12 month-old not interested in table foods or feeding himself. Freak out? Not just yet...

After a workshop for a small corporate daycare center, I got an email from a staff member worried about a little boy in her care:...I am concerned about one of the infants at our center. He is almost a year old and has no interest in feeding himself and will only chew and swallow either stage 3 food or food from the food grinder. He also is not oral at all—never puts a toy or anything else in his mouth. He has been a little slow to meet other milestones compared with the other infants, but has met them. I am trying to follow DOR (Division of Responsibility) and not be pushy. He is in the 75th percentile for height and weight so that is not an issue. I just want to be sure I am doing all I can for him while he is in my care. I have had two children of my own and have worked in infant care centers for more than ten years. I am baffled. Usually by now the babies are wanting to feed themselves at meal time, or are at least trying (I usually let them go to town with their meal on their tray mashed and cut up as needed and assist if they are having problems and still sit with them for bottle feeding). Any suggestions?

my reply:First of all, it sounds like you are doing an amazing job with feeding, not pushing, and providing a variety of appropriate foods. You are tuned in to the children, and they are lucky to have you caring for them.It's tough to know if there is or isn't a problem for this boy. Sounds like you know babies really well, and though he is behind his peers, that may be just fine for him. If his eating and development are both behind and he is making progress that is reassuring.  I don't know if there are any developmental concerns beyond what you are describing as a general delay, but that is something for his parents and doctors to follow and consider.You could think about getting some textured teething toys, like Tri-Chew, or nubbly spoons (duo-spoon) that he can dip into his foods and handle, or you can dip it and hand it to him, as long as it is enjoyable for you both. These are fine options for the other infants in your care as well. Not getting pushy, even if there is an oral motor delay is critical. What you describe, with him taking and gumming and swallowing purees and stage 3 foods, seems within the normal range of experiences, but it's good to keep a watchful eye as you are.  I have had clients who had a similar experience and the babies did fine, though at their own pace. Others, albeit with more significant delays, had feeding clinic evaluations with one or two visits with some instructions for gentle oral stimulation  tasks and saw progress. Still others started feeding clinic therapies where the parents were instructed to perform "desensitization" with brushes and stim toys that the children fought. For these families,  therapy tasks and feeding became a battle, which most often slows down progress with learning to eat. That's not okay.Whatever road these parents take, they need to follow the child's lead, continue to expose him to increasingly textured and self-feed foods without pressure. It's okay if he doesn't eat anything for a meal or snack here and there. Too often, parents will always fall back on the less challenging, often sweeter pureed foods like the squeezie pouches, if the child rejects or is "too slow" to accept the more challenging foods.  Basically, if children are supported well, challenged appropriately with a variety of textures and flavors, are fed with the DOR in a pleasant setting, children most often do their own desensitization. Hope that helps.About three months later, I got this response:Just wanted to follow up—without any special intervention, Baby is suddenly eating almost everything in sight! Also have found out through various conversations with the parents that they don't have family meals together—Dad is picky and both parents are trying to lose weight, so they mostly eat individual-serving frozen meals. Neither cook, and parents prefer stage 3 foods because they are easy. I don't feel it's my place to give my input, but the info does offer some insight to the feeding issues the Baby had been having. Dad picks him up and is amazed by all the different foods the little boy has been eating at daycare—the kids actually get a great variety of foods. Thanks again for replying to me on this—helped a ton! What do you think? Did your little one lag behind her peers, then suddenly catch up? If you experienced concerns with feeding, did your child's doctor have any tips or ideas that helped, or not? (Chapter 3 in my book Love Me, Feed Me is a primer of sorts on selective eating, oral-motor delays, how feeding issues are often diagnosed and treated, and how to tell if you are getting the right information/support. I let the words of the parents themselves describe their experiences with feeding challenges.)