Why Some Kids Struggle With Chewing Food

Introduction to Pediatric Chewing Challenges

Children’s ability to chew food effectively is a critical milestone in their development, impacting nutrition, growth, and mealtime experiences. However, some children struggle with chewing due to a variety of developmental, sensory, medical, and behavioral issues. This article explores why some kids face challenges with chewing food, the underlying causes, how to identify these difficulties, and the strategies available to support their progress towards safe and efficient eating.

Why Some Children Struggle With Chewing Food

Developmental causes of chewing difficulties

Children develop their oral motor skills gradually, starting around 7 to 8 months with initial exploration of food textures. By 1 year, children typically improve coordination of their tongue and develop chewing reflexes. Between ages 2 and 3, chewing becomes more refined, and by ages 4 to 5, the muscles involved in chewing become faster and smoother.

However, some children face delays or difficulties in this process. For example, children with developmental delays may not develop proper rotary-lateral chewing patterns, which are essential for effectively breaking down food. Early feeding difficulties, such as trouble with sucking or swallowing, can delay the transition from liquids and purees to solids.

Medical and structural factors

Physical abnormalities and health conditions can significantly impact a child’s ability to chew. Conditions like craniofacial anomalies, including cleft lip and palate, can interfere with the structure and function of the mouth. Dental problems or previous injuries to the jaw or oral cavity may also impair chewing.

Neuromuscular diseases such as cerebral palsy, muscular dystrophy, or nerve injuries affect the muscles and nerves that coordinate chewing movements. Premature birth and associated medical issues—like reflux, heart disease, or surgeries—may further interfere with feeding development.

In addition, structural issues like jaw deformities or enlarged tonsils and tongue can hinder the proper movement necessary for effective chewing.

Sensory sensitivities and behavioral issues

Sensory sensitivities, especially linked to textures, smells, or tastes, are common reasons for chewing challenges. Some children dislike lumpy or fibrous foods because of past negative experiences or heightened oral sensitivities. This aversion can lead to restricted diets and poor chewing skills.

Behavioral factors also play a role. Some children may refuse to chew due to anxiety, feeding disorders, or negative mealtime experiences. Picky eating habits and environmental distractions during meals can further complicate the development of proper chewing.

In summary, a combination of physical, neurological, sensory, and behavioral issues can cause children to struggle with chewing. Early intervention, often involving speech and feeding therapists, can support these children to develop effective chewing skills and improve their overall nutrition.

Common Causes and Risk Factors Associated with Chewing Difficulties

What are the common causes and risk factors associated with chewing difficulties in children?

Chewing is a complex process that requires coordination of multiple muscles and sensory inputs. Several factors can interfere with a child’s ability to chew effectively.

Developmental delays are a primary cause. Children typically develop chewing skills between ages 4 and 5, but if there are delays—due to neurological or developmental issues—they may struggle with proper mastication. These delays can stem from conditions like cerebral palsy or other neurological disorders.

Sensory processing disorders also play a significant role. Some children have heightened oral sensitivities, causing them to dislike certain textures or avoid chewing altogether. Past experiences like reflux or medical interventions can heighten oral sensitivities and hinder acceptance of various food textures.

Neurological and structural abnormalities are critical factors. Conditions such as cleft lip or palate, jaw deformities, or craniofacial anomalies can restrict the mouth’s structural capabilities, making chewing difficult. Similarly, neurological issues, including brain injuries or nerve paralysis, can impair the coordination needed for effective chewing.

Impact of prematurity and muscle weakness should not be overlooked. Premature infants often experience delayed oral-motor development, which impacts their ability to chew and swallow. Muscular weaknesses in the jaw or facial muscles can hinder the grinding and crushing of food.

Dental health also influences chewing function. Missing teeth, misaligned teeth, or appliances like braces or retainers can obstruct proper mastication.

Behavioral and environmental factors contribute as well. Lack of exposure to varied textures during early development, pressure to eat, or distractions during meals can delay or impair the development of effective chewing skills.

In many cases, chewing difficulties are caused by a combination of these factors. Recognizing the interplay between neurological, anatomical, sensory, and behavioral issues is essential for effective diagnosis and treatment.

Understanding these factors helps caregivers and healthcare professionals identify and address the underlying causes of chewing difficulties, ensuring appropriate interventions and supporting healthy eating habits.

Typical Developmental Stages of Chewing and Feeding Skills

What are the typical developmental stages related to chewing and feeding skills in children?

The progression of chewing and feeding skills in children follows a predictable pattern, beginning from early reflexes and advancing to refined motor abilities.

In infancy, children initially display reflexive behaviors such as sucking and swallowing, which are essential for milk feeding. Voluntary sucking emerges around 2 to 3 months of age, marking the beginning of more controlled feeding movements.

Between 4 to 6 months, infants start to explore solid foods. During this stage, they develop mouthing and munching patterns, along with early jaw movements. This is also when they begin to show interest in textures other than liquids.

From approximately 6 to 9 months, children typically develop lateral rotary chewing, which involves moving the food side to side—a critical step towards mature chewing. They also begin to control their biting and execute finer tongue movements, essential for manipulating different food textures. During this period, many infants start self-feeding with their hands and may begin using utensils with supervision.

Between 9 to 12 months, children enhance their ability to hold utensils, chew larger and firmer foods, and improve their lip closure and tongue control. These skills set the foundation for more independent eating.

By the time children are 12 to 36 months, they refine their chewing efficiency further, enabling them to handle increasingly harder foods such as meats and raw vegetables. They also become more skilled in using utensils, managing bite sizes, and coordinating jaw and lip movements, which are vital for advanced eating skills.

Understanding these stages helps caregivers and health professionals support children’s developmental needs and identify any delays early on.

This developmental pathway supports a child’s journey from simple reflex actions to complex, coordinated chewing and self-feeding abilities, which are crucial for proper nutrition and growth.

Identification of Chewing and Swallowing Issues in Children

What signs and symptoms indicate a child may have chewing or swallowing issues?

Children with difficulty eating or swallowing often display a range of observable signs. Coughing or choking during or immediately following meals is a common indicator that their swallowing mechanism may be compromised. Drooling excessively or food and liquids coming out of the nose are also notable signs. Some children refuse to eat or take an unusually long time to finish a meal, which can point to challenges with managing food textures.

Additionally, children may repeatedly gag, exhibit difficulty chewing, or frequently spit up or vomit during or after eating. An abnormal or raspy voice during meals can also indicate trouble swallowing. Behavioral signs such as irritability, being less alert during feeding, or showing a reluctance to eat certain textures further suggest underlying issues.

Other clues include a sensation that food is stuck in the throat or mouth, and observed difficulty in moving food from the mouth into the esophagus. If any of these signs are noticed, it is important to seek a healthcare professional’s advice promptly. Early diagnosis and intervention can prevent complications like aspiration pneumonia, malnutrition, or long-term feeding problems.

Common Feeding and Swallowing Disorders Affecting Chewing

What are common feeding or swallowing disorders in children and how do they impact chewing?

Children can experience several feeding and swallowing challenges that interfere with proper chewing and safe eating. Among these, dysphagia is a prominent condition characterized by difficulty moving food, liquids, or saliva from the mouth into the throat and down the esophagus. Dysphagia has three main types:

These disorders can stem from various causes, including neurological conditions like cerebral palsy, developmental delays, craniofacial anomalies such as cleft palate, or acquired problems like injuries or surgeries. Children with dysphagia often show signs like coughing or choking during meals, drooling, slow eating, or weight loss. They may also experience recurrent respiratory infections due to aspiration.

Proper diagnosis involves a comprehensive evaluation by specialists, using tools like video fluoroscopic swallow studies or endoscopy. Treatment varies based on the underlying cause and severity and can include therapy to strengthen oral muscles, postural adjustments, dietary modifications, and sometimes surgical interventions. Addressing these issues early is vital to prevent complications such as malnutrition, dehydration, and long-term feeding difficulties.

How does this affect chewing and nutrition?

Children with impaired chewing may fail to break down food adequately, leading to larger chunks that can cause choking or choking hazards. Improper chewing also affects nutrient absorption, resulting in poor growth and development. For example, children who do not develop efficient rotary-lateral chewing patterns by age 4 may experience gastrointestinal issues like bloating, indigestion, or constipation. Furthermore, sensory issues may cause aversions to certain textures, limiting food variety.

Effective intervention supports the development of proper chewing skills and safe swallowing, which are critical for maintaining a nutritious diet and healthy growth.

Why is early assessment important?

Early detection of feeding and swallowing issues allows for prompt intervention, minimizing risks like aspiration pneumonia or nutritional deficiencies. Children with symptoms such as difficulty initiating a swallow, frequent coughing, or refusal to eat require multidisciplinary evaluation involving pediatricians, speech-language pathologists, and dietitians. Early assessment also guides targeted therapy strategies to improve oral-motor skills and reduce feeding aversions. Prompt management supports not only physical health but also fosters positive mealtime experiences, essential for long-term healthy eating habits.

Diagnosis and Evaluation of Pediatric Feeding and Chewing Problems

How are pediatric feeding and chewing problems diagnosed and evaluated?

Diagnosing and evaluating feeding and chewing difficulties in children requires a comprehensive, team-based approach. This process begins with collecting detailed medical histories and observing the child’s feeding behaviors in different settings.

A physical examination assesses oral structures, muscle tone, and coordination. Clinicians, including pediatricians, speech-language pathologists, and occupational therapists, look for signs like gagging, coughing, drooling, and refusal to eat certain textures.

Instrumental assessments are often critical for a complete picture. The videofluoroscopic swallow study (VFSS) uses X-ray imaging to visualize how food and liquids move through the mouth and throat during swallowing. FEES (fiberoptic endoscopic evaluation of swallowing) involves passing a small camera through the nose to directly observe swallowing in real-time.

Additional tests may include esophageal studies to identify structural abnormalities or motility issues, and allergy testing or lab work to rule out underlying medical causes such as reflux or eosinophilic esophagitis.

Early and precise diagnosis is vital. Recognizing red flags—such as significant weight loss, persistent respiratory infections, or difficulty gaining weight—helps determine when urgent intervention is needed. Confirming the diagnosis of pediatric feeding disorder enables the formulation of a tailored treatment plan involving multiple specialists.

The assessment aims to identify the specific nature of the problem—whether oral, pharyngeal, or esophageal—and its underlying causes. This comprehensive evaluation directs appropriate treatment strategies to improve feeding safety, nutritional intake, and child’s overall growth and development.

Treatment Strategies and Practical Tips to Support Chewing Development

What treatment options and strategies support children in developing proper chewing skills?

Supporting children in developing effective chewing skills requires a multifaceted approach involving professionals, caregivers, and suitable tools. One common strategy is oral motor therapy, which focuses on strengthening the muscles involved in chewing and improving coordination. These therapies often include exercises that enhance tongue movements and jaw control.

Sensory integration techniques are also employed to help children become more comfortable with different food textures, reducing aversions. Behavioral interventions and caregiver-led feeding practices are crucial, as they reinforce skills learned during therapy sessions and promote consistency at home.

Introducing textures gradually is another vital element. Starting with soft, dissolvable foods and progressing to more challenging textures, such as chewy or fibrous foods, supports safe development. Using specialized tools like mesh feeders allows cautious children to explore new tastes and textures safely.

Early, individualized intervention tailored to each child’s needs aims to foster both nutritional health and developmental progress. Regular assessment and adjustments ensure that treatment remains effective and supportive.

What practical tips can parents and caregivers use to improve and encourage chewing in children?

Parents and caregivers play an essential role in developing a child’s chewing abilities. Begin by offering a variety of textures, starting from smooth purees and moving toward soft, chopped foods. This gradual progression helps children build confidence and skills without feeling overwhelmed.

Ensure foods are appropriately sized—bite-sized and manageable—and avoid challenging foods like nuts or tough fibrous vegetables initially. Incorporate fun sensory activities, such as allowing children to touch, mouth, or play with foods, which can improve oral awareness.

Using tools like chewy tubes, safe kitchen utensils, and mesh feeders supports oral muscle development and safe exploration. For example, chewy tubes can strengthen jaw muscles, while mesh feeders let hesitant eaters try new textures without choking risks.

Observing cues and progressing at a pace comfortable for the child is vital. If there are concerns about delayed development or choking, consulting a speech-language pathologist or feeding specialist is recommended. Creating a positive mealtime environment with patience and encouragement helps foster a lifelong healthy relationship with food.

Supporting Children to Overcome Chewing Challenges

Understanding why some children struggle with chewing food requires a comprehensive look at developmental milestones, medical and sensory factors, and behavioral influences. Early identification of signs and symptoms combined with expert evaluation can lead to effective interventions tailored to each child’s unique needs. Treatment approaches that involve oral motor therapy, sensory integration, and supportive caregiver involvement foster not only chewing skills but also positive mealtime experiences and overall growth. With patience, appropriate strategies, and multidisciplinary care, many children can overcome feeding difficulties and enjoy healthier, more fulfilling eating routines.

References

• Chewing and Swallowing Problems: Noah’s Story
• What should you do if the 4-year-old child doesn’t chew …
• Dysphagia – Children’s Health
• Is My Child Chewing? – Pediatric Feeding
• Picky eating in children: causes and consequences – PMC
• Dysphagia in Children
• How to support your child develop their chewing skills
• Feeding Therapy: Common Feeding Disorders in Toddlers
• Chewing practice