FACT: In the U.S., over 40,000 infants are born extremely pre-term (less than 28 weeks)
FACT: Over 50% of former pre-term babies present with feeding difficulty in infancy and toddlerhood that result solely from being pre-term
FACT: Some studies have shown reflux in up to 100% of preterm infants and 90% of term infants, resulting in the need for feeding therapy.
FACT: Reflux is one cause of a feeding aversion.
FACT: Some toddler- and school-age children refuse food due to pain, difficulty eating, and anxiety.
FACT: Qualified professionals provide feeding therapy to help babies and children receive adequate nutrition and thrive.
Looking for information in Spanish? Click here: Información Sobre la Alimentación de los Niños Pequeños
I have a confession to make. I HAVE felt freaked out about feeding! Why you ask? Here are MY facts!
FACT: Feeding wasn’t a course that was offered during my graduate school experience.
FACT: Dysphagia can lead to pneumonia and I definitely don’t want to be responsible for that!
FACT: I have beaucoup knowledge to learn about feeding therapy and evaluations.
However, here’s another fact. Through seminars and continuing education I HAVE made gains in my feeding knowledge that I would like to share with you to HELP you with this area.
The Critical Oral Motor Milestones for Feeding
0-1 months of age
coordination of suck-swallow-breath pattern
establish stable neurophysiological regulation, including feeding and eliminating
liquids only
1½-3 ½ months of age
steady head control
parents provide nutrition and child drives amount of intake
4-6 months of age
anatomical changes- downward/forward growth of mandible, larger oral space, tongue no longer fills oral cavity, laryngeal space widens, muscle function takes over previously protective anatomy
reflexive sucking is replaced by learned/volitional motor response (active sucking)
anterior –posterior movement achieved with active movement forward and backward versus pressure changes
beginning hand to mouth play
begin pureed solids
WATCH FOR: Child’s anterior/posterior tongue movement
6-7 months of age
trunk control sufficient for independent sitting for greater than 3 minutes
stable head control in sitting
establish mutually contingent feeding interactions-parent follows the baby’s cues
begin meltable solids (rice crackers, Baby mum mums, cheese puffs or other puffed foods, Town crackers; We don’t want anything too small! The food should easily dissolve
7-9 months of age
emerging tongue lateralization
munching/vertical jaw movements develop
lip closure supports anterior-posterior movement of food
begin soft foods in cube form (ripe pear without skin, avocado) The goal is that the food will become mashed quickly; the child should be able to swallow with 1 swallow
WATCH FOR : Refusal between 6-12 months if child does not have sensory experiences with new textures
12-14 months of age
active tongue lateralization
rotary chew emerges
change in taste bud perception
child begins to assert self as separate individual and may refuse previously accepted foods
begin soft regular solids and mixed textures (ADD EXAMPLES)
WATCH FOR: If tongue lateralization is absent, child may not feel safe creating bolus and moving it posteriorly in the oral cavity.
WATCH FOR: Is child asserting him/herself and refusing food?
Straw drinking can be introduced at this time.
14-16 months of age
efficient finger feeding
practicing utensil use
begin harder to chew solids
18-24 months of age
mature rotary chewing pattern
able to eat regular table food diet
If child is gagging, an oral problem may be present because the food ‘level’ is too high.
Signs and Symptoms of Feeding Difficulties
Failure to thrive with poor weight gain, weight loss or difficulty maintaining weight
Choking, gagging, coughing or vomiting during meals
Report of overstuffing the mouth with food and fear of choking
Vomiting, reflux, crying/arching with feeding or other identified GI issues
History of eating and breathing coordination problems with ongoing feeding concerns
Children with oral feeding skills at risk for G-tube placement, with G-tubes or transitioning off tube feeding
Refusal of bottle/breast feeding, especially with report of better results with sleep feeding (sleep feeding may occur due to child not feeling good while feeding/reflux)
Inability to transition to baby food purees WHY? May be hyposensitive and need meltables or home prepared purees
Inability to transition to table food solids or wean off baby purees
Inability to transition to table food solids or wean off baby purees
Inability to transition from breast/bottle to a cup
Aversion or avoidance of a wide repertoire of tastes, temperatures and textures of foods
Ongoing report of decreased appetite and limited intake with growth and/or nutrition concerns
Food range of less than 20 food with concerns and/or other rigid feeding behavior
Family distress over food and feeding; feeding time is stressful or meals are ‘battles’
Still feeling frieked out? Here are 2 comprehensive websites/resources to support you during the learning process.
Tengo un Centro de beneficencia para niños con problemas de aprendizaje en Linares N. L. (cerca de Monterrey) y me interesa mucho todos sus artículos que publican y su material para apoyo de los niños.
Estoy tan feliz que usted está usando los materiales que estamos publicando. Favor de contactarnos para cualquier ayuda que se necesite para el centro. ¡Están haciendo un trabajo muy importante enseñando los niños!
engo un guardería y centro de rehabilitación en Monterrey mi página esta aqui.
Me gusta e intensa sus materiales favor de comunicarse !!,
Dra Odet muciño milano
We added information on feeding in Spanish:
Agregamos más información en español. Haga clic en el enlace: Información Sobre la Alimentación de los Niños Pequeños
You did not address the importance of open cup drinking at 8-9 months to get lip closure, jaw stability, and correct tongue positioning before straw drinking. If you present the straw too soon they will suckle the straw like the bottle precipitating the front to back tip down positioning rather than the ability to collect the bolus. It is also very important to stay away from all spout cups. Use the 360 flat top no spill cups. Avent for 8 months to 12 or 14 months then the WOW, Munchin, or Sassy.
I do Early Intervention and we are seeing way too many mouth issues as a result of poor oral development due to spout, incorrect/prolonged use of pacific er, incorrect straw drinking, open mouthed posture, prolonged drooling, mouth breathing and severe clarity issues.
Tengo un Centro de beneficencia para niños con problemas de aprendizaje en Linares N. L. (cerca de Monterrey) y me interesa mucho todos sus artículos que publican y su material para apoyo de los niños.
Hola Señora Guadalupe,
Estoy tan feliz que usted está usando los materiales que estamos publicando. Favor de contactarnos para cualquier ayuda que se necesite para el centro. ¡Están haciendo un trabajo muy importante enseñando los niños!
engo un guardería y centro de rehabilitación en Monterrey mi página esta aqui.
Me gusta e intensa sus materiales favor de comunicarse !!,
Dra Odet muciño milano
Glad that this information is useful. We are translating a page on feeding help into Spanish. It should be published soon.
Contento de que esta información es útil. Estamos traduciendo una página sobre ayuda con la alimentación a español. Debe ser publicada pronto.
We added information on feeding in Spanish:
Agregamos más información en español. Haga clic en el enlace: Información Sobre la Alimentación de los Niños Pequeños
You did not address the importance of open cup drinking at 8-9 months to get lip closure, jaw stability, and correct tongue positioning before straw drinking. If you present the straw too soon they will suckle the straw like the bottle precipitating the front to back tip down positioning rather than the ability to collect the bolus. It is also very important to stay away from all spout cups. Use the 360 flat top no spill cups. Avent for 8 months to 12 or 14 months then the WOW, Munchin, or Sassy.
I do Early Intervention and we are seeing way too many mouth issues as a result of poor oral development due to spout, incorrect/prolonged use of pacific er, incorrect straw drinking, open mouthed posture, prolonged drooling, mouth breathing and severe clarity issues.
This is really good advice. Thanks for the addition!