Gastrointestinal & Allergy Issues in Feeding: Why They Matter More Than You Think
Feeding isn’t only about oral skills, sensory experiences, or mealtime routines. Beneath all of that sits another crucial factor – the gastrointestinal (GI) system.
The GI system plays a central role in how children experience eating. In the Circles to Feeding™ Approach, Comfort is the foundation that allows curiosity and capability to grow. When children feel physiologically comfortable – including comfort within the gastrointestinal system – they are in their best state to explore, learn, and develop feeding skills. I often describe this as “learning mode.” When comfort is missing, children are more likely to shift into “protection mode,” where refusal, aversion, and stress dominate.
In this post, I’ll share why gastrointestinal and allergy issues are so important in feeding, what the research tells us, and how health professionals can support children and families without stepping outside their scope of practice.
Why Do We Need to Know About Gastrointestinal Issues?
The gastrointestinal tract begins with the mouth and its role is to break down food and fluids into the nutrients the body needs to grow and function. Feeding and GI function go hand in hand – one complements the other.
When the GI system is functioning well:
- Children feel physiologically comfortable
- They can tune into their hunger and satiety cues
- They’re ready to learn new tastes, textures, and skills
When it isn’t:
- Discomfort, pain, reflux, constipation, allergies, or inflammation can dominate
- Children may withdraw into protection mode (choosing not to eat, or refusing foods that cause distress)
- Ongoing discomfort can lead to feed aversion, disrupted skill development, and strained parent–child interactions at mealtimes and beyond
Comfort is a cornerstone of feeding therapy, and in the Circles to Feeding™ Approach, it forms the very first of the Priorities for Progress circles. GI comfort is one of the most essential layers within this – when it’s missing, children cannot fully engage in the next circles of Curiosity or Capability.
Comfort, Learning Mode, and Protection Mode
When everything is balanced, a child can access their internal drive to eat and enter learning mode. This is where new foods, tastes, textures, and skills can be explored.
But when GI discomfort is present, the body shifts into protection mode.
What does protection mode look like?
- The drive to eat is replaced by the drive to protect
- Children may withdraw, refuse food, or show stress behaviours
- The body shifts into a stressed “fight-or-flight” state, making eating physiologically and emotionally harder
If eating continues to cause pain or discomfort, these experiences can reinforce aversion and fear around food. Over time, this is how entrenched feeding difficulties can develop.
The cumulative impact can be broad – affecting feeding interest, skill development, internal cues, nutrition and hydration, and even the parent–child relationship at mealtimes.
How Common Are GI Issues in Children with Feeding Difficulties?
It’s worth asking: are GI problems really this common in children with feeding difficulties? The answer is yes.
π In one large hospital feeding clinic study with 700 children, more than 50% were known to have a GI condition.
π In an intensive outpatient program for children with severe feeding difficulties (where previous therapy hadn’t been “successful”), rates of GI involvement were striking:
- 76% had constipation
- 63% had reflux or oesophagitis
- 15% had eosinophilic oesophagitis (EoE)
- 36% had IgE-mediated food allergies (the type of allergy that shows on skin prick testing)
The takeaway? If a child presents with entrenched feeding difficulties, selectivity, aversion, or therapy “plateaus” or regressions, GI factors should always be considered as part of the bigger picture.
Scope of Practice: What Feeding Therapists Can (and Can’t) Do
This is a critical point. Unless you’re a medical doctor, diagnosing GI conditions is outside scope. But that doesn’t mean you have no role to play.
Here’s how I recommend approaching this area within the scope of practice of a speech pathologist or other therapist working with feeding:
β Screen for Red Flags
Go deep in case histories (all the way back to birth), and observe closely before, during, and after feeding. Look for potential indicators such as:
- Vomiting
- Gagging or retching
- Arching or grimacing
- Coughing during feeds
- Constipation
- Food allergies or atopic history
- Refusal or distress during feeds
Validated tools can help too – for example, the GIGER Scale for infants and toddlers, which screens for GI distress and reflux.
β Share Observations Without Diagnosing
Document what you see and hear. If I see potential signs or red flags of GI conditions, I describe what I see and hear to families and in my reports and letters (think, signs and symptoms observed or reported, like “Stella has a history of vomiting”), but I don’t say, “Stella has reflux” if it hasn’t been medically diagnosed.
β Explain the Rationale to Families
Families often feel relieved when someone takes their concerns seriously. Frame your questions as part of a thorough feeding assessment that considers the whole child. I will share that we are looking for signs of other medical issues that may impact on feeding, so that we can then help direct them to get the support they may need.
β Refer & Liaise
Don’t stop at observation. Work as part of a multidisciplinary team – write a letter to the GP, liaise with the paediatrician, or help families access paediatric gastroenterology support where needed. How we manage this is individual to each child and family’s situation, care team, and our local context. There is no one-size-fits-all approach here.
β Advocate for Families
Families may have had a long, frustrating journey, sometimes being told the problem is “behavioural.” Therapists can be powerful advocates – giving voice to children and families and helping them to have a voice and be heard in the medical system.
Why This Matters for Feeding Therapy
If GI discomfort is unrecognised or untreated, therapy progress will be limited.
You could deliver the most creative, engaging, and evidence-based feeding therapy in the world – but if a child is in pain or dysregulated, they won’t be physiologically or emotionally ready to eat.
This is why understanding GI and allergy issues isn’t “extra.” It’s fundamental.
Practical Takeaways
β If you’re a therapist or health professional working with a child with feeding difficulties:
Screen every child for GI symptoms (especially if difficulties are entrenched or unexplained). Refer to medical professionals when red flags arise.
β If you’re a medical or health professional seeing a child with GI issues:
Always ask families about feeding. Eating, drinking, and the feeding relationship may be affected – and referral to a trained feeding therapist can make all the difference.
Final Thoughts
In the Circles to Feeding™ Approach, Comfort is one of the three essential priorities for progress, alongside Curiosity and Capability. If gastrointestinal discomfort is overlooked, the comfort circle is incomplete – and therapy progress stalls.
By staying within scope, screening thoughtfully, and collaborating across disciplines, we can make sure GI discomfort isn’t the missing piece in a child’s feeding journey.
Addressing gastrointestinal and allergy issues isn’t just good practice – it’s essential for positive feeding experiences, reducing aversion, and supporting long-term Feeding Freedom.
