Whether your child is 8 months, 18 months, or 18 years...mealtime behaviors are learned. Now, that being said, there needs to be a catalyst for the behavior to occur in the first place. A child may refuse foods at a young age because of the texture, taste, consistency, or temperature. Depending on the reaction of the caregiver to that refusal, the tone for future presentations is set. While head turning, swatting, and blocking of the mouth are common behaviors, gagging and vomiting suggest a deeper level of distress. Many professionals suggest ignoring the unwanted behavior, distract with toys or TV, and/or reward systems to extinguish the negative. Many will also argue that their way is the "only" way based on published studies....however, I will disagree with these professionals on this point....why did the behavior start? No one can seem to answer or care to answer that question.
I have found throughout many years that children do have a reason and that there is clearly no one way to treat all children with behavioral feeding issues. Frequently, we provide assessments as a second opinion and find that basic oral motor evaluations were not conducted rather these children were 'observed' and if an oral motor evaluaiton was conducted, it was only to determine movement of the structures. When we look at these children more intensely, we note that although a child may be able to perform a static oral motor task, the orchestrated movement needed to move food items functionally is determined to be dysfunctional or disordered.
Following in depth questioning of the parent/caregiver we find that sometimes developmental feeding milestones were missed or bypassed. For example, a 6 month who refuses puree is then provided with puffs, cheerios, (skill set approx. 8 months) etc., now skips the Stage I or puree stage. Well meaning family supporters and other professionals will tell the parents..."don't worry, he/she can learn how to eat it later." However, the ability to retrieve food from a spoon is a primary movement not only for feeding but for speaking. As the child accepts these food items, they begin to compensate for movements they missed which can lead to thrusting of the tongue or suckling upon the food rather than closing the lips together. The wheel is now set in motion for future difficulties. As parents, we wouldn't make a child try and sit unsupported if they didn't have adequate head control nor would we make them attempt walking prior to crawling however, with feeding, skipped developmental milestones are never addressed. Therefore, as we advance the child through the textures, they are continually required to compensate for what they missed until they reach a point where they no longer can. As a child is encouraged to keep moving along, he/she begins to demonstrate insecurity and perhaps inability about what he/she can handle and ultimately begins to distrust the caregiver which perpetuates the behaviors described above. Frustration at the parental/caregiver level due to refusals thus leads to anxiety about feeding and now everyone involved in mealtime has an issue.
If we take the time to find out 'why' the behavior began in the first place and respect & treat it, we as therapists/caregivers will be able to assist the child to become a more successful feeder.