Picky Eaters and Early Childhood Feeding Delays
We travel to North Shore, Mid Island, & the South Shore

Eating is a primary human activity needed for survival. But for very young children, feeding can be a complicated task that needs complex coordination of different oral motor skills—biting, chewing, and finally, swallowing. Most babies and toddlers learn instinctively over time how to suck, bite, chew, and swallow food and how to drink from a nipple, straw, and cup. But there are some who demonstrate difficulty learning these oral motor skills, interfering with their feeding development.

Young children begin their feeding journey by first learning how to suck liquids then chew single grain cereals or pureed food. When introducing solids, it is a messy process that needs plenty of practice and monitoring from parents. Certain difficulties like gagging, pushing food back, spills, and trouble with swallowing are normal and correct themselves over time.

Read about Feeding Milestones.

Likewise, children with a feeding delay or disorder, they may exhibit a difficulty transitioning from one food type to the next. These challenges will persist as they get older if not addressed or given adequate feeding therapy.

  • Oral phase – The sucking, chewing, and moving of food or liquid into the throat. Feeding is part of the oral phase.
  • Pharyngeal phase – The squeezing of food down the throat, which begins the swallowing action.
  • Esophageal phase – The opening and closing of the esophagus as it squeezes food down to the stomach.

How Feeding Therapy Helps

A feeding disorder can occur alongside developmental delays or medical conditions, such as autism spectrum disorder, Down syndrome, cerebral palsy, or respiratory disorders.Young children with feeding difficulties typically demonstrate a delay in or difficulty swallowing, sucking, chewing, and display food aversions, food refusal, texture selectivity, and food selectivity. Many factors can cause a young child to become a picky eater.Feeding therapy involves improving the the child’s oral motor and underlying feeding skills and their eating habits. We assess the child’s sucking, swallowing, chewing patterns, diet, behavior, and the home environment during meal time time. Once we pinpoint the underlying problem(s), we create a family treatment plan. Some children require additional one-on-one feeding therapy, and we demonstrate to the parent how to tackle their child’s feeding or eating delay.Read about Early Childhood Developmental Milestones.

About Infant Feeding Evaluations

Pediatric feeding disorders are characterized by challenges in oral intake that are not typical for a child’s age. It often involves delays and difficulties in eating, drinking, chewing, sucking, and swallowing as well as food aversions, food refusal, and food and texture selectivity. Swallowing problems or dysphagia refers to problems in one or more areas of the three phases of swallowing. These phases or stages are:

  • Oral phase – The sucking, chewing and moving of food or liquid into the throat. Feeding is part of the oral phase.
  • Pharyngeal phase – The squeezing of food down the throat, which begins the swallowing action.
  • Esophageal phase – The opening and closing of the esophagus as it squeezes food down to the stomach.
Causes of Feeding Disorders

Several factors can cause a child’s feeding and swallowing disorder. Infants who were hospitalized at birth and received tracheotomy for an extended time will often have difficulties adopting proper feeding patterns. In some cases, even children with no known conditions or relevant medical histories can develop a fear of food.Other possible factors that could lead to feeding and swallowing disorders include:

  • cerebral palsy, meningitis, and other nervous system disorders
  • autism
  • stomach problems, such as reflux
  • premature or low birth weight
  • heart disease
  • cleft lip or palate
  • asthma or other respiratory problems
  • muscle weakness in the face and neck and other head or neck problems
  • medication that causes sleepiness or loss of appetite
  • sensory issues
  • behavioral problems

Signs and Symptoms of Feeding and Swallowing Disorders

Feeding and swallowing disorders in children are often difficult to spot at first. Most of the time, children who struggle during mealtimes are simply assumed to be picky eaters. And while this is true for many, there are other signs and symptoms that family members can consider to distinguish between a child who is a picky eater or one with a feeding problem. These include:

  • back arching and stiffening during meal times
  • crying, fussing, or falling asleep when feeding
  • throwing tantrums when presented with new or unfamiliar foods
  • trouble breathing while eating or drinking
  • coughing, choking, or gagging during meals
  • preference for specific textures of food (crunch or soft food) or aversion to a particular food group
  • taking a long time to eat or simply refusing
  • struggling to chew or swallow
  • excessive drooling during meals, has liquid come out of mouth or nose, or gets stuffy
  • frequently spitting or throwing up
  • not gaining weight or growing
  • eating less than 20 types of foods
  • refusing to eat meals with the family or a group

Meanwhile, a child who is a picky eater may sometimes exhibit similar behaviors as someone with a feeding disorder. However, there are key differences to monitor. Typical signs of a picky eater are:

  • eats a limited variety of foods (around 30 types)
  • consumes enough calories daily for growth and nutrition
  • often loses interest in a particular food but will accept it again after a certain period
  • accepts and eats at least one food from all food groups
  • allows new or unfamiliar food on the plate even if they do not touch or eat it

Picky Eaters and Early Childhood Feeding Delays
How Feeding Evaluation and Feeding Therapy Work

Treatment for feeding or swallowing disorders starts with getting a comprehensive check on the child’s general health. A pediatrician can assess the child’s growth and weight based on what is appropriate for his or her age. Children must also be checked for any condition that interferes with feeding skills.If your child’s doctor determines that there is cause for concern, a speech-language pathologist (SLP) may be consulted to conduct a feeding evaluation and provide a diagnosis.During the feeding evaluation, the speech-language pathologist will:

  • ask questions about the child’s medical history and overall development
  • observe how the child moves his or her mouth, tongue, and jaw when eating and drinking various foods and liquids.
  • watch how the child eats and take note of the way he or she picks up food, chews, swallows, and drinks
  • observe the child’s behavior during meals
  • consider the parent child interactions
  • assess mealtime routines
  • conduct additional special tests, if necessary

Once a diagnosis is made, the SLP or therapist may work closely with a team to design a feeding therapy plan to address the child’s needs. This team may include a physical or occupational therapist, a dietitian or nutritionist, a physician or nurse, or a developmental specialist.As part of the multidisciplinary team, the SLP can help your child address the following issues:

  • improving the child’s tongue and jaw movement
  • Improving the child’s lateral chewing
  • introducing new foods and drinks
  • improving the way the child sucks from a bottle or drinks from a cup
  • adjusting textures of food and thickness of liquids to make swallowing easier
  • encouraging the child’s good behavior during meals, such as increased focus at meal times, not refusing food, and not fussing
  • addressing the child’s sensory issues (how the food feels in his or her mouth or hands)

The SOS Approach to Feeding

The Sequential Oral Sensory (SOS) approach to feeding therapy addresses not only the child’s needs and eating difficulties but also its underlying causes. It is based on the feeding steps, stages, and skills found in typically developing children. The SOS approach relies on several factors, including motor, oral, behavioral/learning, medical, sensory, and nutrition, in determining the root cause of a child’s feeding problems and managing it successfully.In conducting SOS feeding therapy, it is important to create an environment wherein a child can interact and get familiarized with food in a non-stressful way. Feeding therapy may be done individually, as a group, or at home, with the primary goal of helping the child develop and master the necessary skills to become a healthy and safe eater.Feeding therapy meals are done to help children work on feeding skills and expose them to new foods. It typically starts with foods the child is already familiar with and able to tolerate before moving on to new ones. The therapist encourages the child to smell the food, learn about its texture, and explore its taste. Modeling and reinforcement are crucial during feeding therapy in order to help the child develop a positive relationship with food.The SOS approach can also be applied during family meals, wherein the goal is to improve the volume or amount of the child’s food intake. Pediatric feeding therapists use several strategies that may include:

  • Serving a piece or spoonful of every food offered on the child’s plate. Whether the child eats it or not, the goal is to familiarize them with the food’s texture, smell, color, and where it comes from.
  • Including at least one food that the child is guaranteed to eat in order to expose the child to new foods while still ensuring they are eating the right amount of food.
  • Parents modeling good eating habits and describing the food and its taste.
  • Praising the child’s attempt to eat or explore new foods but taking care to not let the child be the sole focus of the meal.

At Staten Island Letters, our pediatric feeding therapy involves improving the underlying feeding skills and eating habits of babies, toddlers, and preschoolers. We assess the child’s sucking, swallowing, chewing patterns, diet, behavior, and the home environment during meal time time. Once we pinpoint the underlying problem(s), we create a family treatment plan. Some children require additional one-on-one feeding therapy. Our pediatric feeding therapists work closely with parents on how to tackle their child’s feeding or eating delay.


Staten Island Rates
Feeding Therapy

  • $140-$185 for 60 minutes

  • $120-$160 for 45 minutes

  • $100-$125 for 30 minutes

Feeding Evaluations

  • $350-$600 for Feeding (any age) – evaluations performed by infant feeding specialists when warranted (see below for more information)

CPT Codes for Feeding Therapy

92507: One-on-One Feeding Therapy
92610: (Feeding/Swallow Evaluation)

95: is a modifier for telepractice, and the CPT code, e.g. 92507 or 92508 stays the same. CPT 95 is for reporting telepractice-related services e.g. synchronous telemedicine service rendered via real-time interactive audio and video telecommunication systems.

If insurance asks for a place code it’s (POS) 12 for home-based services and (POS) 11 for office-based services.

ICD-10 Codes for Feeding Therapy

R63.3: Feeding Difficulties
92526: Feeding Therapy
R13.10: dysphagia, unspecified
R13.11: Oral Phase Dysphagia
R13.12: Oropharyngeal Phase Dysphagia
92610 (Feeding/Swallow Evaluation)


Danielle is wonderful! Night and day compared to our other feeding therapist that was outside the Brooklyn Letters network of providers.

-mother to a 4-year-old
My son is now 6 years old and he just graduated from Christina’s feeding therapy sessions!

I noticed that my son had difficulties with food since he was 1 year old. Everybody I talked to (even my pediatrician) told me that I was worrying for nothing and that he was only a picky eater. I always felt that it was more than that. After fighting over and over and trying out every little trick or piece of advice I could find I finally decided to get him evaluated at NYU when he was 5. It turned out that my son had sensory issues when swallowing. They recommended feeding therapy.

I reached out to Craig who put me in contact with an amazing person Christina R.
Christina has a tremendous experience and is incredibly gentle and patient with kids.
She connected right away with my kid (and with us!) and started to help him through play and positive reinforcement. She immediately understood my sensitive son and found her way through him, helping him to become more confident and to change his perception of food and mealtime into something positive. She also helped me with my struggles. Always here for me and my family. Each time I was lost and didn’t know how to react I would text her and she would answer me right away, texting me or calling me back with the best advice or tips, or just to reassure me and tell me that I was doing great.

Christina has been incredible and helped my family and especially my little boy who is now comfortable with a lot of different food but most importantly he is not afraid to try new things and enjoys mealtime.

Today was time for our family to say goodbye to Christina as her work with us was over. It was bitter-sweet. I was so happy that my little boy overcame his issues and fear but I was really sad to have to let Christina go. She feels like part of our family and we will definitely miss her.

If your kid is struggling with food, I highly recommend you to ask for Christina, she is just terrific and I have no doubt she will bring you the help you need.

Many thanks

- Julie & Greg
I highly recommend you

I would like to thank you, Craig, for the wonderful work you are doing with my daughter Rivka. When you started, she was not eating much- just cheese and crackers and most of her caloric intake was from the formula. As of today (six months later) she eats so much more solid food and eats a more diverse diet. Craig, your approach is very gentle and Rivka has liked you from the start.

- JP, mom of Rivka


Picky Eaters and Early Childhood Feeding Delays

Sarah is a New York State licensed clinician who received her undergraduate degree from CUNY Brooklyn College and a Master’s degree in Communication Sciences and Disorders from Teachers College, Columbia University. She holds her Certificate of Clinical Competence in Speech-Language Pathology from the American Speech-Language-Hearing Association (ASHA) and is a recipient of ASHA’s Award for Continuing Education. Sarah is a member of ASHA’s Special Interest Group in Swallowing and Swallowing Disorders and the National Association of Neonatal Therapists (NANT). She serves as an Adjunct Professor/Clinical Educator at New York Medical College training post-graduate clinicians in the diagnosis and treatment of pediatric feeding/swallowing disorders.

Sarah has received extensive post-graduate training and education in the diagnosis and treatment of feeding/swallowing disorders in infants, children, and adolescents. Sarah has worked in the Neonatal Intensive Care Unit (NICU) since the beginning of her career. She has also worked with pediatric patients admitted to the hospital who present with diagnoses related to airway disorders, respiratory/pulmonary disorders, gastrointestinal disorders, and congenital/acquired neurogenic disorders. Sarah has also worked with patients in the outpatient setting who present with sensorimotor and/or behavioral feeding/swallowing disorders.  She has treated babies who struggle with bottle feeding, helped transition infants to purees and solids, worked on introducing PO feeding to medically complex patients, and helped patients expand their food repertoires and transition to age-appropriate textures/consistencies. Sarah considers infant feeding/swallowing to be a specific area of passion, but she finds great pleasure in helping all children/families establish and reach their respective goals.

Sarah believes in utilizing evidenced-based approaches in the treatment of her patients, carefully making recommendations that are supported by current literature to curate realistic client-centered goals and optimize care. She aims to collaborate with other interdisciplinary professionals and will work with her patients and families to identify the necessity of other specialists if/when needed. Sarah prioritizes family training and education to ensure family independence and carry-over of skills into daily life. She truly enjoys celebrating wins of all sizes with the clients and families she cares for.


LOCATION: BROOKLYN: Bay Ridge, Dyker Heights, Sunset Park, Gravesend, Bensonhurst, Sheepshead Bay, Borough Park, and more
TYPE OF SERVICES: Individual therapy, feeding/swallowing evaluations, and treatment, parent consultations
EXPERTISE: Feeding and swallowing disorders, sensorimotor or behavioral feeding delays/disorders, oropharyngeal dysphagia, infant feeding and swallowing
AGES: birth through adolescence

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Phone: (347) -394-3485

Text: (917) 426-8880

Email: [email protected]