Q: I have a three-year-old male client who is beginning to talk. He is a very picky eater and rarely eats at school, although he has started eating a few bites of pear, apple, or fish crackers for me.  He bites, lateralizes, and chews, but then he leaves the food smashed all over between his teeth and lips.  Can you tell me why he may be doing this? How I can help him with creating a bolus and swallowing?

He is doing it because he has a feeding disorder.  He probably has low oral-tactile sensitivity, poor bolus formation, and an inadequate swallow which results in incomplete evacuation of the bolus.

Instead of telling you what to do, let me use your situation to state an opinion about this situation.

Many of our clients have both feeding and speech problems.  Such is the case with your client.  Unfortunately, not all SLP’s are trained in feeding therapy, and I believe this to be one of the great tragedies of our profession as it is taught today.  In my opinion, all of us should be taught how to handle feeding issues while we are at university because the problem is so common.

How could a client who can barely handle food in the mouth be expected to make refined adjustments in mouth movements for speech?  It doesn’t make any sense.  Gross movements develop before fine movements.  Feeding movement is gross and speech movement is fine.  Feeding and swallowing activities should proceed, or at least occur simultaneously with, speech activities in a case such as this.

Van Riper said this: “Whenever possible the articulatory exercises given should proceed out of the movements used in the biological function” [Charles Van Riper, Speech Correction: Principles and Methods, 1939, p. 242.] Van Riper used feeding activities as warm-up or preparation activities for speech improvement.

If you have not studied feeding development, assessment, and therapy, let me refer you to the greatest book ever written on the topic––

Morris, S. E., & Klein, M. D. (2000, 1983). Pre-Feeding Skills: A Comprehensive Resource for Mealtime Development. Austin: Pro-Ed.