Pocketing: When Your Child Won't Swallow Table Food
There are many reasons that a child may pocket food rather than swallowing it - some include:
Being afraid to swallow due to a past choking incident
Preventing others from force feeding
Protecting their airway (and knowing that it is not safe to swallow)
An immature swallow pattern can prevent them from swallowing appropriately
Limited awareness/sensation of the food in their mouth
Enlarged tonsils/adenoids
The first step to help your child at mealtimes (no matter what the cause) is making sure that you are being a responsive feeder. And we use the word feeder lightly, because ultimately, we want you to be a responsive partner in the mealtime. For the child who is scared due to a previous choking or gagging incident, we need to rebuild their trust and relationship with food to ensure them that they are safe. This is the same for a child who is pocketing their food to prevent someone else from feeding them. Being a responsive partner allows the child to be in the driver’s seat and guide the meal at her own pace, trusting that someone isn’t going to sneak up and try to get her to take another bite. In order to decrease and eliminate pocketing in these children, we need them to have trust in food, their mealtime partners, and themselves.
Children are smart, especially when it comes to eating and protecting themselves. If it does not feel comfortable to swallow and the child does not have the language or understanding to tell you, her way of expressing this is by pocketing the food and ultimately spitting it out. You may say “but she eats yogurt or macaroni and cheese fine” – and it’s likely because she feels safe with those foods. Your child may benefit from something to dip food in to help hold the food together while she is chewing and help her swallow. Your child could also benefit from a drink after swallowing to help "rinse" it down. The child may even benefit from further evaluation to ensure that enlarged tonsils or other anatomical obstacles are not the cause.
A child who has limited oral motor skills for chewing and swallowing may pocket food because she is being offered foods above her skill level. It is important to understand what foods your child can successfully chew and swallow at her given age. Taking it slow and offering these children smaller bites and verbal encouragement as they progress to more challenging foods will set them up for success.
A child who has limited awareness or sensation of the food being pocketed may benefit from more alerting flavors, textures, or temperatures. This child can also benefit from explicit training that can be done by using a mirror during mealtime to help her learn what it means when you say “chew” or what it can look like when being told to “swallow.” Using a mirror is also helpful when modeling a “clean mouth” before leaving the table.
Lastly, it is important to remember that every child is different when it comes to mealtime successes and challenges. Follow your gut; if you are unsure of why your child is pocketing food and it is leading to stressful mealtimes, it is important to seek help in order to get you and your child on the right path!
For more information on how to help your baby develop chewing skills:
Helping Your Baby Learn to Chew
How to Offer Bite-Size Table Foods to Your Baby
#tablefood #pocketing #responsivefeeding
