As a dietitian working in feeding therapy, one thing I have learned over time is that eating is never “just about food.”

When a child struggles with chewing, swallowing, sitting at the table, or managing different textures, there are often many systems working together behind the scenes. Sensory processing, oral motor skills, emotional safety, motor planning, regulation, and physical stability can all play a role.

This is why feeding support is often most effective when approached as a team effort.

Recently, I spent time reviewing perspectives from pediatric physical therapists, occupational therapists, and speech therapists on the connection between posture, core strength, and feeding. While this is not my area of expertise as a dietitian, I found their insights incredibly valuable and important for parents to understand.

One of the strongest themes across the literature was this:

A child’s posture and core stability create the physical foundation for feeding skills.

Core Stability: The Foundation Beneath Feeding

Pediatric Physical Therapist Jill, featured by Ivy Rehab, explains that “core stability is kind of the foundation that kids need for any skills,” particularly skills like chewing and swallowing, which require coordination between multiple body systems.

This makes sense when we think about how complex eating actually is.

A child needs to:

• Sit upright

• Coordinate breathing and swallowing

• Stabilise their jaw and neck

• Use both sides of the body together

• Bring food to their mouth

• Maintain balance while focusing attention on eating

If simply sitting upright requires a huge amount of effort, there is less energy available for higher-level feeding tasks.

Jill explains that when posture becomes more automatic, children can focus more easily on learning, social interaction, communication, and feeding skills rather than using all their energy trying to stay upright.

Why Posture Matters During Meals

Physical therapist Erin Lublow, DPT, describes posture as one of the foundational components of safe and functional feeding.

She explains that feeding begins with:

• Pelvic stability

• Trunk alignment

• Head and neck control

Without this foundation, jaw stability, chewing, biting, and swallowing may all become more difficult.

Poor posture can also increase fatigue during meals. Some children may appear distracted, wiggly, avoidant, or “picky,” when in reality their body is working extremely hard simply to maintain position.

The Speech Therapy team at Cutting Edge Pediatric Therapy offers a helpful comparison:

“Imagine having to do crunches while eating a snack.”

For children with low muscle tone, postural instability, or motor challenges, mealtimes can genuinely feel this effortful.

They also explain that poor positioning can contribute to coughing, spilling, difficulty chewing, and increased effort while eating.

The Importance of 90-90-90 Positioning

One of the most common recommendations across physical therapy, speech therapy, and feeding therapy literature is the “90-90-90” sitting position.

This means:

• Hips bent at 90 degrees

• Knees bent at 90 degrees

• Ankles bent at 90 degrees

• Feet firmly supported

• Hips positioned at the back of the chair

• Table height around elbow level

According to the Speech Therapy team at Cutting Edge Pediatric Therapy, this positioning helps children maintain postural stability against gravity while freeing up energy for eating and learning.

Pediatric Physical Therapist Jill also notes that this posture encourages better core engagement and postural control, particularly for children with low muscle tone.

Sometimes simple adjustments can make a significant difference, including:

• Adding a footrest

• Using a cushion behind the back

• Providing trunk support

• Adjusting table height

• Improving chair fit

These changes give the child’s body enough support so eating feels easier, and less exhausting.

W-Sitting and Low Tone

Several therapists also discussed W-sitting, where a child sits on the floor with their knees bent and legs positioned behind them in a “W” shape.

According to Jill, this position reduces the demand placed on the core muscles and postural system. While children may choose it because it feels more stable, relying on it consistently can sometimes limit opportunities to build trunk strength and balance.

Occupational Therapist Sarah Layton notes that frequent W-sitting may be one sign that a child could benefit from additional core strengthening and postural support.

Other possible signs may include:

• Slouching

• Leaning heavily on surfaces

• Fatigue during fine motor tasks

• Difficulty sitting still

• Frequent falls or clumsiness

• Avoidance of physical play requiring coordination or balance

Of course, these signs can have many contributing factors and should always be considered within the broader context of the child.

How Physical Therapists Help Support Feeding

Physical therapists often focus on the physical foundations that support feeding success.

This may include:

• Core strengthening

• Balance activities

• Postural control

• Gross motor development

• Weight-bearing activities

• Trunk and pelvic stability

Examples of activities include:

• Animal walks, such as bear and crab walks

• Wheelbarrow walks

• Balance games and challenges

• Obstacle courses

• Tummy time (yes even for big kids)

• Climbing

• Crawling

• Exercise or yoga ball activities

• Yoga

Importantly, these activities are designed to feel playful and engaging rather than like “exercise.”

Why Multidisciplinary Feeding Support Matters

Feeding challenges are often multifactorial, which is why multidisciplinary support can be so valuable.

Different professionals contribute different expertise:

Occupational Therapists (OTs)

Occupational therapists often support:

• Sensory processing

• Motor planning

• Functional participation in mealtimes

• Food exploration

Physical Therapists (PTs)

Physical therapists focus on:

• Gross motor skills

• Postural stability

• Core strength

• Balance

• Physical endurance

Speech-Language Pathologists (SLPs)

Speech therapists specialise in:

• Oral motor function

• Swallowing

• Chewing

• Feeding safety

• Communication

Dietitians

Dietitians help assess:

• Nutritional adequacy

• Growth

• Food variety

• Mealtime patterns

• Nutrient intake

• Medical and feeding history

Final Thoughts

One of the biggest takeaways for me from reviewing these perspectives is this:

A child’s body, posture, motor skills, regulation, sensory experiences, and physical endurance can all influence what happens at the table.

For some children, improving seating, posture, and physical stability may reduce effort enough to make eating feel more manageable.

And of course, every child is different. If concerns around feeding, posture, swallowing, or motor development are significant, individual assessment from appropriately qualified professionals is important.

Parent Observation Checklist

This is not a diagnostic tool. It is simply a way to help parents notice patterns and communicate observations to their child’s therapy or medical team.

You may wish to tick any areas you commonly notice.

During Meals

• My child struggles to stay sitting upright during meals

• My child leans heavily on the table, tray, or one arm

• My child frequently slouches, slides down, or wraps legs around the chair

• My child prefers eating while lying down, walking around, or moving constantly

• My child seems physically tired during meals

• My child coughs, splutters, gags, or appears to work hard while eating

• My child spills food or drinks frequently

• My child avoids difficult textures or chewy foods

• My child becomes frustrated or dysregulated at the table

• Meals seem exhausting for my child

Sitting & Posture

• My child often W-sits on the floor

• My child struggles to sit still without constantly shifting position

• My child prefers leaning against people or furniture for support

• My child tires quickly during seated activities

• My child struggles to maintain upright posture without reminders

• My child avoids floor sitting or certain movement activities

Movement & Coordination

• My child appears clumsy or falls often

• My child struggles with balance

• My child avoids climbing, jumping, crawling, or active play

• My child tires more quickly than other children their age

• My child seems to use a lot of effort for everyday physical tasks

Seating Setup

• My child’s feet do not comfortably reach a stable surface during meals

• The chair or table seems too large or too small for my child

• My child benefits from cushions, footrests, or extra support

• I notice improved eating when my child is positioned well

You know your child best. Even small observations can help build a clearer picture for your child’s support team.

References

Ability Innovations. (2025). Core Strengthening for Kids: Simple, Play-Based Exercises for Better Posture. Written by Sarah Layton, MOT, OTR/L (Occupational Therapist). Retrieved from: https://www.abilityinnovations.com/blog/core-strengthening-for-kids-simple-play-based-exercises-for-better-posture

Cutting Edge Pediatric Therapy. (2023). Why Do We Need to Remember 90-90-90 for Eating? Written by the Speech Therapy Team. Retrieved from: https://cuttingedgepediatrictherapy.com/2023/05/why-do-we-need-to-remember-90-90-90-for-eating/

Firelands Regional Medical Center. Posture is Important for Picky Eaters. Written by Erin Lublow, DPT (Physical Therapist). Retrieved from: https://www.firelands.com/empower/pediatrics/picky-eaters-vs-problem-feeders-physical-therapists-perspective/

Ivy Rehab. Building Strong Foundations: Core Stability in Pediatric Physical Therapy Supports Feeding, Communication, and Mobility in Children. Featuring insights from Jill (Pediatric Physical Therapist). Retrieved from: https://ivyrehab.com/health-resources/pediatrics/building-strong-foundations-core-stability-in-pediatric-physical-therapy-supports-feeding-communication-and-mobility-in-children/

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