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Care and feeding for children with feeding difficulties

Generic RCEL (USAID Advancing Nutrition | 2021)
Care and feeding for children with feeding difficulties

Key Messages

Key Messages

  • Sometimes children have difficulties feeding, and they may require additional support to be able to feed well. It is important to consult a health care provider if you have any concerns about your child’s feeding.
  • Children with feeding difficulties are at increased risk of becoming malnourished. Regular growth monitoring is important for all children.
  • Seek immediate care at a facility if your child is losing weight, or displays warning signs like frequent coughing or tearing while feeding, jaw tightening that prevents feeding, fast breathing or breathing becoming wet-sounding, excessive sweating or tiring quickly when feeding, or vomiting after feeding.

Practical Tips

  • ASK: Can you tell me more about the concerns you have about your child’s feeding?
  • ADVISE based on the caregiver’s concerns and the child’s age:


  • Difficulties latching to the breast:
    • Try different breastfeeding positions and find one that works for you. You may need different positions for each breast. Refer to the UNICEF C-IYCF card on different breastfeeding positions.
    • If your baby cannot latch, express breast milk. Use a cup to feed your baby instead of a bottle. Refer to the C-IYCF card on expressing breast milk.
    • To cup feed safely, bring the cup to your baby’s lower lip and allow him to take small amounts of breast milk, lapping the breast milk with his tongue. Do not pour the milk into your baby’s mouth.

Complementary feeding starting at 6 months

  • Difficulty controlling head or body:
    • A stable, upright position with support for eating and drinking is one of the most important factors for safe feeding. Make sure your child’s whole body is supported well, so that she can focus on eating.
    • If your child is floppy, provide support to his back and head using your body or a chair. Always keep his head upright while feeding to prevent choking or having food go down his airway.
    • Persistent difficulty chewing or swallowing:
  • Difficulty chewing and swallowing can cause choking and can lead to illness. Consult with a health care provider and ask for specific feeding strategies for your child.
    • Consider pureeing foods by passing soft foods through a sieve. It is easier for children to learn to control foods in their mouth and swallow if they are only one texture.
    • Water and other liquids are easy for children to choke on if they have problems swallowing. Never pour liquids into your child’s mouth. Consider thicker liquids like soft porridge or yogurt.
  • Difficulty self-feeding:
    • Spoons and forks with thicker handles are easier for children to hold. Attach a rubber tube or piece of wood to the spoon handle to make it thicker.
    • Plates with steep sides may make it easier for some children to scoop up food themselves.

Context-specific feeding issues to include in country adaptations if common in the context

  • Picky eating:
    • Wait until your child is hungry to give her healthy foods she has not liked in the past. She may be more willing to try them when she is hungry.
    • Let him feed himself. This will help him feel like he is in control of what he is eating.
    • Do not use food as a reward or as a punishment. Your child will eat when she is hungry.
  • Poor appetite:
    • Provide more frequent, smaller meals throughout the day.
    • Avoid juices or sugary drinks. Provide only water instead.
    • Avoid distractions during mealtimes, and encourage routines of the family eating together to make mealtime fun.
    • A child is getting enough to eat if they are growing well. Consult with a health care provider if you are concerned or if your child’s poor appetite lasts for several days.

Note: If the feeding problem is that the child is sick with common illnesses such as fever or diarrhea, refer to UNICEF C-IYCF counseling card on feeding a sick baby up to 6 months of age or a sick child over age 6 months for guidance on appropriate feeding during and after illness, or refer child to a health care provider.

CLOSE by asking the caregiver to demonstrate or explain to you what they agreed to do with their child. Make sure there is a clear plan for a visit to the health facility to address the feeding issues. Brainstorm with the caregiver ways to address barriers to accessing a health facility.