The Feeding Family

Imagine you are at your favorite café or restaurant, enjoying a cool, rich, delicious bowl of chocolate pudding for dessert. Maybe you come to this spot every week (or more if it’s a particularly stressful week!) and indulge in this smooth, creamy treat. Now imagine that one week, you are served your pudding and it looks a little different. You take a bite and realize that the chef has changed the recipe! Your silken chocolate pudding now contains small, soft lumps of mushy brownies! This is not what you expected! Maybe you even cover your mouth with a napkin and spit out the lump to see what the heck it is. Maybe you don’t finish your pudding today because it’s just not what you wanted. Either way, you notice that you can’t just let the pudding slip down your throat anymore. Now you must swallow a part of your mouthful, chew the rest, and then swallow again. This pudding just got complicated.

Now imagine that you are 8 months old. You’ve never had a lump in your life! That lump in your food might be surprising and even a little scary if it starts to slip down your throat. You might gag to try and get it out. Maybe your eyes start watering and you start to cry. Chances are that you might be a little wary of that food the next time mom or dad brings it out.

Not all children have difficulty transitioning from a stage-2 thick puree to a stage-3 lumpy puree. If they did, the baby food companies might go out of business! But I frequently see families for feeding evaluations because their child is having a lot of trouble transitioning to textured foods. Some of these children demonstrate sensory aversions or oral-motor delays, but many are not really displaying either. How can we help our kids with this sometimes troublesome transition?

A Little More Time: Every child is different and reaches their developmental milestones at slightly different times. Some children may have no problem with lumpy textures the first time they are offered, while others may react strongly to the change. My first suggestion for families experiencing difficulty with this transition is to wait a few days to a week and try it again. If the difficulty persists, then you can move on to some of the following ideas to help your little one adjust.

Ignore the Numbers: Just because the number “3” comes after “2”, doesn’t mean that you are bound by law to offer stage-3 foods immediately. Often changing the order in which solid textures are introduced can help children transition more easily to the lumpy texture. Here is an example of a different transition plan that has helped many families make the change (see the articles on puree, soft solid, and hard solid textures for more information on the different food textures listed below) The following textures should be offered for exploration IN ADDITION TO stage-2 or thick purees and breastmilk or formula for the majority of their nutrition:

   1. Hard Munchables: Offer hard, stick-shaped foods like carrot or celery sticks. Encourage your child to dip the sticks in their pureed food and to play with the texture in their mouth. When the stick is placed in the side of the mouth, it encourages the tongue to move to both sides, a skill necessary for chewing. The hard munchable is NOT intended to be eaten. It is purely for exploration of a new shape and texture in the mouth.
   2. Small, soft cubes: Ripe banana or well cooked carrot works very well for this stage. Think of it as offering the “lumps” from the stage-3, but without the surrounding puree. The pieces should be small, but still able to be picked up with the fingers. Offering small, soft cubes on their own can help a child learn to manage the one texture before mixing it with others.
   3. Lumpy puree or mashed table food: At this point, parents have the option of trying the stage-3 jars again, or moving to mashed table foods. Both are a lumpy texture, but the mashed table foods tend to be thicker. If your child has tolerated the hard munchables and soft cubes well, the transition to lumpy purees should be much easier.

If your child still demonstrates difficulty transitioning to lumpy textures or does not tolerate the hard munchables or soft cubes, seek the advice and guidance of a feeding team evaluation. Ask your pediatrician for a referral and see our guide on what to look for in a feeding team.

Often, I will meet a family for a feeding evaluation and they will ask me this question: “All he eats are chips and crackers, but I can’t get him to take a bite of meat! Why won’t he chew?” Children with oral-motor delays or sensory aversions to food can sometimes be very particular about what kinds of foods they will and will not eat. In this article we will discuss what the differences are between different types of hard or crunchy solid foods. Previously we have discussed pureed foods and soft solid foods. With these three resources together, you should now have a fairly complete glossary of food texture types and descriptions.

Meltable Solid: This is often the first type of “hard” solid food that we offer to toddlers. A meltable solid is a dry texture that, when placed in the mouth, softens and dissolves within a few seconds. Examples of this texture are toddler “puffs”, butter crackers, and shortbread cookies. Children are able “chew” these foods a few times and easily swallow them. If you are unsure whether a food is considered “meltable”, hold a piece in your mouth without chewing. If the food begins to break apart just with saliva, it is considered meltable.

Crunchy Solid: These are often similar to meltable solids, but require more chewing to break apart. Examples are cheerios, saltines, and graham crackers. These foods require better control of the food in the mouth and more endurance for chewing. 

Hard Munchable/Hard Stick: These two terms are used to mean a hard solid that is used for food exploration or mouth exploration without the expectation that the child will actually bite off a piece and eat it. Hard sticks can be used to stir and taste purees or simply for exploration on their own. These textures can help a child “get used to” the feeling of a hard texture in their mouth without having to chew and swallow the food. Examples of hard munchables/sticks are celery or carrot sticks, jicama spears, or hard pretzel rods. Always supervise a child when they are exploring with hard munchables to make sure that they do not accidentally bite off a piece and choke.

Hard Mechanical: A hard mechanical is the same texture as a hard munchable or hard stick but one that is meant to be eaten. These are textures that are appropriate for older children with mature oral-motor skills. Some tougher meats could also be included in this category, since they require a lot of chewing in order to be swallowed.

Mixed Texture: A mixed texture is just what it sounds like! It is a food which combines one or more of the textures featured here and in the Purees and Soft Solids articles. Stage 3 pureed baby foods might be considered a mixed texture, since they combine soft cubes within a thick puree. Chicken soup is also a mixed texture which combines thin liquids with soft solids and hard mechanicals. A child should be able to eat all the textures SEPARATELY before they are expected to eat the textures together.

Now that you know all about food textures, take a look around the next time you are at the grocery store or standing at your fridge. How many soft cubes can you find? How many hard munchables? Keep these textures in mind when choosing foods for your child. Ask your feeding team for additional information if you notice that your child is have difficulty with one or more of these textures.

Many parents and caregivers might not give much thought to the differences between a puree and a soft cube until they are faced with teaching a child with an oral-motor delay how to eat. The small differences between different food textures can make a big difference for your child when they are having difficulties with chewing and/or swallowing. The terms that your speech-language pathologist or feeding team might use to describe food textures can be confusing. In our last segment, we looked at the differences between many types of purees. This week we will address different types of soft solid textures.

Soft Cube Texture: This type of soft solid allows children to appreciate the mouth feel of a formed solid, without demanding a lot of chewing skills. Examples of soft cubes include boiled or steamed potato or carrot pieces, ripe banana or mango. A soft cube texture is one which turns into a thick puree when pressed with the tongue or teeth. 

Finely Chopped: Any fruit, cooked vegetable, or meat can be made into a softer solid texture by chopping it well in a food processor. This allows for more texture in the solid food, but with less effort needed for chewing. Finely chopped foods can be softened even further by adding sauces or gravies to help keep pieces together in the mouth. 

Mechanical Soft: The term “mechanical soft diet” is most often heard in hospitals or other medical settings. This describes a set of foods with are soft enough to be easily chewed, but are not required to be chopped or diced. Sometimes this kind of texture is useful as a transition between a pureed diet (which requires no chewing) and a full regular diet for children or adults who have suffered an injury or other feeding setback. Foods which are considered a mechanical soft texture include soft scrambled eggs, flaked fish (no breading), noodles, rice, and softer fruits and veggies (NOT carrot sticks or apple slices).

“Soft” Foods to Avoid: If your child requires soft foods due to difficulty with chewing skills, there are some common foods which are “soft” to the touch, but which can be difficult to chew and swallow nonetheless. One of these foods is bread. While bread is soft, it can be very chewy and sticky when it becomes moistened in the mouth. I often advise parents to avoid bread (slices of bread, rolls, hot dog/hamburger buns, etc.) until there child is able to handle more complex, or multi-textured foods consistently. Meats are another “soft” food that might be avoided for children with oral-motor difficulties. Even if meats are tender, they require more advanced chewing and biting skills. Ground meats with some sauce or gravy can be a nice alternative to whole meats at this stage.

I've gotten more than a few questions from readers about different food textures. What is a texturized puree? A soft cube? A meltable solid? For typically developing children the boundaries between these textures are sometimes fuzzy, and therefore many parents aren't aware that a scrambled egg and a piece of banana can be two very different foods from an oral-motor perspective! Today we'll talk about purees and what those "stages" really mean in relation to your child. The focus of this article is on children with oral-motor delays or oral-sensory aversions, but the content can be applied to children with typical skills as well.

What is a puree? A puree is a consistency similar to baby food. There are many different puree textures, some can be thin and runny, while others are thick or have soft lumps.

Stage 1 or Thin Puree: This consistency is similar to a slightly thickened liquid. It coats the spoon well but still drips off easily. This consistency is offered as a first step solid food because it is considered one to two steps "thicker" than breast-milk or formula. For older children this consistency is easy to swallow quickly, however it can pose a risk for children who are known to aspirate or choke on thinner liquids and foods.

Stage 2 or Thick Puree: This consistency is considerably thicker than stage 1. It can be similar to a smooth applesauce. It should stay mounded on the spoon when scooped but fall off the spoon if you tip it upside down.

Pudding Thickness: This type of puree is similar to, you guessed it, pudding! Foods that would be considered a pudding thickness are yogurts or smooth mashed potatoes. These foods can be very difficult to swallow for children with weak oral muscles or a weak swallow.

Stage 3 or Texturized Puree: This can be a very complicated texture for children with even mild oral-motor or sensory delays or impairments. It consists of a stage 2 or pudding thick puree with small, soft lumps throughout. I would say that about 20% of my initial evaluations are for children who are having difficulty transitioning from stage 2 purees to stage 3 purees. In future articles we will discuss strategies to help children transition to texturized foods.

Almost any food that you or your family eats can be blended into a puree. Foods should be allowed to cool to room temperature and then blended in a food processor or blender with liquid until the desired consistency is reached. Adding small amounts of water, milk, or broth will make a puree thinner, while adding small amounts of corn starch can add more thickness.