Helping Your Special Needs Child Transition to Textured Food

Sometimes children have difficulty transitioning to textured foods. This could be resistance to transitioning from formula to cereals and purees, or transitioning from purees to table food, or anything in between. This resistance is more common among special needs children, but I have seen it in children who are otherwise typically developing. Read on for general tips, and an outline of steps on how to transition to textured food.

My Eureka Teaching Case

As an occupational therapist I served with a multidisciplinary group of specialists on a pediatric feeding team. There was one special needs child that was a great learning experience, and a fantastic success story for transitioning to textured food.

The child had spastic quadriplegic cerebral palsy, and moderate cognitive impairment. He was about 7 years old at the time, and surprisingly well nourished. His mother sought our help because he would only consume Pediasure and one brand of smooth yogurt. At that time, Pediasure was not covered by Tricare (military insurance), and four to six cans a day was very expensive.

Our speech therapist developed the plan for the transition. She instructed the mother to start by adding ¼ teaspoon of level one baby food applesauce puree to two cartons of the child’s favorite yogurt, about 8 ounces, his usual serving. The mother was extremely patient, and very gradually increased the amount of puree in the yogurt. She then transitioned to regular applesauce in the yogurt. She continued to experiment, increasing the texture of baby food purees. In less than a year, her son was eating Gerber Graduates, and chopped and minced table foods.

This mother was ecstatic! She thought the speech therapist and I were miracle workers. I deserved no credit. I was just fortunate enough to be present when the speech therapist dispensed fabulous advice. The miracle worker of course was the mom.

Getting Started Adding Tastes and Textures

Before I start with step-by-step instructions for increasing texture, I need to cover a few key points.

You will be introducing taste and texture. These steps are presented in the context of increasing food texture, but you will be introducing new tastes too. This progression could be used for introducing new foods, if that is the issue rather than texture.

Don’t get impatient. Easier said than done, I know, but the consequences can be severe. Initially you want to introduce tastes and textures in a way that they will not be detected. Then you hope to increase the taste and texture so gradually that the child will become accustomed to them. If you try to increase too fast, the child may refuse to try again.

You will be increasing texture by ¼ teaspoon every fourth day. If your child shows reluctance at any time, back off on the amount of puree or cereal, and try increasing by one scant ¼ teaspoon measure, every five or six days.

Choose compatible tastes when adding texture. When selecting your texture, consider what flavors will be compatible. Add fruit purees to yogurt. Add level two vegetables, or level two meat and pasta blends to level one vegetables. Add level two fruits to level one fruits.

Follow your doctor’s or therapist’s advice. This article is not meant to substitute for medical advice. Consult your team before embarking on any course of action. Your doctor or therapist, among other things, needs to determine that your child will be safe to pursue new food textures, and is not at risk for aspiration. They will determine precautions, and red flags, such as coughing, wheezing, or diarrhea.

When Your Child Only Drinks Formula or Pediasure

Add ¼ teaspoon of baby cereal flakes or ¼ teaspoon of level one baby food pureed fruit, such as applesauce or banana, to 8 ounces of formula or Pediasure.

Increase by ¼ teaspoon every three days:

Day 1: Add ¼ teaspoon puree or cereal to 8 oz formula or Pediasure.

Day 4: Add ½ teaspoon puree or cereal to 8 oz formula or Pediasure.

Day 7: Add ¾ teaspoon puree or cereal.

Day 10: Add 1 teaspoon puree or cereal.

Day 13: Add 1 ¼ teaspoon puree or cereal.

Continue increasing by ¼ teaspoon puree or cereal flakes every fourth day. As the mixture gets thicker, you will need to use a cereal feeder nipple, or start using a spoon. You may want to introduce a few spoons of the mixture early in the process, so that the spoon won’t be such a big adjustment later.

Adding Texture to Yogurt

Add ¼ teaspoon of level one baby food puree such as applesauce or banana, to two 4-ounce cartoons of smooth yogurt.

After 3 days (day 4), increase to ½ teaspoon of level one fruit puree to two 4-ounce yogurts.

After 3 days (day 7), increase to ¾ teaspoon of level one fruit puree.

After 3 days (day 10), increase to 1 teaspoon of puree.

Continue to increase puree by ¼ teaspoon every 4th day.

If the transition has been going well, when you reach 2 to 4 tablespoons of level one baby food fruit puree per eight ounces of smooth yogurt, you could try increasing puree by ½ teaspoon every 4th day.

Transitioning from Level One to Level Two Baby Food

The progression from level one baby food purees to level two purees is very similar to the progression above with purees added to yogurt. This can be a fun process, if your child is primarily reluctant about texture, but is fairly open to different tastes and flavors. You have numerous choices of fruits, vegetables, and meat blends.

Add level two fruits to level one fruits. Add level two vegetables to level one vegetables. Add meat and pasta, or meat and rice level two purees to level one vegetables. Choose flavor combinations that make sense.

Day 1: Add ¼ teaspoon of level two puree to two or three 2.5-oz containers of level one vegetables.

Day 4: Add ½ teaspoon of level two puree.

Day 7: Add ¾ teaspoon of level two puree.

Day 10: Add 1 teaspoon of level two puree.

Continue increasing level two puree by ¼ teaspoon every 4th day.

Transition to Level Three Baby Food

Once the child tolerates level two foods, begin introducing level three baby food.

Begin adding level three, ¼ teaspoon at a time to level two baby food. As above, increase the amount of level three baby food by ¼ teaspoon each fourth day.

The chunks of vegetable, pasta, rice, and meat vary in firmness and size. You may want to mash level three with a fork to break it up further for the first couple weeks.

Alternatively, add your own table food to level two baby food. Just keep food tastes compatible. Make sure foods are soft, and can be mashed with a fork, or pulse a couple times in the blender or food processor.

Add mashed or processed fruit to level two fruits. Add mashed or processed vegetables, pasta, rice, or meat to level two vegetables or blends. Start with ¼ teaspoon of your experimental texture to level two food. Increase by ¼ teaspoon every fourth day.

Graduates and Table Food

If you’ve made it this far, you’re on the homestretch. Continue to progress with junior food like Gerber Graduates, and table food. Mash soft foods with a fork, or pulse in a food processor, until they are similar to your level three foods. Gradually decrease the fineness of your processing, gradually increasing the texture of the food.

Talk to Your Health Care Provider

This article is not intended to be a substitute for professional medical advice, diagnosis or treatment. Consult your pediatrician, nutritionist, speech therapist, and occupational therapist.

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