Q. My 2.5-year-old son doesn’t chew his food. He seems to swallow foods whole and when he does attempt to chew, he quickly gets tired of doing so. I’ve noticed that he seems to prefer foods with a smooth texture because he can eat them more easily. Should I be concerned that he does not chew well at this age? What can I do about it?
A. We often receive referrals for young children who are not effective chewers. These children commonly mash food between their tongues and the top of their mouths instead of using their upper and lower gums or teeth to chew correctly. This incorrect mashing movement results in food being swallowed whole.
Some improper chewers also chew with their lips closed as they are mashing food to the roof of their mouth or the food is stuck on the middle of their tongue. While I know it’s good table manners to chew with your mouth closed, we prefer to see children under the age of 3 using an open mouth posture for chewing.
If children are struggling with chewing problems, parents will often notice signs indicative of their struggles. These signs may include:
- Grimacing when swallowing
- Pocketing food in the cheeks
- Chewing with a closed mouth under age 3
- Overstuffing the mouth
- Seeing whole foods in your child’s diaper or vomit
- Gagging while eating
- Frequent constipation
As you have already expressed concerns about your son’s ability to effectively and safely chew food, you should discuss this with his pediatrician very soon. She may refer you to a pediatric speech-language pathologist who specializes in feeding and swallowing to evaluate him and determine if he does indeed have issues with manipulating age-appropriate foods. Therapy may be recommended to increase his chewing skills and overall feeding abilities.
It is important to note that there are some medical conditions that can develop as a result of improper chewing—reflux and chronic constipation. If are you are concerned that your son is struggling with either condition, speak with your pediatrician about a possible referral to a pediatric gastroenterologist.
Without proper intervention, poor chewing skills may not get better over time. As a child continues to swallow large, whole pieces of food, her gag reflex may become desensitized causing her less discomfort perpetuating the problem. With untreated chewing issues, it is also common for a child to develop even more picky eating habits as she prefers to eat certain textured foods and may even eliminate whole food categories like meat that require a lot of chewing. This then causes concerns for whether a child is getting adequate nutrition, which can lead to constipation and nutritional deficits. Lastly, there is an increased risk of choking episodes causing airway obstruction.
Please continue to offer your son foods that are easy for him to eat until the appropriate professionals have evaluated him. Choose foods that are smooth in texture or that melt in the mouth—such foods include yogurt, crackers, mashed fruits and vegetables, cheese, etc. We certainly do not want to him to continue swallowing foods whole given the safety issues associated with that action. Once your son has been evaluated, it will then be important to follow the recommendations of the professional as to what he should eat and when.
Do your best to hang in there with him as you sort through this issue. You’re moving in the right direction by realizing that there is a problem and seeking out help for your son.
Allison Crumpler is a speech-language pathologist and the director of clinical compliance for Raleigh Therapy Services, Inc., a multidisciplinary pediatric therapy practice in North Raleigh. (919-791-3582)
Image Credit: Shutterstock.com/Pauline Breijer