At Galway Nutrition & Therapy Clinic, we recognise that feeding difficulties in children can be complex and emotionally challenging—for the child and their family. A widely respected framework used internationally to support children with feeding difficulties is the “Steps to Eating” hierarchy, originally developed by pediatric feeding therapist Dr. Kay Toomey.
This stepwise approach acknowledges that eating is not a simple behaviour, but rather a learned process made up of many smaller steps. Understanding and respecting this process is essential in supporting children with feeding challenges, including those with sensory processing difficulties, anxiety, or medical histories that affect their relationship with food.
🥄 The Six Major Steps to Eating
Each child learns to eat in progressive, manageable stages. The six core steps are:
- Tolerating the Physical Presence of Food
- The child is able to be in the same room as the food or sit at a table with it present.
- Interacting with the Food
- The child may use utensils or objects to interact with the food without directly touching it.
- Tolerating the Smell
- The child is exposed to and tolerates the aroma of the food without distress.
- Touching the Food to Skin
- This includes tolerating food on hands, fingers, or face—proximity to the mouth increases perceived threat.
- Tasting the Food
- The child may lick or briefly taste the food, beginning the process of oral exposure.
- Chewing and Swallowing
- Full consumption of the food, or at least a component of it, occurs at this stage.
🧠 Why These Steps Matter: A Neurosensory and Developmental Perspective
Research shows that children with feeding difficulties benefit from graded exposure. This mirrors models used in CBT (Cognitive Behavioural Therapy) and desensitisation therapies used for anxiety (Toomey, 2002; Dovey et al., 2008).
By breaking eating into smaller, tolerable tasks, we reduce pressure and increase the child’s sense of safety and control. For many children, especially those with ARFID (Avoidant Restrictive Food Intake Disorder), autism spectrum conditions, or post-traumatic feeding experiences, skipping steps leads to distress and food refusal.
✅ Practical Tips for Parents and Professionals
- Tailor the approach to each child's current tolerance level.
- Avoid jumping to advanced steps like tasting or swallowing—this may increase anxiety.
- Progress may be non-linear. Children may move forward and back depending on day-to-day variability.
- Always model calm, non-judgemental behaviours around food.
“Children often need to learn it’s safe to bring food to their mouth before they’re ready to swallow it. Spitting out food can be a helpful part of this learning.” — Ellyn Satter Institute, 2022.
🩺 When to Seek Professional Support
If a child is consistently distressed around mealtimes, severely restricting food variety, or has stopped gaining weight or growing appropriately, it’s important to seek help from a CORU Registered Dietitian trained in paediatric feeding. A coordinated approach involving Occupational Therapists, Psychologists and Speech & Language Therapists is often most effective (Kerzner et al., 2015).
📚 References
- Toomey, K. (2002). SOS Approach to Feeding. www.sosapproachtofeeding.com
- Kerzner, B. et al. (2015). A practical approach to classifying and managing feeding difficulties. Pediatrics, 135(2), 344–353.
- Dovey, T.M. et al. (2008). Food neophobia and ‘picky/fussy’ eating in children: A review. Appetite, 50(2–3), 181–193.
- Satter, E. (2022). Ellyn Satter Institute. www.ellynsatterinstitute.org
👨⚕️ Support from Galway Nutrition & Therapy Clinic
As a Galway-based CORU Registered Dietitian and Trained Psychotherapist, I integrate psychological and nutritional strategies to support children and families facing feeding challenges. If your child is struggling with food, please feel free to reach out for a consultation at www.gntc.ie.
