Polyvagal Theory and Trauma-Informed Care in Paediatric Feeding

As therapists working with children who experience feeding challenges, we increasingly recognise that traditional approaches focusing solely on oral motor skills or behavioural strategies may miss a crucial piece of the puzzle. Polyvagal Theory, developed by Dr Stephen Porges, provides a neurobiological framework for understanding why some children struggle at mealtimes and why creating a sense of safety is paramount for feeding success.

Understanding Polyvagal Theory: The Science of Safety

The vagus nerve, the longest cranial nerve in the body, connects the brain to vital organs including the heart, lungs, and digestive system. It controls our 'rest and digest' functions and is essential for successful feeding. Polyvagal Theory describes three hierarchically organised neural circuits:

•  Ventral Vagal (Social Engagement): Associated with feelings of safety and connection. Children in this state can engage socially, feel calm, and are physiologically ready for digestion. This system coordinates suck-swallow-breathe behaviours essential for feeding.
•  Sympathetic (Fight/Flight): Activated when children perceive danger. Digestion is inhibited, and children may appear anxious, defiant, or unable to settle at mealtimes.
•  Dorsal Vagal (Freeze/Shutdown): Associated with immobilisation when overwhelmed. Children may withdraw, appear tired or dissociated, and digestive function is significantly impacted.

Neuroception, Trauma, and Feeding

Central to this theory is neuroception: the unconscious process through which our nervous system evaluates safety or threat without conscious awareness. A child's nervous system may detect threat in foods, textures, or even caregivers' facial expressions, triggering protective responses that interfere with feeding.

Children who have experienced trauma (whether through medical interventions, NICU stays, tube feeding, or difficult early feeding experiences) may perceive threat even in ‘safe’ situations. Importantly, feeding therapy itself can be traumatising if approaches pressure children or trigger fight/flight/freeze responses, creating or reinforcing negative associations with food.

The Power of Co-Regulation

Co-regulation is the process through which a calm adult's nervous system helps a child's nervous system find balance. As Dr Bruce Perry reminds us, 'A dysregulated adult will never regulate a dysregulated child.' Our own regulation as therapists and caregivers is fundamental to supporting children's feeding development.

Principles of Trauma-Informed Feeding Practice

Trauma-informed feeding therapy prioritises safety, trust, empowerment, and collaboration:

•  Safety First: Create environments where children's nervous systems can detect safety from the sensory, physical, emotional, and relational perspective.
•  Child-Led Exploration: Ensure children can advocate for themselves and say 'no'. Allow exploration at their own pace without pressure.
•  Understanding Behaviour: Recognise that challenging behaviours serve adaptive, protective purposes
•  Family Support: Help families understand nervous system regulation and support their own regulation alongside their child's.

Practical Intervention Strategies

•  Use warm, prosodic vocal tones and calm facial expressions
•  Create predictable, consistent mealtime routines with adequate time
•  Support vagal tone through deep breathing, humming, singing, or calm music before meals
•  Follow the child's lead, honour refusals, and offer choices
•  Use playful, low-pressure food exploration and validate the child's emotions
•  Ensure comfortable, supportive seating and reduce sensory overwhelm

Conclusion

Polyvagal Theory demonstrates that feelings of safety are not just beneficial but neurobiologically necessary for successful feeding. We want to help children (and caregivers) move from survival mode into states where they can engage, explore, and develop positive relationships with food. Relationship comes first; feeding skills follow. By attending to the whole child and recognising that safety is the foundation upon which all feeding skills are built, we provide more effective, compassionate care that supports lasting change.

Conclusion

If you're finding this helpful and want to go deeper into trauma-informed feeding approaches, I'm running a Mealtime Masterclass on January 21st where we'll explore practical implementation strategies you can use in your very next session.

🤓👍 2026 Masterclass Mealtime

Kerry

P.S. Sometimes it just takes one small shift in understanding to transform those challenging cases. This might be that shift.

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References

Dana, D. (2018). The Polyvagal Theory in therapy. W. W. Norton & Company.

Feeding Matters. (2024). Trauma-informed care for children with PFD. https://www.feedingmatters.org/trauma-informed-care/

Perry, B. D., & Winfrey, O. (2021). What happened to you? Conversations on trauma, resilience, and healing. Flatiron Books.

Porges, S. W. (2011). The Polyvagal Theory: Neurophysiological foundations of emotions, attachment, communication, and self-regulation. W. W. Norton & Company.

Porges, S. W. (2022). Polyvagal theory: A science of safety. Frontiers in Integrative Neuroscience, 16, 871227.

Sanders, M. R., & Thompson, G. S. (2021). Polyvagal theory and the developing child. W. W. Norton & Company.