Pediatric Swallowing Therapy: A Parent’s Complete Guide to What to Expect

Written by Sarah Keller, Last Updated: November 20, 2025

When we received a referral for 12 weeks of swallowing therapy, my heart sank. More therapy? I thought. When does it end?

My son Jonas had already been through months of treatment for tongue tie, torticollis, and disorganized suck. We’d done daily exercises, multiple therapy appointments, and extended my maternity leave to manage his feeding struggles. After all that work, he’d finally started gaining weight and nursing better.

Then came solid foods, and everything fell apart again.

The first time Jonas tried pureed chicken, his eyes went wide. He gagged, then started choking. Before I could even pull him from the high chair, vomit poured from his mouth and nose. It happened again with applesauce. And again with anything more substantial than the thinnest purees. Mealtimes became traumatic for both of us.

If you’re reading this, you probably know exactly how that feels. The worry. The frustration. The questions about whether you’re doing something wrong. This guide shares what I learned through 12 weeks of pediatric swallowing therapy with a speech-language pathologist at the University of Minnesota Medical Center. It’s the real story, with all the messy moments, small victories, and practical strategies that actually helped.

Understanding Why Your Child Needs Swallowing Therapy

Not every baby who struggles with feeding needs swallowing therapy. Some catch up on their own. But when a lactation consultant warned us that “sometimes babies with Jonas’s issues struggle a bit with solids,” I didn’t fully understand what that meant.

After months of therapy for his initial feeding problems, I thought we’d be ahead of the curve. Instead, Jonas developed feeding aversions after several negative eating experiences. When gagging and vomiting become mealtime norms, babies learn to be afraid of food.

Common signs that lead to swallowing therapy referrals include:

• Consistent gagging or vomiting with textured foods
• Refusing to progress beyond purees past the expected age
• Weight loss or failure to gain weight appropriately
• Pocketing food in the cheeks instead of swallowing
• Choking incidents that are more frequent than typical
• Extreme selectivity with food textures or types
• Tongue tie, torticollis, or disorganized suck patterns

The connection between early feeding issues and later challenges with solid foods isn’t always obvious. Jonas’s tongue tie affected how he moved food around in his mouth. His disorganized suck meant he hadn’t developed the oral-motor patterns needed for chewing. These issues don’t magically resolve when babies start solids.

Week 1: The First Evaluation and Getting Started

Kyrsten, our speech-language pathologist, greeted us warmly and led us back to a private room. After asking about Jonas’s feeding habits and struggles, she buckled him into a high chair and spread a large piece of plastic around the perimeter.

“Feeding therapy is messy,” she warned.

She dumped purees out onto the tray and handed him a spoon. Jonas looked at her uncertainly and gingerly touched one of the purees with his free hand.

“Like this, Jonas,” she encouraged, swirling the food around on his tray and encouraging him to play with it.

Maybe it was a lack of a nap, the new environment, or his fear from previous vomiting experiences, but he wasn’t interested. At all. She tried a silicone Kidsme Feeder, which he examined briefly before looking at me with a definite OK, Mom, I’m done here expression.

The Developmental Chart Reality Check

After watching him eat a few spoon-fed bites, Kyrsten pulled out a feeding developmental chart.

“This is where Jonas is at right now,” she explained, pointing to the thicker baby food smooth purees segment in the 7-8 months range.

At more than 10 months old, that put Jonas 2-3 months behind. My mother’s heart dropped. How had we gotten this far behind? Why had I waited for our pediatrician’s referral instead of seeking help sooner?

Kyrsten didn’t shame us. She didn’t ask why or suggest we should have done better. Instead, she looked forward.

“This week we’ll work on making food fun, and then next week I’ll spend some time watching how he eats and experimenting with different things.”

First Week Assignments

She wrote out a plan for us:

• Put solid foods in the Kidsme Feeder and encourage chewing
• Try carrot sticks or celery sticks for gnawing
• Make mealtimes about messy play with purees
• Don’t force-feed
• Create more scheduled meals (7:30 am – puree/bottle,9:30 am – snack/bottle before nap, 12 pm – purees and Kidsme/bottle)
• Space feedings 2-3 hours apart so he has time to get hungry
• Encourage independence (Jonas using the spoon instead of mommy doing the feeding)

Messy is Progress

That evening at home, more food ended up on the floor, down his shirt, and in his hair than in his mouth. Cleaning up took longer than the actual eating time.

But he ate a little. And there were no tears. That was progress. So I ran a warm washcloth over my child’s body, the table, the chair, and the floor, reminding myself: one step at a time.

Early Therapy Sessions: Building Foundation Skills

The early weeks of therapy challenged everything I thought I knew about feeding. Baby-Led Weaning? Out the door. Plates of lovely, organic, pureed veggies?” Nice idea, but not happening.

Because Jonas had developed feeding aversions, Kyrsten wanted us to focus on playing with food. For a while, actually getting anything into his stomach was just a bonus.

Why Playing with Food Matters

Instead of going into his mouth, a good percentage of that precious organic baby food I’d blended and stocked our freezer with went everywhere but his mouth. At the same time, I had half a pig, a lamb, and a grass-fed cow in the freezer, ready to be cut into bite-sized pieces, even ground and pureed meat induced gagging and vomiting every time.

So we started with mashed beans, which he loved. (My child might turn into a vegan.)

The process of introducing foods wasn’t going like I planned—fresh, organic food cut straight from mommy’s plate. But he was eating consistently, three meals a day. That counted for something.

Learning Proper Technique Through Modeling

Back when we started hard munchables, Jonas couldn’t seem to get through a mealtime without some form of eating-related drama. This was a mommy-fail because I’d misunderstood the point of the exercise.

The goal, Kyrsten explained, is for Jonas to gnaw on the hard stick foods at the back of his mouth to encourage his tongue’s lateral motion. Actual eating of the carrots and celery wasn’t really expected.

“He’ll learn best by example,” she said during the appointment, handing me a carrot stick. She then handed one to Jonas and took one herself.

Jonas immediately tried to bite it with his front teeth, but Kyrsten caught his attention.

“Like this, Jonas, on the side. You do it too, Mommy.”

Open wide—carrot to the back corner of the mouth. Pretend to chew. Jonas looked at Kyrsten, then me, and back at Kyrsten. Slowly, he adjusted the carrot to the side of his mouth.

“Yes! That’s good, Jonas!” Kyrsten said.

It’s a simple thing, but sometimes there’s so much information during sessions that it’s hard to keep it all clear. By doing things together, I had a concrete memory to draw on at home. I also appreciated the sense of “being in this together.”

Managing Fear and Frustration

I’ll be honest—I still found feeding new foods at home intimidating. Have you ever done the Heimlich Maneuver on someone? In real life? I haven’t, and I have no desire to test my life-saving skills on my 11-month-old child.

I appreciated that Kyrsten didn’t minimize my fear. She validated the reality of my concern (and sometimes helped me adjust my perception) and then we talked about how to approach the issue.

I get that how we, as parents, feel and act around feeding affects our child’s emotions about eating. I’m pretty calm when it comes to trying and gagging on fruit, mashed veggies, or beans. Meat, however, continued to induce more disturbing gag-and-vomit responses. Jonas started pocketing the beef in his cheek instead of swallowing.

Some days Jonas threw pretty much everything I gave him on the floor or pocketed it and spat it all out without swallowing. Other times, he tried to shove way more food than he could ever chew into his mouth, and I had to help him dislodge some of it.

When I got frustrated—because I’d literally spent more time preparing his food than my own—I took a deep breath or walked into the kitchen to get water. I reminded myself that maintaining a positive attitude toward food now would pay off in the long run.

Also, there’s this thing: he’s a baby. Why wouldn’t he be upset that instead of his beloved milk, we give him strange lumps of unusual tastes and textures that may or may not lead to gagging and vomiting?

Mid-Therapy Progress: Weeks 6-8

By week six, we’d made real progress. Jonas’s weight was back up to the 50th percentile. He was eating veggies, fruit, grains, and meat or beans at every meal. We’d mostly moved off purees and onto ground or well-cut foods.

The biggest remaining issue was pocketing. Even thin slivers of meat or unmashed beans got shoved into his cheek. One step at a time, right? We still had six appointments on the calendar, so there was plenty of time for improvement.

Why Explanations Matter

Here’s something I know about myself that I suspect is pretty standard: I’m much more likely to comply with a therapy recommendation when I understand why I’m supposed to be doing something.

Early on with Jonas’s suck therapy, we were given so many suggestions at once that it was physically impossible to carry them all out. Sleep-deprived, overwhelmed from birth recovery, and attempting to pump enough milk for my little guy, I did the best I could. But I later found that I’d somehow dropped the single most crucial therapy modality.

Once the therapist explained the “why” of this modality, it stuck in my overloaded brain, and I was able to adjust my at-home therapy.

I’m sure providers see so many patients that it’s sometimes hard to remember whether they’ve explained the reasoning behind specific actions. But for me, these explanations enhanced my motivation and my ability to follow instructions accurately.

Creating Fun Food Experiences

At home, we found creative ways to make eating fun. I always told Jonas what I was giving him before a new food item, and sometimes I made a special face or sang a silly song. One morning, I walked in on my husband making bunny teeth out of asparagus for Jonas to try to grab, which Jonas thought was hilarious.

If I’m being honest, keeping it fun was hard some days. But I also appreciated the sense that we were building positive associations with food that would matter later.

Travel and Social Situations

Mid-therap, we had a two-week trip to Texas for a family reunion. Our family is massive—from Grandma and Grandpa, down there are over 70 of us. That meant for four days straight, Jonas was eating with a dozen cousins, five in his age group, who were modeling “normal” eating.

I had high hopes for the influence this modeling would have, but those expectations were a bit unrealistic—no miracles from this trip.

What it did do was convince him to put several foods in his mouth that he’d never experienced before. Breakfast tacos, hamburgers, massive bowls of guacamole, corn chips, lettuce, and a variety of raw veggies all got their chance with his palate.

Most of these just got one taste or mouthful, then they wanted the things he was used to. (Exception: guacamole. He would have eaten nothing but guacamole the whole trip if I’d let him.)

Common Challenges and Solutions

The Food Pocketing Problem

At times Jonas looked like a bit of a chipmunk, with cheeks full of food that never actually got swallowed. Kyrsten set up a home plan that included:

1. Giving him only small amounts of food at a time so he couldn’t overstuff his mouth
2. Encouraging him to take sips of water in between bites
3. Gently using a Jigglers Massager animal (kind of like a vibrating toothbrush, but with an animal on top) along his cheek when he would start to pocket food

To get him ready for his Jiggles alligator, we first modeled playing with it against our hands, our head, and our cheeks. Jonas actually loved putting it at the base of his neck.

Once he felt comfortable with the “toy,” we started gently placing it against his cheek when he would pocket food. At first, he gave a startled look and pulled away, but he eventually took the cue to un-pocket the food and keep chewing.

Understanding the Steps to Eating

Once the cousins’ influence was gone after our Texas trip, Jonas pushed most new foods aside, not even giving them another taste.

“Keep offering them,” Kyrsten encouraged when we came home. “The first goal is just to get him to let the food sit on his tray. Then encourage him to pick it up and play with it.”

She reminded me that kids often need to go through a series of steps before eating new food items:

1. Tolerates the food
2. Interacts with the food
3. Smells the food
4. Touches the food
5. Tastes the food
6. Eats the food

Each of these steps gets broken down even more. For example, “Tolerates food” includes a progression that starts with “being in the same room as the food” and moves through bringing the food closer and closer until it’s on the child’s tray.

Luckily, Jonas wasn’t so averse that he didn’t want to be in the same room as food. He didn’t want them to touch his tray. For some foods, like macaroni in spaghetti sauce, he would let it sit on his tray but pretty much ignore it.

The Power of Praise

During one appointment, I complained to Kyrsten that we seemed stuck on step 1 with so many foods.

“I know it can seem to take a long time,” said Kyrsten, “but things will change. Every time he does something, I go through the steps and praise him. Celebrate it when he allows broccoli to stay on his tray or plays with a slice of chicken.”

I decided to experiment with focusing on pasta for a while. I bought a variety of gluten-free macaroni options and found the one with the best texture. Since he no longer seemed to be reacting to tomatoes (thank God), I did a simple marinara sauce with pasta.

“Oooh, Jonas,” I said. “Look what mommy is eating!” I took a big bite while he sat in his chair next to me. “Yummy! Does Jonas want some?”

“Yeah!” he said.

I put it on his tray, and instead of just playing with it this time, he put it in his mouth. At first, he screwed up his face, and I thought he was going to spit it out, but then he kept chewing.

He only ate a few bites at this meal, but the next day he polished off everything I put in his bowl.

When Chewing Doesn’t Lead to Swallowing

As we progressed, we hit a barrier we couldn’t seem to get past: at least once a day, sometimes at every meal, Jonas would chew some food item until it was well pulverized, and then instead of swallowing it, he would spit it out.

“It seems like we’re a little stuck here,” Kyrsten said after a few weeks of work on this. “Jonas has all of the mechanical skills he needs, and we’ve done some behavioral work, but I think my colleagues in the Pediatric Behavioral Therapy Center might have some other ways of addressing this that could help Jonas move forward.”

And so we began the process of transitioning to a new therapist.

Therapeutic Techniques and Tools

Equipment That Helps

Throughout therapy, we used several tools that made a real difference:

Kidsme Feeder: A silicone feeder that lets babies gnaw on solid foods safely. The food stays contained in a mesh or silicone pouch, so they get the texture and taste without the risk of choking.

Jigglers Massager: A vibrating oral massager with animal designs that helped address food pocketing. The gentle vibration against the cheek reminded Jonas to move the food and keep chewing.

Hard Munchables: Carrot sticks and celery sticks weren’t about eating—they were about developing lateral tongue movement. Jonas gnawed on these at the back corners of his mouth to practice the motion he needed for chewing.

Home Practice Strategies

The clinic was stocked with food, but not always food Jonas could eat. (Yep, we’re that family. The ones with a list of “can’t eat” items: gluten, dairy, tomatoes, corn, citric acid, and a handful of other things.)

Kyrsten often had me bring food from home, both specific things she asked for (gluten-free puffs, soft fruits and veggies, meat) and problem foods from during the week.

Between appointments, consistent home practice made the most significant difference:

• Scheduled mealtimes at consistent times each day
• Letting Jonas use utensils independently, even when messy
• Modeling proper chewing technique
• Praising every small step forward
• Keeping mealtimes positive and playful
• Offering new foods repeatedly (it can take up to a dozen exposures before a toddler accepts a new food)

What Parents Need to Know About the Process

The Value of Professional Therapy

At times, others suggested that maybe we would have gotten this far without therapy, and that perhaps we should have just let things “work themselves out.”

To this, my response is: Absolutely not.

It wasn’t until Kyrsten started working with Jonas on tongue movement that he finally began chewing food small enough to swallow, even though my husband and I had been trying to help him with this on our own. Before working with her, he regularly choked on his food, and mealtimes could be somewhat traumatic.

If it weren’t for our work in therapy, I suspect Jonas would have an even more limited diet at this point than he does now.

Managing Expectations

This season was an exercise in letting go of my Type-A, get-things-done personality. Because Jonas developed feeding aversions after negative eating experiences, Kyrsten wanted us to focus on playing with food. For a while, actually getting anything into his stomach was just a bonus.

That meant precious organic baby food went everywhere but his mouth. It meant spending more time eating and cleaning up than seemed reasonable. It meant accepting that progress wouldn’t be linear.

But it also meant Jonas learned that food could be safe and fun. That foundation mattered more than hitting arbitrary milestones on someone else’s timeline.

Being “That Family”

Jonas can’t have gluten. Or dairy. Or tomatoes. Or corn. Or citric acid. Or a handful of other things.

We’re that family. The ones that come to school with a list of “can’t eat” items and send kids to birthday parties with their own special allergen-free cupcake.

This added complexity to therapy, but Kyrsten worked with us to find solutions. Sometimes that meant bringing all food from home. Sometimes it meant finding creative alternatives that fit Jonas’s restrictions.

If your child has dietary restrictions, don’t let that stop you from seeking therapy. Good therapists adapt to your family’s needs.

Measuring Progress and Success

It felt strange to come back and document the end of this therapy journey after such a long gap since my last update. Jonas’s feeding issues proved ‘more complex’ than usual, which I suppose shouldn’t seem strange given everything we’d been through.

The difference is that when we completed our 12 weeks with Kyrsten, we were transitioning out of the SLP world and into behavioral therapy to address the remaining chew-and-spit behavior.

What Success Looked Like

By the end of our time with Kyrsten, Jonas was eating:

• Various meats (well-cut into small pieces)
• All soft fruits
• Some veggies, if well-cooked
• Pasta
• Gluten-free bread items
• Smoothies packed with mustard greens, collards, or kale

He’d moved from the 0.1 percentile for weight-to-height back up to the 50th percentile. He no longer regularly choked during meals. We had more good days than bad days at mealtimes.

While we still had work to do, I was grateful for the time Kyrsten and others at her clinic spent working with us. The foundation our speech-language pathologist laid made everything that came after possible.

Signs Your Child Is Progressing

Progress in swallowing therapy isn’t noticeable day-to-day, but over weeks, you’ll likely notice:

• Increased weight gain or stabilization
• Wider variety of foods tolerated
• Fewer choking or gagging incidents
• More positive reactions to mealtimes
• Greater independence with self-feeding
• Better chewing mechanics
• Less food refusal

When Additional Support Is Needed

Sometimes, as in Jonas’s case, the SLP addresses mechanical skill, but behavioral components remain. That doesn’t mean the therapy failed. It means your child needs a different type of support for the next phase.

Kyrsten recognized when we’d hit that point and helped us transition to specialists who could address the behavioral aspects of feeding. That transition was part of successful therapy, not a failure of it.

Frequently Asked Questions

Sarah Keller

Sarah M. Keller, MS, CCC-SLP, is a licensed speech-language pathologist with 15 years of experience in pediatric clinics and university training programs. She earned her master’s in speech-language pathology from a CAHPS-accredited program in the Midwest and supervised clinical practicums for online and hybrid SLP cohorts. Sarah now advises students on graduate school applications, clinical fellowships, and state licensure. She lives in Colorado with her family and golden retriever.

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