Difficulty Chewing in Children: what it is, signs, and how to treat it

Chewing difficulties in children are much more common than many parents imagine. They can range from taking forever to eat, frequent choking, or refusing to accept more solid foods, to situations where the child hardly chews and only swallows pieces.

Beyond the stress caused by eating, these chewing difficulties in children can affect growth, nutrition, oral health, and even speech development.

In this article, we will explain clearly what chewing difficulties in children are, what the warning signs are, the main causes, and how speech therapy can help. The goal is that, by the end, you will be able to distinguish what is part of normal development and what requires specialized evaluation.

What are chewing difficulties in children?

Simply put, we talk about chewing difficulties in children when the way a child grinds, moves, and prepares food in their mouth is not effective, safe, or appropriate for their age.

Chewing is part of orofacial motor skills, an area that encompasses functions such as breathing, sucking, chewing, swallowing, and speech. When children have chewing difficulties, it is common for other functions, such as swallowing or articulating sounds, to also be affected.

Some examples of chewing difficulties in children:

• A child who is unable to transition from purees to foods that are more "able to chew".

• Very slow and tiring chewing.

• Food that gets trapped in the cheeks without being properly chewed.

• Choking, coughing, or vomiting during meals.

• Always chew on the same side of your mouth.

• A child who seems "not to know what to do" with more solid foods.

These chewing difficulties in children can exist in children with neurological or developmental diagnoses, but also in children without any diagnosis, only with oral motor immaturity, sensory alterations, or poorly adjusted eating habits.

How does chewing develop in children?

To better understand chewing difficulties in children, it helps to know about typical development. Chewing doesn't appear overnight; it's the result of a journey that begins in the first few months of life with sucking.

Studies on oromotor development Studies show that the functions of sucking, chewing, swallowing, and speech mature throughout the first few years, with important milestones between 6 months and 6 years.

In general:

• Around 4-6 months

  • The child begins to take an interest in what adults eat.

  • Preparations are underway for the introduction of solid foods.

• Around 6 months

  • Complementary feeding begins, often with purees.

  • The child learns to move food around in their mouth and to swallow different textures.

• Between 8-10 months

  • More active chewing appears, with jaw movement.

  • Softer foods can be introduced in pieces.

• Between 12-18 months

  • The child is expected to chew small pieces, with more coordinated movements.

  • It starts chewing on both sides, albeit with some preference.

• Between 2-3 years

  • Chewing becomes more mature and efficient.

  • The child should already be able to handle most of the usual food consistencies found in the family diet, with supervision.

When this process is significantly delayed, inconsistent, or insecure, chewing difficulties in children become more evident, especially when compared to siblings or peers of the same age.

Main causes of chewing difficulties in children

Chewing difficulties in children rarely occur "without reason." They usually result from a combination of motor, sensory, medical, and environmental factors.

The most common causes include:

1. Changes in orofacial motor skills

When there is weakness, poor coordination, or limited movement of the tongue, lips, jaw, and cheeks, it becomes more difficult to chew efficiently. Children with orofacial motor disorders may have difficulty grinding food, moving the food bolus, and preparing for swallowing.

It is precisely this area that is addressed by speech therapy in the field of orofacial motor skills.

A good way to delve deeper into the basic concepts is to consult a glossary of orofacial motor skills, where terms such as unilateral chewing, tongue posture or atypical swallowing They are explained in an accessible way.

2. Neurological or developmental conditions

In children with cerebral palsy, autism spectrum disorders, genetic syndromes, or developmental delays, chewing difficulties are very common. There may be alterations in muscle tone, coordination, oral sensitivity, or motor planning, which directly impacts feeding.

3. Sensory issues

Some children have oral hypersensitivity or hyposensitivity: they overreact to certain textures, temperatures, or flavors, or they hardly react at all. This leads to refusal of solid foods, vomiting, choking, or a lot of stress at mealtimes, contributing to chewing difficulties in children.

4. Oral habits and feeding routines

Prolonged use of bottles, pacifiers, and foods that are constantly pureed or very "broken down" can delay the maturation of chewing skills. Studies show that prolonged use of bottles and pacifiers is associated with poorer chewing performance and a less efficient oromotor pattern.

5. Medical factors

Gastroesophageal reflux, food allergies, breathing difficulties, dental problems, or structural alterations (e.g., altered lingual frenulum) can also contribute to chewing difficulties in children. In these cases, collaboration between the pediatrician, dentist, and ENT specialist is important. speech therapist.

Warning signs of excessive chewing in children

Not all food refusal is a chewing problem. But there are specific signs that should draw parents' attention. When several of these signs are repeated, it is very likely that children have chewing difficulties and that an evaluation is necessary.

Some warning signs:

• Avoid foods that are meant to be chewed.

  • Refuse meat, raw fruit, raw vegetables, or bread.

  • He accepts purees, yogurts and porridge, but refuses pieces of meat.

• Very slow or inefficient chewing

  • A meal takes a long time.

  • He gets tired halfway through and stops eating.

• Frequent choking, coughing, or vomiting.

  • He seems unable to coordinate chewing and swallowing.

  • Parents are afraid to offer certain foods.

• Keep food in your mouth

  • The child keeps food "in their cheeks" without swallowing it.

  • Adults need to remind them to "chew and swallow".

• Chewing always on the same side

  • The child only chews on one side of their mouth, which can affect muscle balance and dental occlusion.

• Prolonged dependence on pureed foods

  • Even after the age of 2, he still needs everything from the past.

  • If the food is not thoroughly crushed, refuse it.

• Difficulties in other oral aspects

  • Saliva running frequently.

  • Difficulties in blowing, licking, and imitating tongue movements.

  • Speech that is unclear, with poorly defined sounds, which may be related to associated oromotor disorders.

When several of these signs are present, it makes perfect sense to consider chewing difficulties in children and not just dietary "quirks.".

Impact of chewing difficulties on children's development.

Chewing difficulties in children don't just affect mealtimes. They can have an impact in several areas:

• Nutrition and growth

  • Poor chewing can lead to insufficient or limited intake of certain food groups, compromising the vitamins, minerals, and energy necessary for growth.

• Oral health

  • Chewing too little or on only one side can influence dental occlusion and the development of the dental arches.

• Speech development

  • The same muscles used for chewing are involved in the production of sounds and words. Studies point to a relationship between chewing, oromotor performance, and speech quality.

  • It is no coincidence that children with chewing difficulties are more frequently seen in pediatric consultations. Language delay, childhood apraxia of speech or articulatory disorders.

• Behavior and relationship with food.

  • Tense mealtimes, pressure to eat, fear of choking – all of this can create a cycle of anxiety around food, both for the child and the family.

For all these reasons, chewing difficulties in children should be seen as an important sign, and not just as "tantrums" or "lack of appetite.".

Assessment of chewing difficulties in children

The professional best suited to assess chewing difficulties in children is the speech therapist, often integrated into a multidisciplinary team with pediatrics, nutrition, occupational therapy and other areas, depending on the case.

During the assessment, the speech therapist will:

• Gather the medical history.

  • Pregnancy, childbirth, motor development, medical history.

  • Dietary history: introduction of solids, current habits, preferred and rejected foods.

• Observe the orofacial structure and function

  • Mobility of the lips, tongue, jaw, and cheeks.

  • Muscle tone, tongue posture, breathing (oral or nasal).

• Assessing chewing in a real-world context.

  • Observing the child eating different textures (pasty, soft, solid).

  • Analysis of how it grasps, cracks, crushes, moves, and swallows.

• Identify sensory and behavioral factors.

  • Reactions to smells, textures, and temperatures.

  • Behaviors such as refusal to eat, avoiding meals, and associated tantrums.

In many cases, the assessment of chewing difficulties in children also considers speech, as alterations such as dysarthria or oral motor disorders may be present simultaneously.

Treatment of chewing problems in children

The good news is that, in most cases, chewing difficulties in children can be significantly improved with appropriate intervention.

A Speech therapy It acts directly on orofacial motor skills, masticatory coordination, and swallowing safety.

Intervention plans are always individualized, but typically include:

1. Orofacial motor skills exercises

Specific exercises help to strengthen and coordinate the lips, tongue, cheeks, and jaw, making chewing more efficient.
Some examples (only the speech therapist should decide what is appropriate for each child):

• • Directed tongue movements (up, down, sideways).

  • Practice opening and closing the mouth with control.

  • Exercises involving blowing, sucking, and lip pressing.

If you want to know ideas of orofacial motor skills exercises, There are resources designed to be used in conjunction with a speech therapist, never as a replacement.

2. Chewing practice with real food.

To treat chewing difficulties in children, it's not enough to do exercises "in the air." It's essential to train with real foods, chosen based on their safety level and therapeutic objective.

Evidence points to structured approaches to functional chewing training, in which strength, rhythm, and chewing coordination are worked on gradually, with proven improvement in function in children.

3. Adaptation of textures and security strategies

While working on chewing, it is often necessary to adapt textures, cut food in a specific way, or adjust the child's posture to ensure safety and comfort.

The speech therapist advises parents on:

• • What foods to offer at each stage.

  • How to cut or prepare food to reduce the risk of choking.

  • Proper seating positions at the table and mealtime rhythm.

4. Sensory and behavioral work

For chewing difficulties in children associated with food refusal or hypersensitivity, the plan includes gradual desensitization, gentle exposure to new textures, and strategies to reduce mealtime anxiety.

When necessary, the speech therapist collaborates with other professionals, for example in cases of... childhood stuttering, Dyslexia or more comprehensive disorders, where nutrition is only one part of the intervention.

5. Ongoing guidance for the family

Parents play a central role in improving chewing difficulties in children. Speech therapy always includes parental training: how to react during meals, what to avoid (pressure, blackmail, excessive distractions), and how to build predictable and calmer routines.

For many families, it is helpful to have access to online speech therapists that allow for continued monitoring even with tight schedules or when there are no specialized services near home.

What parents can do at home

Even without a formal diagnosis, there are simple and safe strategies that parents can implement to support children with chewing difficulties:

• Offer a variety of textures, gradually.

  • Don't keep the child on purees forever.

  • Introduce soft foods in small pieces, under supervision.

• Give yourself time to chew.

  • Avoid rushing and constantly saying "go on, swallow".

  • Respect the child's pace, without prolonging the meal indefinitely.

• Avoid excessive distractions.

  • Television or tablets can be helpful occasionally, but they prevent the child from paying attention to what they are doing with their mouth.

• Encourage safe oral play.

  • Blowing bubbles, using appropriate whistles, and playing with straws – always under supervision – can help strengthen the muscles involved in chewing.

• Observe and record

  • Make a note of the foods that cause the most difficulty, episodes of choking, and situations in which chewing difficulties in children are most evident.

  • This information will be very useful during your speech therapy consultation.

These strategies do not replace an assessment, but they help support the process when intervention is already underway or while awaiting consultation.

When to seek expert help

You should seek help from a speech therapist if:

• The child is over 12-18 months old and systematically refuses any food that is not pureed.

• Choking is frequent, even with age-appropriate foods.

• Mealtimes are always a stressful time, with intense tantrums and persistent refusal.

• Note that the chewing is clearly different from that of other children of the same age.

• The child has a neurological diagnosis, genetic syndromes, or global developmental delay, and, in addition, has very pronounced chewing difficulties.

In these cases, it is worth scheduling an appointment with Speech therapy to clarify the situation, to determine if there are indeed chewing difficulties in children, and to define an intervention plan.

For many families, the Online speech therapy It is a practical solution that allows you to maintain monitoring, receive real-time guidance, and adjust strategies to your daily routine, without time-consuming travel.

Conclusion

Chewing difficulties in children are not just an "odd" phase of eating. When they persist, they can compromise nutrition, oral health, emotional well-being, and even speech development.

The good news is that, with proper assessment and speech therapy intervention focused on orofacial motor skills and feeding function, the vast majority of children can significantly improve their chewing.

If you recognize yourself in the signs described throughout this article, observe your child carefully, record what happens during mealtimes, and take the next step: seek specialized support.

The sooner chewing difficulties are identified in children, the faster the path will be to more peaceful, safe, and enjoyable mealtimes for the whole family.