Feeding Development

Question 1

Why is it important to learn about feeding?

Answer 1

• It is an essential ADL
• Needed for growth and nutrition
• Part of socialization

Question 2

What are oral motor behaviors from birth to six months?

Answer 2

• Suckling: extension-retraction of the tongue, up and down jaw excursions, and loose approximation of the lips (lips are not definitively secure around the nipple)
• Sucking: negative pressure in the oral cavity, rhythmic up and down jaw movement, tongue tip elevated, firm approximation of the lips and minimal jaw excursion. It is a more nutritive process

Question 3

What is the phasic bite reflex?

Answer 3

• Rhythmic bite and release pattern. Helpful for eventual munching and chewing

Question 4

What is the rate of nutritive and non-nutritive suck-swallow-breathe pattern?

Answer 4

• Nutritive suck: 1 suck/second

- Non-nutritive suck: 2 sucks/second. It is faster but not an efficient pattern

Question 5

What are oral motor behaviors from six to 30 months?

Answer 5

• Munching: flattening and spreading of the tongue combines with up and down jaw movements. It is a primitive motion
• Chewing: spreading and rolling movements of the tongue, tongue lateralization and rotary movements
• Tongue lateralization: movement of the tongue to the sides of the mouth to propel food between the teeth for chewing
• Rotary jaw movements: smooth interaction and integration of vertical, lateral, diagonal, and eventually circular movements of jaw used in chewing
• Controlled, sustained bite: easy, gradual closure of the teeth on the food, with an easy release of the food for chewing

Question 6

In relation to food textures, what does it mean if a child has good head control and a more mature suck?

Answer 6

• Spoon feeding, strained, or pureed foods

- Suggested foods: infant cereal, 1st and 2nd stage baby foods, pureed table foods

Question 7

In relation to food textures, what does it mean if a child can handle food through sucking action but cannot move food to sides of mouth?

Answer 7

• Thickened pureed or soft mashed foods

- Suggested foods: mashed potatoes, well cooked mashed vegetables, soft diced fruits, applesauce

Question 8

In relation to food textures, what does it mean if a child begins up and down chewing movement?

Answer 8

• Ground table foods

- Suggest foods: ground fruits and vegetables, non-stringy meat mixed with gravy

Question 9

In relation to food textures, what does it mean if a child has increased tongue and lip control and sits alone without support?

Answer 9

• Cup drinking

- Suggested foods: juice, formula, milk

Question 10

What should a child have mastered by 1 year of age?

Answer 10

• Pureed/blended/strained foods

Question 11

What should a child have mastered by 1.5 years of age?

Answer 11

• Ground/lumpy foods

Question 12

What should a child have mastered by 1.5 to 2 years of age?

Answer 12

• Cut up/chunky/diced foods

Question 13

What should a child have mastered by 2.5 to 3 years of age?

Answer 13

• All textures of table foods

Question 14

What are the stages of introducing different textures of food?

Answer 14

• Stage 1: thin, pureed, no lumps
• Stage 2: ground/lumpy
• Stage 3: pureed with chunks
• Stage 4: table foods, smaller bites than an adult

Question 15

What is the timeline for self-feeding development?

Answer 15

Finger feeding:

• 2 months: brings fisted hand to mouth (supine and prone)
• 3 months: hand to mouth with object
• 3.5 months: recognizes bottle
• 5-6 months: mouths and gums can melt crunchy food (i.e. baby crackers and puffs)
• 6-7 months: feeds self cracker
• 9 months: independent finger feeding

Question 16

What is the timeline for spoon and fork skills?

Answer 16

• 9 months: will bang a cup
• 9.5 months: will stir spoon in imitation
• 12-14 months: will bring filled spoon to mouth, but turns it over in route (more pronated grasp pattern)
• 15-18 months: scoops food and will bring spoon/fork to mouth, spilling some
• 24 months: brings food to mouth with utensil (spoon or fork), palm facing up
• 4.5 to 5 years: uses knife to butter bread or cut soft food

Question 17

What is the timeline for cup drinking?

Answer 17

• Birth to 4 months: accepts liquid from breast or bottle
• 4-6 months: able to drink from a cup if held by caregiver, poor lip seal. Most of the liquid will spill
• 9 months: able to hold and drink from bottle independently, able to drink from a cup (may spill), independent with sippy cup with valve
• 18 months: can skillfully drink from a cup with lid holding with two hands
• 24 months: can drink from an open cup with minimal spilling or liquid loss, by 30 months should be able to skillfully drink from open cup with one hand
• 4 to 4.5 years: can pour liquid from carton or pitcher

Question 18

What are typical weight and length growth expectations during the first year of life?

Answer 18

• 6 months: weight doubles

- 12 months: weight triples and length increases 5-10 inches

Question 19

What are typical weight and length growth expectations during the second year of life?

Answer 19

• Weight gain: 4-6 lbs

- Length gain: 4-5 inches

Question 20

What are typical weight and length growth expectations during the third year of life?

Answer 20

• Weight gain: 3.5-5.5 lbs

- Length gain: 2-2.5 inches

Question 21

What is the loss of growth if a child is not receiving adequate nutrition?

Answer 21

• Weight > length > HC