Freaked out about Feeding? Some Food for Thought

Here are some Feeding Therapy Facts…

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

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 freaked out? Here are 2 comprehensive websites/resources to support you during the learning process.

ASHA Information about Feeding

Pediatric Feeding Association

References: Carmen Huston, M.A., CCC-SLP