sucking pattern. They might have trouble compressing nipples to get milk flowing using their lips and cheeks. Faster-flowing liquids can be very hard or even dangerous for them to drink. They often have messy feedings and can become tired easily since sucking can take so much effort. These babies can also struggle to find a good sucking rhythm, which can lead to even more tiring and stressful feedings.

Babies with low muscle tone or weak hearts and lungs tend to have this particular challenge.

Babies with low muscle tone or weak hearts and lungs tend to have this particular challenge. This can include babies with Down syndrome, babies with cerebral palsy, babies exposed to substances such as drugs or alcohol in the womb, babies born early, or babies who are medically fragile or have neurodevelopmental delays. 

4. The baby who coughs, chokes or gags.

These babies might cough, choke or frequently gag and spit up while taking liquids from a bottle during a feeding, directly after feeding or both. These babies might look like they are struggling to eat and breathe and gasp for breaths while feeding. This can include babies with heart (cardiac) conditions, Down syndrome, muscle tone issues such as cerebral palsy, or cleft lip and/or palate. This may also include babies exposed to substances such as drugs or alcohol in the womb or babies born early or with neurodevelopmental delays. 

5. The baby who frequently spits up.

Gastroesophageal reflux (GER) happens when food from the stomach comes back up into the throat causing pain and discomfort. Gastroesophageal reflux disease (GERD) is a more serious and long-lasting form of GER and may prevent a baby from feeding well and gaining weight. These babies tend to spit up often, sometimes after every feeding. They appear uncomfortable and seem hungry but frustrated when feeding. Often, over time, these babies may refuse to eat because it is such an uncomfortable and stressful experience. This can include babies with low muscle tone (cerebral palsy), babies exposed to substances such as drugs or alcohol in the womb, or babies born early or with neurodevelopmental delays. 

6. The baby who is born early. 

Babies who are born prematurely include those born before 37 weeks gestation. Depending on how early the baby is born and how much the baby weighs, feeding difficulties are common and will vary in their complexity. When babies are born early, their bodies aren’t fully developed. This means that feeding skills are usually not fully developed and that babies will need additional time and support in order to become safe and successful feeders. This can include babies with a variety of additional medical issues such as heart (cardiac) conditions, neurodevelopmental delays, Down syndrome, muscle tone issues such as cerebral palsy, or cleft lip and/or palate, or babies exposed to substances such as drugs or alcohol in the womb.

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7. The baby or child who tires easily. 

These babies will often feed for only a few minutes before getting tired. They frequently fall asleep during feedings and can have trouble finishing them. Feeding is hard work, especially for babies with fragile systems. Babies with heart or lung issues or those born early tend to tire more quickly than expected and have difficulty building endurance for feeding as well as difficulty with many other activities, such as sitting and crawling.

Babies who tire easily can grow into children who tire easily at mealtimes.

Remember: Babies who tire easily can grow into children who tire easily at mealtimes. This can look like a child who eats less at meals, needs frequent breaks, avoids certain food textures or shows increased fatigue with foods that are harder to manage or chew. This might include babies and children with cardiac (heart) or respiratory (lung) conditions or Down syndrome, or babies and children who are medically fragile, born early or exposed to substances such as drugs or alcohol in the womb. 

8. The baby or child who has problems with muscle tone. 

Babies and children can have low hypotonia (floppy) or high hypertonia (tight, rigid). When a child has trouble controlling the tone in their muscles, feeding activities can be challenging, including sitting upright, holding the head in a neutral position and using the tongue and lips for managing foods. These children can also be at higher risk for swallowing problems and aspiration because the muscles that assist with swallowing can be floppy or tight.

Some children move back and forth between high and low tone. This is called “fluctuating tone” and it is most commonly seen in children with specific types of cerebral palsy. Low and high hypertonia can also occur in children with damaged spinal cords or brain injuries, Down syndrome, heart (cardiac) conditions or children who are medically fragile, born early or exposed to substances such as drugs or alcohol in the womb.  

9. The baby or child who has difficulties with structures of the mouth. 

Babies or children may have feeding difficulties due to structural differences in their bodies. Problems with the jaw, tongue, lips, cheeks and palate may lead to problems with feeding, such as difficulty sucking, biting, chewing, swallowing and eating more difficult food textures. Babies and children born with birth defects that affect the lips, nose and/or roof of the mouth (cleft lips and/or palates) might also experience feeding difficulties.

Because of these clefts (slits, openings), babies tend to have problems forming a tight seal around a nipple (cleft lip) and creating the necessary suction needed for efficiently sucking liquid from bottles (cleft palate). This can also include babies and children with a variety of syndromes or conditions such as Down syndrome, cerebral palsy, autism spectrum disorders and neurodevelopmental delays, as well as children who are medically fragile, born early or exposed to substances such as drugs or alcohol in the womb. 

10. The baby or child who has a sensitive sensory system.

Every baby and child has a unique sensory system. A child can have a sensory system that is hyporeactive (understimulated) or hyperreactive (overstimulated). Problems with a baby or child’s sensory system occur when the body does not process and control sensory information well. This can make many daily activities difficult and very stressful, especially at mealtimes. This may include babies and children with cerebral palsy, Down syndrome, autism spectrum disorders or fetal alcohol spectrum disorders, children with visual or hearing impairments, or children who are medically fragile, born early or exposed to substances in the womb.  

11. The child who is born substance exposed.

Substances, such as drugs or alcohol, hurt a child’s developing body when in a mother’s belly. Children who are exposed to drugs (prescription and/or illegal) and/or alcohol often have feeding difficulties. Depending on what the child was exposed to, how much she was exposed to and how often, the feeding difficulties will vary in their complexity. These children tend to have very sensitive systems because of the substance exposure, leading to frequently spitting up, discomfort when feeding, and difficulty staying calm and focused when fed. This can include children with a variety of additional medical issues, such as heart (cardiac) conditions, neurodevelopmental delays, Down syndrome, muscle tone issues such as cerebral palsy, and cleft lip and/or palate.

12. The child who has trouble biting and/or chewing or swallowing. 

These children have trouble biting through solids and developing effective chewing for eating all types of foods. For children who have cavities and other tooth and gum problems, eating harder textured foods can be painful, leading to avoidance of these foods. For some children with lots of medical needs, biting and chewing can be very tiring, which means they tend to eat less during meals. These children may also cough while taking liquids from a cup or straw during a feeding, directly after feeding or during both interactions. They might look like they are struggling to eat and breathe or are gasping for breath while feeding however we can’t always see that they are having problems.

Just as every child is unique, so too are their feeding difficulties and needs around mealtimes.

Other reasons for these challenges may be linked to high or low muscle tone, sensory issues and/or structural abnormalities. This might include children with Down syndrome, muscle tone issues such as cerebral palsy, heart (cardiac) conditions, dental problems, visual impairments, or cleft lip and/or palate. Additionally, it could also include children who were born early, are medically fragile, have neurodevelopmental delays and have been exposed to substances such as drugs or alcohol in the womb.

Just as every child is unique, so too are their feeding difficulties and needs around mealtimes. It is essential that all caregivers understand each individual child’s strengths and areas for growth, and have the knowledge and skills to offer the best possible support. Mealtimes are valuable experiences that happen every day, multiple times a day. Therefore, it is essential to work toward ensuring each child has the opportunity for positive and safe feeding experiences. If you have any questions about your baby or child’s feeding development, seek support from an expert in your community, such as a feeding specialist or occupational therapist.

For more details on feeding best practices, download Holt International’s Feeding & Positioning Manual: Guidelines for Working With Babies and Children. 

Receive Family & Adoptee Support

All parents encounter challenges as their children grow up. And sometimes, issues may arise that leave you uncertain as to how best to respond. But not every issue requires therapy or counseling. The Holt Family & Adoptee Support program is here to help during those times.

Learn More

The post Feeding Difficulties appeared first on Holt International.

During the early years, so much is going on in a child’s brain and body to get them to a place of skill mastery and confidence. With the support of mindful and loving caregivers, the stage is set for children to successfully navigate these feeding transitions on their journey toward becoming independent eaters and drinkers.  

The chart below displays the typical feeding timeline for a child between birth and 36 months of age. It also shows the most likely food and liquid they can safely manage and the associated skills they gain along the way. Keep in mind that with all development, culture and cultural practices play a vital role in the way in which development unfolds.  

Typical Feeding Development for Children 0 to 36 Months (0 to 3 Years)

Concerned about food safety for your young food explorer? Refer to FoodSafety.gov for information on the safe preparation and storage of formula and pureed foods.

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6 Tips for Supporting Food and Liquid Introductions to a Child  

1. Pay attention to development, not just age. A child’s chronological age is only one indicator of their readiness for advancing in their feeding development. What’s often more important are their developmental skills. A child will show you their “readiness” to take on a new feeding challenge by demonstrating specific and necessary skills. Watch for these key developmental skills that help indicate when new experiences may be on the horizon for a child.  

2. Be prepared. Preparing children before a new mealtime experience is critical for success. Prepare the environment and the child’s body and mind. Share with the child what you will be offering that is different before it happens. Try using spoken words (“Let’s try a new taste today! Pears!”), offer opportunities to explore new smells and textures, or show a child visually what new food is to come. Get yourself excited and organized for the new experience. The more preparation you offer, the more potential for success!   

3. Start with what is familiar. Children do best when consistent, familiar routines are used. Keep a schedule for meals, use the same feeding utensils, feed in the same chair and room, and offer a child a familiar food or liquid first. This will aid in the steady expansion of new flavors, textures and other feeding experiences when a child is ready. 

4. Offer lots of exploration time. Exploration of new food and non-food items (i.e., cups, bowls, spoons, etc.) is a great way to support the novelty of an experience for a child. Let children explore items using all of their senses often, especially their hands. 

5. Make changes one at a time. Children do well when changes are made one at a time versus all at once. Take your time when making changes to a mealtime, including offering a new flavor, texture or experience. For example, if you’re offering a new cup, keep the liquid inside of it familiar to the child. If you’re offering a new food, offer one new item at a meal alongside other tried-and-true, familiar favorites. 

6. Be positive. Offering positive interactions with a child during mealtimes (and beyond) is the best way to support this process. Keeping mealtimes calm, low-stress and enjoyable all lead to more positive mealtime experiences for everyone.  

So much is happening during the first three years of life, including a child’s learning how to safely eat and drink. When caregivers better understand early developmental milestones related to feeding development and this potential feeding timeline, they are more equipped to successfully support this process for a child. Also, it’s important to remember that this is an estimated guide. Some children will have a timeline that looks different based on their own unique capacities and needs. If you have questions or challenges regarding a child’s feeding development, seek support from an expert in your community, such as a feeding specialist or occupational therapist.

For more details on feeding best practices, download Holt International’s Feeding & Positioning Manual: Guidelines for Working With Babies and Children. 

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The post Feeding Development: The First Three Years of Life appeared first on Holt International.

The concept of “mealtime” has changed over the years, resulting from changes in our cultural, economic and social structures; and for children who have been adopted, mealtime experiences might differ greatly. Mealtime is when two or more people in a shared relationship come together to eat food in the same place at the same time. Successful mealtimes can help develop family identity, provide structure, support family cohesion, encourage a sense of belonging and positively influence the health and well-being of family members. 

Some of our children have experienced adverse childhood experiences at various points in their lives. Adverse childhood experiences (or ACEs) can influence children’s behavior and have an impact on mealtime participation. We want all of our children to be engaged and participate in mealtimes to support their overall growth and development.

Here are 11 areas where you can help to support your child and create successful mealtimes.

1. Safety  

Safety is the condition of being secure from undergoing or causing hurt, injury or loss. When it comes to shared meals, caregivers should ensure the environment and food they are presenting are “safe” for the child. Aim for consistent, relaxed, engaged meals where everyone is facing the table and the environment feels calm.  

 2. Food texture 

Food texture can also be thought of as the “density” of the food. Your child’s food needs to be a good match for his skill level (not his age). Matching the texture of food with a child’s skill level is the best way to avoid choking, or blocking the airway. Typically, the progression goes like this: bottle-feed only until 6 months, then offer smooth purees, textured purees, “mashable” soft foods, “meltable” soft foods and finally soft foods. For example, if I have a 3-year-old who still uses a bottle for primary nutrition, they may not be ready for a typical child’s diet of chicken nuggets and fries. 

 3. Your child’s anatomy

Assess the anatomy of your child. Consider how children’s physical structures and abilities may make them more successful or have more challenges with different types of eating, chewing or swallowing. Consider the structure of their chewing surfaces — the lips, tongue, cheeks and back of the throat. All these need to be in good repair for a child to eat and swallow. A young toddler or child will not eat if it hurts. What is the condition of their teeth? Do they have cavities? Thrush? Big tonsils? Look for clues in a child’s behavior, such as refusing foods that are cold or hot, swallowing food whole or only wanting liquids. 

 4. Positioning 

The ideal positioning for eating is 90/90/90. This means we are looking for a 90-degree angle at your child’s hips, knees and ankles, with their feet resting on a solid surface to ensure they feel secure. Avoid putting feeding seats on the table. Make sure your child cannot slip off their chair, that the chair cannot tip over and that your child has good support to the back and sides. Proper positioning will allow a child to use their arms to feed themselves freely. It will also ensure that their airway won’t be compromised, their jaw will be able to chew food normally, and they will feel more safe, secure and available to participate in the meal.  

 5. Utensils 

Always aim to use utensils that are the right size for the child. Allow your child opportunities to practice or play with them. If you have a smaller child try and use silverware that the child can easily pick up, hold and manipulate with tiny hands, and that has small surfaces that will fit easily into their mouth. Conversely, make sure the utensil is big enough for older children. A baby spoon with a metal handle and a plastic-covered bowl is typically not big enough for a 4-year-old to use efficiently. Using utensils or certain types of utensils could be a new experience for some children. Starting with “finger foods” presented with a fork or spoon may be a great way to help your child learn without the pressure of having to get it right every time. 

Mealtimes can help develop family identity, provide structure, support family cohesion, encourage a sense of belonging and positively influence the health and well-being of family members. 

 6. Cup drinking 

Drinking from an open cup is more complex than you would think. There are many steps to drinking successfully from a cup. Let’s help children learn skills without the embarrassment or shame of spilling on themselves, swallowing the wrong way or “not being allowed” to drink at the table (when everyone else is). Sippy cups, bite-and-sip cups, juice pouches, straws, and little “dosing” cups are all great ways to introduce the skill of cup drinking. 

 7. Safe learning 

We want to allow children the opportunity to learn, play, try new things and participate with the whole family. To do so, we want to create an environment that promotes safe learning — an environment where spilling, dropping and making messes are OK and part of learning how to develop eating skills. Be conscious of saying things that may hurt a vulnerable heart, or of using sarcasm, teasing or pointing out an error in a disparaging way. Sometimes things said in jest can undermine your relationship: for example, “Are you going to eat all of that?” or “What are you crazy? All kids your age like this!”.

Research shows that sometimes the things that are said to us can leave behind a long-term injury. The focus of shared meals needs to be about creating a shared experience between family members, not about a power differential that can cause children to feel unsafe. 

8. Predictability 

Creating predictable habits and schedules can be very helpful for children. Children can develop feelings of safety by having predictable mealtimes and predictable rituals for shared meals. Unpredictability can keep your child’s nervous system on high alert. It can often take very little to trigger a fight-or-flight response in many of our children who have experienced ACEs or have some type of disability or special health care need.

When a fight-or-flight response kicks in, blood and energy move away from digestion, limiting appetite and impeding adequate nutritional intake. It may be helpful to create a visual schedule of the day for your child. (This could be sticky notes stuck on the refrigerator — it doesn’t have to be fancy.) On that schedule, include at least three meals and two snacks.    

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 9. Routines 

Create predictable routines and expectations around food and meals. Work together as a family unit to come up with some mealtime expectations: for example, food is only eaten at the table or in the kitchen. Set up simple and functional routines, such as starting with everyone washing their hands and then sitting down together.

Other routines can be about how food is shared around the table and how everyone is expected to clean up after the meal together. Come up with achievable plans, such as everyone sitting at the table for 10 minutes. Set a timer to help. Timers can help with the complicated concept of time by making it concrete. It may take time to establish a mealtime routine that everyone can stick to. It can be helpful to plan ahead of time what is going to happen if things don’t go as planned.      

10. Food security 

Food security is the physical and economic access to sufficient food to meet dietary needs for a productive and healthy life. Some children who have experienced ACEs or have certain types of disabilities may struggle with stress around food security. Many of these children may need to know that they have consistent and secure access to food.  They may also need help in understanding how this consistent and secure access can help them develop a better relationship with food. 

If your child is feeling food insecure, let them know that there is enough food in the house.  Locking cupboards and policing food can be destructive to a child’s mental health in this situation. Typically, it leads to hoarding-type behavior. To avoid this, have certain foods always available to your child. You can set up certain drawers in the fridge, space in the pantry, or a low cabinet with foods for your child to access. 

11. Food rewards and punishments 

Hunger is a survival cue. It is our biological need to eat. It can be very stressful for a child when food, which satiates hunger, is used as a reward or punishment. Our culture makes it very hard not to refer to food as “good” or “bad.” For example, stating “If you eat your vegetables, you can have ice cream after dinner” implies that you can only eat the “bad” foods if you have the “good” foods first. It can lead to overeating, misunderstanding natural hunger cues and problems with the ability to regulate eating. Don’t force your child to eat or be disappointed when they refuse food. Consider using other, non-food-related rewards, such as an extra book at bedtime or a special toy for bath time.  

For more details on feeding best practices, download Holt International’s Feeding & Positioning Manual: Guidelines for Working With Babies and Children.   

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All parents encounter challenges as their children grow up. And sometimes, issues may arise that leave you uncertain as to how best to respond. But not every issue requires therapy or counseling. The Holt Family & Adoptee Support program is here to help during those times.

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The post Successful Mealtimes – It’s Not About the Food appeared first on Holt International.

The sensory system is a complex group of neurons (cells in the body), cell pathways and parts of the brain that work together to allow an individual to feel different sensations from the environment. A child’s senses are used to learn while they are growing in the womb, and this learning continues the moment they are born.

The 8 Senses That Make Up Our Sensory Systems

Why Is the Sensory System Important? 

Sensory systems have a powerful impact on the success of mealtimes for our children. Every individual has a sensory system that is unique to them. The way a child’s sensory system is made will impact the way he experiences the world, including feedings and mealtimes. For example, the different tastes and smells of food can lead to a positive, enjoyable mealtime. However, if the tastes and smells are perceived as “bad,” negative or unappetizing, this can lead to a stressful and unenjoyable feeding experience. It is a parent’s job to discover a child’s sensory preferences (what sensations his body likes most and least) and any sensory challenges in order to make mealtimes and all daily activities more comfortable and manageable. 

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Every Child Is Unique 

Just as every child has certain preferences or capacities (a favorite hobby, craft or skill they are best at), every child also has a sensory system that is unique to them. Further, a child may have a hypersensitive sensory system or a hyposensitive sensory system. We call these “sensory sensitivities.” Children may also be overstimulated or understimulated in their environments and when they encounter certain sensory information.

Because sensory sensitivities can make feedings much more challenging, it is important that parents are able to identify when a child may be showing areas of concern and that they know how to help.

Because sensory sensitivities can make feedings much more challenging, it is important that parents are able to identify when a child may be showing areas of concern and that they know how to help. Different sensory information can cause a child to have more hypersensitive and hyposensitive reactions or less hypersensitive and hyposensitive reactions. Understanding what a child may be reacting to in an environment, especially during mealtimes, can help caregivers limit a child’s overstimulation or understimulation and make daily routines easier. 

8 Tips for Supporting Sensory Systems at Mealtimes  

1. Observe your child. Your child will show you their sensory preferences and needs through their reactions and behaviors. Let them show you what works best. 

2. Be prepared. Preparing children before a meal is critical for a successful mealtime. Prepare the environment as well as your child’s body and mind.

3. Know your child’s preferences. Every child will have unique and different sensory preferences. These preferences can often change.

4. Choose foods that are enjoyable. Offer items that a child can successfully eat and drink and that will be enjoyable for them. Offer new items alongside familiar ones to increase a child’s interest and comfort. 

5. Start with the familiar. Children do best when they are presented with consistent, familiar routines. Keep a schedule for meals, use the same feeding utensils, feed in the same chair and room, and offer a child a familiar food or liquid first. Expand to new flavors and textures when a child is ready. 

6. Make changes slowly. Children with sensitive sensory systems do well when changes are made one at a time versus all at once. Take your time when making mealtime changes, including offering a new flavor or texture. 

7. Offer lots of exploration time. Exploration of different non-food items and food items with different textures and flavors is a great way to support sensitive sensory systems. Let children explore items using all of their senses, especially using their hands. 

8. Be positive! Children learn best in the context of positive relationships. Offering positive interactions with a child during mealtimes (and beyond) is the best way to support this process. 

All children have a sensory system that is special to them. These systems, whether highly sensitive or not, can impact mealtimes and feeding development. When parents discover how best to support a child’s sensory preferences and needs, they allow their child the chance to experience the world in a safer and more comfortable way. If you have any sensory questions or challenges, seek out the support of an expert in your community, such as a feeding specialist or occupational therapist.  

For more details on feeding best practices, download Holt International’s Feeding & Positioning Manual: Guidelines for Working With Babies and Children. 

Receive Family & Adoptee Support

All parents encounter challenges as their children grow up. And sometimes, issues may arise that leave you uncertain as to how best to respond. But not every issue requires therapy or counseling. The Holt Family & Adoptee Support program is here to help during those times.

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The post The Importance of the Sensory System in Child Development appeared first on Holt International.

Further, feeding involves all areas of a child’s development: motor/movement, cognitive/thinking, communication and social-emotional skills.

When an area of development is not working to its fullest potential, challenges can arise for a child in their quest to feed and drink independently. Therefore, when supporting a child’s feeding development, it is critical to understand their specific needs and capacities and offer support that is in alignment with them. The earlier challenges can be identified, the sooner support can be provided, resulting in happier, healthier children and caregivers! 

Feeding development is comprised of these 5 primary components:  

1. Positioning 

2. Swallowing 

3. Sensory Systems  

4. Food & Liquid Textures and Consistencies  

5. Relationships 

Positioning 

Positioning refers to the way we hold a child in our arms or on our laps, and how we place a child in a chair, seat or on the floor for mealtimes. Ensuring a child is properly positioned during feedings is critical to keeping them safe. Additionally, when a child is well-positioned, they feel safer and ready to handle the task of learning to eat and drink!  

There are 6 key elements of positioning for infants and children of all ages:  

The way we position a child will depend on:  

• Age of the child  
• General developmental skills of the child, especially physical capabilities  
• Individual needs of the child (i.e., higher elevation of body during feeding due to reflux, increased head/trunk support due to low muscle tone, etc.)  
• Caregiver’s abilities  
• Resources available in the environment 

Swallowing 

Proper swallowing helps with digestion and prevents food and liquid from going into the lungs, which can lead to serious health issues. Eating and drinking during mealtimes should be enjoyable for children and their caregivers. However, when swallowing challenges arise, feeding can sometimes become uncomfortable, scary and even life-threatening.  

  There are 4 phases of the swallow:  

• Phase 1: Oral preparatory (a)
• Phase 2: Oral transit (b)
• Phase 3: Pharyngeal (c)
• Phase 4: Esophageal (d)

Each phase helps collect and transport food and liquid from the mouth through the throat and into the stomach.  

Aspiration is when food or liquid passes into the airway and lungs instead of moving into the stomach where it belongs. Depending on the child (and how often and how much he aspirates), improper swallowing can lead to illness, malnutrition, dehydration and even death. If a child is suspected of aspirating, it is critical to contact medical professionals for support.  

Swallowing Challenges

Sensory Systems 

The sensory system is a complex group of neurons (cells in the body), cell pathways and parts of the brain that work together to allow an individual to feel different sensations from the environment. Every individual has a sensory system that is unique to them. The way a child’s sensory system is made will impact the way he experiences the world, including feeding development. Eating is the most sensory-rich activity a child will experience!  

 
The 8 Senses That Make Up Our Sensory Systems  

Hyper- and Hyposensitivity

Some children have sensory systems that show increased (hypersensitivity) or reduced (hyposensitivity) sensitivity to certain sensations: for example, a child who covers their ears while in a noisy room, an infant who frequently falls asleep at the bottle or breast, the child who engages more in mealtimes following rocking and hugs, or the child who gags on new food textures. There are many reasons why a child might have a sensitive sensory system. Sometimes we can tease out the “why” and sometimes we may never uncover an answer. By being aware of what our children show us and noticing how they respond, we can make our best attempt at creating positive and manageable mealtime experiences that also grow their feeding capacities over time.  

Check out additional parenting resources!

View our expanded list of recommended parenting websites, books and other resources organized by topic.

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Food & Liquid Textures and Consistencies

From soft and smooth, to lumpy and bumpy, to crunchy and hard, to thin and thick – not all food and liquid feel the same or require similar skills to eat and drink! Because of this, it’s helpful for caregivers to understand these differences and identify which may be best suited for a child based on their specific needs and skills. Choosing the right texture and consistency for a child makes mealtimes safer, and more comfortable and enjoyable for everyone. When children can eat and drink safely and comfortably, they tend to eat and drink more!  

Why might a child need a certain texture or consistency? Or why might a child not be able to have a certain food or liquid? There are many reasons why we might choose to offer certain foods and liquids and/or avoid offering others to a child. A medical provider who specializes in pediatric feeding can offer support in this area.  

Some reasons include: 

• Medical conditions involving reflux, the lungs or heart 
• Children who are born early (prematurity) 
• Structural/anatomical differences (i.e., cleft lip and/or palate) 
• Neuromuscular disorders such as cerebral palsy 
• Developmental disabilities such as Down Syndrome  
   

Types of Textures

Types of Consistencies

Relationships

Learning to eat and drink is relational! One of the primary ways a child learns how to take a bite, drink from a cup or taste a new food is through robust relationships and modeling (showing) of how to do these things by those around them. Early skills such as feeding must be learned. Additionally, learning new skills can be hard! This means that while children are developing, they need extra support from their caregivers to feel safe, stay calm and “try again!” Regulation, or a child’s ability to become and stay calm, is essential for development, especially for eating and self-feeding.  

Learning to eat and drink is relational! One of the primary ways a child learns how to take a bite, drink from a cup or taste a new food is through the robust relationships and modeling of how to do these things by those around them.   

Putting it All Together

So, as you can see, feeding is a much more intricate process than simply putting sustenance into our bodies. It is a foundational process for a child not only to thrive but to also learn and connect with their world. If you are having questions or concerns about your child’s eating and drinking development, connect with a medical provider, such as a pediatrician or a feeding specialist (speech-language pathologist or occupational therapist) in your area for additional support.

For more details on feeding best practices, download Holt International’s Feeding & Positioning Manual: Guidelines for Working With Babies and Children. In addition, check out the Ellyn Satter Institute for more useful feeding information.

Receive Family & Adoptee Support

All parents encounter challenges as their children grow up. And sometimes, issues may arise that leave you uncertain as to how best to respond. But not every issue requires therapy or counseling. The Holt Family & Adoptee Support program is here to help during those times.

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The post Feeding Basics: How We Eat and Drink appeared first on Holt International.