Normal Infant Feeding Development Newborn-6 months Flashcards
1
Q
caregiver-infant dyad
A
- things to think about as we work with this demographic
- role of the caregiver in the feeding: maternal supply, breastfeeding, role of the father, balancing bottle and breast, return to work
- 4th trimester: 1st 3 months of life
2
Q
feeding skill development
A
- impacted by overall development (cognitive, physical-gross and fine)
- also impacted by sensory experiences (neural pruning)
- medical (digestive, airway, GI, allergies)
- psychosocial development: emotional regulation, cognitive development, speech and language development
- family dynamics, cultural norms
- by 4-6 months feeding is solely a learned skill as early reflexes integrate
- look at feeding and oral motor skills within the context of the whole body
- everything is connected
3
Q
tone and motor development and impact on feeding: stability and mobility
A
- changing interactiof stability and mobility as children age
- mobility develops from a proximal base of stability, moving toward more distal control
- refined development of distal oral motor skills is affected if proximal stability is an issue
- oral stability is dependent upon development of neck and shoulder girdle stability, which are dependent upon trunk and pelvic stability
- the jaw is proximal to the distal lips, cheeks, and tongue
4
Q
stability
A
- external more dependent on external support early on in development and around 6 months
- less needed as the child approaches 12 months in typical development where more internal control and stability is developed
5
Q
stability and mobility: the jaw is proximal to the distal lips, cheeks, and tongue
A
the ability to stabilize the jaw is a prerequisite for development of skilled and refined tongue and lip movement
6
Q
sensory development and feeding
A
- normal development of the infant’s sensory systems has a major impact on oral sensorimotor skills
- mouth and hands have the highest number of sensory receptors per square inch of any other part of the body
- sensory receptors of the mouth are the earliest to emerge in fetal development
- early taste exposures com from mother’s diet which influences taste of breastmilk
- newborns pruning helps “engrain” pathways about touch, taste, vestibular input
- early tactile experiences and mouthing activities provide the infant with abundant oral sensory input
7
Q
newborns pruning helps “engrain” pathways about touch, taste, vestibular input
A
- in normal development touch is associated with comfort/warmth care
- considerations in preterm population
8
Q
“as the brain develops, sensory inputs pertinent to feeding extend into the midbrain, cerebellum, thalamus, and cerebral cortex. these developmental processes allow…”
A
“…the older infant and young child to gain competence in the evaluation of the physical character of food and ability to manipulate and swallow it.”
9
Q
taste and smell development
A
- later food/flavor preference relate to earlier taste/flavor experiences
- at 4 months of age there is a change in taste perception which is impacted by earlier taste experiences
- breastfed infants are at an advantage to initially accept a food is the mother ate the food regularly while breastfeeding their child
10
Q
later food/flavor preference relate to earlier taste/flavor experiences
A
infants prefer sweet and it is shown to having calming effects: breastmilk, sucrose on pacifier as analgesic for procedures
11
Q
at 4 months of age there is a change in taste perception which is impacted by earlier taste experiences
A
- variation in formula flavor affected acceptance at age 4 months
- less tasty formula accepted prior to 4 months but not after
12
Q
breastfed infants are at an advantage to initially accept a food is the mother ate the food regularly while breastfeeding their child
A
Forestell and Mennella 2017: infants who are breastfed by moms who have varied flavors in their diets, including vegetables, tend to accept those flavors more readily
13
Q
developmentally food/feeding continuum: 0-13 months
A
breast milk/bottle (formula)
14
Q
developmentally food/feeding continuum: 5-6 months
A
thin baby food cereals
15
Q
developmentally food/feeding continuum: 6-7 months
A
thin baby food purees (Gerber stage 1)
16
Q
developmentally food/feeding continuum: 7-8 months
A
thicker baby food cereals and thicker baby food smooth purees (Gerber stage 2)
17
Q
developmentally food/feeding continuum: 8-9 months
A
soft mashed table foods and table food smooth purees
18
Q
developmentally food/feeding continuum: 9 months
A
meltable solids: Towne House crackers, Gerber biter biscuits, graham crackers
19
Q
developmentally food/feeding continuum: 10 months
A
soft solids: bananas, Gerber Graduate fruits, avocado
20
Q
developmentally food/feeding continuum: 11 months
A
soft single texture solids: muffins, soft pastas, thin deli meat
21
Q
developmentally food/feeding continuum: 12 months
A
soft mixed texture solids: Gerber stage 3, macaroni and cheese, french fries, lasagna
22
Q
developmentally food/feeding continuum: 12-14 months
A
soft table foods
23
Q
got skills? 0-3 months
A
- suckle on nipple, increased jaw ROM, mouth anticipates food, neck flexion, spatial orientation, some reflexes start to extinguish, suckle > suck
- nutrition/hydration: breast or bottle
24
Q
got skills? 4-6 months
A
- dissassociates articulators, oral play, improved control, increased articulator ROM, teething, head and trunk control, transition to suck > suckle
- nutrition/hydration: breast or bottle, introduction to solids at 6 months, BLW at 6 months
25
rooting reflex: cranial nerves
- trigeminal (CV V)
- facial (CN VII)
- accessory (CN XI)
- hypoglossal (CN XII)
26
tongue protrusion reflex: cranial nerves
hypoglossal (CN XII)
27
transverse tongue reflex: cranial nerves
hypoglossal (CN XII)
28
rooting
- stimulus: touch to cheek or corner of the mouth
- response: turns head toward touch
29
rooting: age reflex disappear
3-6 months
30
tongue protrusion
- stimulus: touch to tongue or lips
- response: tongue protrudes
31
tongue protrusion: age reflex disappear
4-6 months
32
tongue transverse
- stimulus: touch to tongue
- response: lateral tongue motion
33
tongue transverse: age reflex disappears
6-9 months
34
phasic bite
- stimulus: pressure on gums
- response: rhythmic closing
35
phasic bite: age reflex disappears
9-12 months
36
gag
- stimulus: touch posterior tongue or pharynx
- response: contraction of palate and pharynx
37
gag: age reflex disappears
persists
38
infant oral reflexes present at term
- rooting
- tongue protrusion
- tongue transverse
- phasic bite
- gag
39
newborn motor reflexes
- moro reflex
- tonic neck reflex
- grasp reflex
- stepping reflex
40
moro reflex
- often called a startle reflex
- extension of head, back, arms, or legs in response to a loud sound or movement and then pulling it back in
- could be triggered by baby's own cry
41
moro reflex: lasts until...
about 2 months of age
42
tonic neck reflex
- often called the fencing position
- when a baby's head is turned to one side, the arm on that side stretches out and the opposite arm bends up at the elbow
43
tonic neck reflex: last until...
about 5-7 months of age
44
grasp reflex
stroking the palm of a baby's hand causes the baby to close his or her fingers in a grasp
45
grasp reflex: lasts until...
about 5-6 months of age
- similar reflex in the toes lasts until 9-12 months (palmer)
46
stepping reflex
- also called the walking or dance reflex
- baby appears to take steps or dance when held upright with his or her feet touching a solid surface
47
stepping reflex: lasts until...
about 2 months
48
motor implications on feeding in the newborn period
- physical flexion
- increased flexor patterns noted after birth
- infant relies on external supports for stability (hands flexed in midline)
- head and neck control are still developing and need support
- flexion of the extremities with the extremities closely adducted to the trunk
49
motor implications on feeding in the newborn period: physiological flexion
increases in the final trimester of in-utero development due to decreasing uterine space
50
motor implications on feeding in the newborn period: head and neck control are still developing and need support
- usually held in semi-reclined position with head slightly elevated
- elevated side-lying position
51
motor implications on feeding in the newborn period: flexion of the extremities with the extremities closely adducted to the trunk
after the first few days of life, the extremities are still predominantly in the flexed position but they are not as tightly adducted as they are in the first 48 hours of life
52
newborn period: motor development
- head lag when pulled to sit
- weight bearing in prone during skin-to-skin (earliest form of tummy time): beginning to raise their head
- lateral head movement when in supine
- postures are very much related to need for pharyngeal airway patency
- hands are usually in tight fists
- visual skills developing: black and white objects, 8-12 inches, faces
53
newborn period: psychosocial development
- primary goal is homeostasis and regulation
- cues for feeding: arousal, crying, rooting (on own hands or others), and sucking
- responds and regulates to voices
- preference for human faces
- developing pattern of sleep-wake-hunger cycles
- hunger-satiety patterns develop
- caregivers had to provide external supports for self regulation
- pleasurable feeding experiences feeding experience increased infants environmental factors
54
newborn period: psychosocial development: responds and regulates to voices
interaction with primary caregiver by smiling
55
newborn period: psychosocial development: hunger-satiety patterns develop
critical for critically ill infants who miss this period of oral feeding
56
newborn period: psychosocial development: caregivers had to provide external supports for self regulation
swaddling, rocking, "shh"-ing, patting, etc.
57
newborn period: psychosocial development: pleasurable feeding experience increased infants environmental factors
smiling while eating, interacting with caregivers during feeding
58
up to 3 months, oral motor/sensorimotor development
- infants still predominantly suckle
- lips begin to move when actively sucking
- cues for feeding: arousal, crying, rooting (on own hands or others), and sucking
59
up to 3 months, oral motor/sensorimotor development: infants still predominantly suckle
- open mouth in anticipation of bottle/breast at 3 months
- improving lip closure seen around breast/bottle by 3 months: less leakage during feeding
60
3-4 months GM, FM, and feeding
- lifting head to 90 degrees in prone
- lifts chest off the floor in prone
- weight bearing on lower abdominal muscles and the pelvis is prone
- will play with body position by using neck flexion and extension of their neck in supine (on their backs)
- improving head control is noted
- early reflexes start to fade
- arms begin to be freed to explore playmats mobiles in prone
- active rolling from supine, accidental rolling from prone
- tactile awareness of their hands
- hold items and brings to mouth
- visual exploration of objects by 4 months
- aided sitting
- the infant will start to blow spit bubbles
- more voluntary control of the mouth is observed: increased sound output (cooing/laughing emerging)
61
5 months
- plays with hands and feet in supine
- puts their hands in their mouths
- rolls actively from prone to supine
- bottle/breastfeeding is still the primary mode of nutrition and hydration
- feeding is more of a social event
- tongue thrust with spoon if offered at this age
- gagging may be noted with new textures
62
3-6 months psychosocial milestones
- increased reciprocity of positive infant/caregiver interactions
- anticipates feeding
- "gets distracted" when eating due to socialization
- prefers parents to feed
- when infant approaches 6 months you may see them start vocalizing for attention
- shows means/end behavior: repeats action for preferred toys/people and things to get a response
63
feeding milestones: 0-1 month of age
mouth hands fisted, incomplete lip closure
64
feeding milestones: 2 months
- mouth starts to open in anticipation of milk
- improved lip closure
- lips are active during sucking
65
feeding milestones: 4 months
- lip and tongue movements dissociate
- lips purse
- blow bubbles with saliva
- voluntary mouth control
66
feeding milestones: 5 months
- holds nipple with center of lips, more stable
- tongue thrust with spoon feeding with anterior loss (if introduced here)
- sucking starts
67
feeding milestones: 6 months
- feeding now results in various planes of movement of oral structures (up and down, forward and back both with tongue and jaw)
- teething
- more oral exploration
- no more rooting or bite reflex
- gag is less sensitive
- more active lip closure
68
birth-3 months SSD development
- swallowing is secondary function, breathing is primary and always take precedence
- breathing/eating coordination matures during the first few weeks after birth
- suck:swallow ratio is 1-3:1 then matures to 1:1
- term infants usually swallow during exhalation or at the end of inspiration or exhalation
69
0-3 months
- infant feeding starts with hunger and satiation pattern interspersed with sporadic and irregular sleep and wakefulness
- 2-3 months of life, more regularity is established
70
newborn oral anatomy and swallow physiology
- swallowing is complex
- rooting reflex helps them find the bottle/breast and latch
- lips closure during feeding is incomplete
71
swallowing is complex
- coordination of respiration, swallowing, and phonation occur at the same anatomic location
- requires the coordination of 31 muscles, 6 cranial nerves, multiple levels of the CNS, and multiple systems of the body
72
lips closure during feeding is incomplete
some minimal anterior loss is expected during the newborn period
73
development of NNS: 27-28 weeks
weak, single sucks with long variable pauses
74
development of NNS: 30-33 weeks
- short but stable suck bursts with long irregular pauses (1-2 sucks per sec)
- RR may increase if observed in preterm infant
75
development of NNS: 34+ weeks
longer suck bursts, more regular infant
76
development of NNS: by 37 weeks
- stability of sucking rate and pattern
- intermittent swallows every 5-6 sucks
77
hunger cues
- bringing hands near their mouth
- increased sucking and breathing for the pacifier
- agitated
78
development of nutritive sucking (NS)
- the rhythmic alternation of suction, compression, and expression
- during swallowing, apnea occurs for ~500 milliseconds, then breath is restored quickly for short breath
- the stability of this rhythm increases from 32-40 weeks
79
development of nutritive suckin (NS): successful coordination of SSB sequencing allows for...
- optimum respiration during feeding
- efficient sucking ability for meeting nutrition needs
- airway protection
80
suckle vs. suck: tongue configuration
- suckling: flat, thin, cupped, or bowl-shaped
- sucking: flat, thin, slightly cupped, or bowl-shaped
81
suckle vs. suck: movement direction
- suckling: in-out movement horizontal
- sucking: up-down movement vertical
82
suckle vs. suck: range of movement
- suckling: extension or protrusion no further out than middle of lip
- sucking: form mandible to the anterior hard palate
83
suckle vs. suck: lip approximation
- suckling: loose
- sucking: firm
84
suckle vs. suck: expected ages/times
- suckling: normal in early infancy
- sucking: normal later infancy, childhood, and adult
85
suckling
- from reflexive to volitional from 3-6 months
- by approximately 3 months infant suckle transitions from reflexive to volitional behavior
- sucking pads still provide positional stability for tongue and nipple but they are starting to disappear
- slowly starting to transition from suckle to suck closer to 6 months
86
mechanics of sucking
- in newborns --> jaw is stable base for movement of tongue lips and cheeks
- cheeks are passive support help with efficient sucking
- lips + tongue = anterior seal and stabilize intraoral position of nipple (breast or bottle)
- tongue forms central groove and stabilizes the nipple and helps direct fluid posteriorly for swallowing
- tongue compresses nipple, positive pressure created expels the liquid
- jaw and tongue drop downward during sucking and create negative pressure (intraorally --> suction) and it pulls fluid into the mouth
87
sucking
- downward jaw movement is rhythmical, enlargers oral cavity
- facilitates generation of suction
88
breastfeeding
- olfactory system
- visual system
- positioning
- supports physiological flexion
- supports head/neck control
- infant-caregiver bond for psychosocial development
- different oral motor patterns than bottle feeding
89
breastfeeding: visual system
color and size of areola
90
breastfeeding: positioning
ventral surface bearing and posterior breathing (will define more)
91
breastfeeding: different oral motor patterns than bottle feeding
- different latch between bottle vs. nipple
- sucking pressures
- position and action of the tongue during sucking
- rate of sucking and the pattern of milk flow
92
breastfeeding vs. bottle feeding
- nipple + underlying and surrounding breast tissue is elongated in the mouth by suction created in the infant's mouth
- nipple extends to where the hard and soft palate meet
- lateral borders of the tongue cup around the nipple and form a central groove
- milk expression and propulsion occurs via rolling action of the tongue from underneath the nipple
- negative suction + positive compression work together synchronously to maintain milk flow and position of the nipple
93
breastfeeding process
- rooting reflex is initiated
- bring baby to chest to ensure adequate latch (deep latch)
- infant suckles for about 1-3 minutes (NNS) before milk ejection "let down" reflex occurs
- rates of NN and nutritive sucking vary during breastfeeding
- nutritive sucking is a slower rate (1 suck per second)
94
breastfeeding process: rooting reflex is initiated
tactile stimulation of breast nipple to infant mouth
95
breastfeeding process: infant suckles for about 1-3 minutes (NNS) before milk ejection "let down" reflex occurs
- NNS occurs in short burst at a rate of up to 2 sucks per second prior to let down
- increased flow rate during let down
- suckling/sucking rate during let down is high and increased coordination is needed by infant for quicker SSB coordination
- cough/choke or disorganized feeding pattern will be noted if let down or variable flow rate isn't tolerated
- after let down, the rate of nutritive sucking decreases to a rate similar to that seen in bottle feeding (1 suck per second)
96
breastfeeding process: rates of NN and nutritive sucking vary during breastfeeding
NN occurs in short burst at a rate of up to 2 sucks per second, most often prior to let down
97
normal infant anatomy that supports feeding
- infants tongue is large in oral cavity, creates central tongue groove to create negative pressure
- pharynx of infant
- larynx descends in the first year of life to accommodate communication
- oral motor components for successful feeding: lips, jaw, tongue, buccal mucosa, hard and soft palate
98
normal infant anatomy that supports feeding: pharynx of infant
- hyoid high neck
- less laryngeal elevation during swallow
- pharynx is gentle curve from nasopharynx to distal pharynx (adults ~ 90 degree angle)
99
other things to consider: swallowing begins in utero
- after birth infant needs to learn coordinate SSB
- feeding involves ability to engage in physiologically and behaviorally challenging task, organizing oral movements, coordinate breathing with swallowing, and regulating depth and frequency of breathing to maintain physiological stability
100
central pattern generators (CPGs)
- the central patterning of aeroingestive behaviors include volitional and reflexive control mechanisms, and benefit from sensory feedback to modify the spatiotemporal organization of the feed sequence to ensure safe swallow
- primarily composed of adaptive networks of interneurons that activate groups of motor neurons to generate task-specific motor patterns
101
central pattern generators (CPGs): think of it as a closed loop system
with synchronized sucking, swallowing, breathing, esophageal function with feedback occurring to stop, delay, or maintain sucking
102
development of nutritive sucking: typical feeding (term infant without comorbidities) has...
- 1 or 2:1:1 SSB ratio, 4-6 SSB bursts (more in older infants)
- a break for respiration without unlatching
- a duration of 30 minutes or less
103
efficient sucking requires compression
1. at rest
2. suction applied to draw nipple in, compression with jaw and tongue to hard palate
3. expression with lingual peristalsis
104
infant swallowing thoughts
- the mature swallow --> voluntary oral-preparatory phase, a voluntary oral phase, and involuntary pharyngeal and esophageal phases
- the infant swallow does not have a voluntary oral-preparatory in early infancy but is otherwise similar but more rapid
- has natural airway protection give anatomy
105
pharyngeal phase, laryngochemoreflexes in infants
- primary sensory mechanism for defending the airway from the aspiration of liquids
- usually containing both parasympathetic components, such as apnea, bradycardia, and laryngospasm, and sympathetic components, such as systemic hypertension and blood flow redistribution
- LCR is mainly present in newborns and infants, with even more robust and prolonged responses occurring in fetuses and premature infants
- the reflex is thought to be largely a feto-protective reflex present to not only prevent aspiration during birth but also during the immediate postnatal development period
- with age, maturation of neural circuitry within the brainstem allows for progression of the primitive LCR from prolonged apnea and glottic closure to a cough reflex, which also serves to protect the airways by expelling unwanted substances
106
6 months
- feeding now results in various planes of movement or oral structures (up and down, forward and back both with tongue and jaw)
- teething
- more oral exploration
- no more rooting or bite reflex
- gag is less sensitive
- more active lip closure
- sucking develops
107
got skills?: 7-12 months
- development skills: skilled coordination or articulators developing, cup drinking emerges, lingual lateralization, control bites
- nutrition/hydration: breast, bottle, cup, straw, spoon
108
got skills?: 13-24 months
- developmental skills: controlled chewing, circulatory jaw rotations, rotary chewing nearing mastery by 24 months
- nutrition/hydration: eats like an adult
109
6 months motor development: by this age, children are...
- more active in the feeding process
- learned to move in prone and supine
- shoulders and neck are more stable and provide foundation for more distal oral motor skills for feeding
- can reach for desired items including food
- transfer from one hand to the other
- can grasp items and bring them to their mouth
- can sit up with minimal support (using hand to balance)
110
6 months motor development: children also...
- use raking hand motions to collect items
- poke at items using their pointer finger
- squeeze objects with their fists
- play with their own hands/discover their hands
111
6 months + sensory development
- mature hearing
- visually tracks items with eye
- visually inspects their hands
- responds to sounds and voice
- vision improves --> improved hand-eye coordination
- smell impacts a child's decision about likes/dislikes of food
- recognize textures by touch using forefinger and thumb
112
6 months feeding
- explore the world through their mouth (taste, texture, weight, and shape)
- eat and drink in an upright position with minimal support from highchair/person feeding
- recognize and show anticipation of food (bottle or spoon)
- can hold bottle independently
- many oral reflexes present b-3 months are now integrated and voluntary skill
- American Academy of Pediatrics recommends introducing spoon feeding/puree no earlier than 6 months
- also need to ensure child has head control and ability to sit up and hold head up with minimal support
113
6 months feeding: recognize and show anticipation of food (bottle or spoon)
recognize sight or touch of spoon
114
6 months feeding: can hold bottle independently
may throw on floor when they are done or want to play
115
6 months feeding: many oral reflexes present b-3 months are now integrated and voluntary skill
why children who start refusing/showing decline in feeding skills at this age are a concern
116
6 months feeding: also need to ensure child has head control and ability to sit up and hold head up with minimal support
adequate postural stability and head control
117
anatomical changes at 6 months +
- increase in intra-oral space as the mandible grows (downward and forward)
- elongation of the oral cavity
- hyoid bone and larynx more downwards --> alteration in coordination of respiration and swallow
- sucking pads absorbed and integrated
- teeth eruption
- buccal space increases as sucking pads decrease --> increased manipulation of foods laterally
118
teeth eruption
impacts intra-oral space, oral-sensory and oral-motor experiences
119
6 month old oral motor skills: spoon feeding
- hold the jaw and tongue steady to anticipate the spoon (mouth open, tongue flat/cupped)
- precise upper lip movement to clear food from spoon
- mixture of suckling and sucking movements is seen in spoon feeding as well
- tongue and jaw move still primarily in tandem
120
precise upper lip movement to clear food from spoon
upper lip moves down and forward and rests on the spoon as the spoon is put in the child's mouth
121
spoon feeding progression: ~ 3-4 months
- suckle response when presented with puree on spoon
- anterior loss of bolus is typical
122
spoon feeding progression: 6-7 months
- visual recognition and anticipatory mouth opening
- forward-backward tongue movements in response to purees
- minimal anterior loss, as bolus is transferred for swallowing
123
spoon feeding progression: 8-9 months
- transition to up and down tongue motion
- intermittent forward-backward tongue movements for bolus transfer
124
spoon feeding progression: 9-12 months
- lip closure with swallowing
- tongue tip elevation with up-down tongue motion to transfer bolus for swallowing
125
spoon feeding progression: 12-18 months
- forward-backward movements of tongue are rare
- tongue tip elevation during swallowing initiation is common
- occasional tongue protrusion
126
spoon feeding progression: 18-24 months
- tongue tip elevation during bolus transfer for swallowing
- no anterior loss of bolus
- no tongue protrusion during bolus transfer
127
6 months: teeth
- first teeth normally in mandible vs. maxilla
- starts around 6 months
- all teeth there by 2 years old
128
skills for solids
- holds head up
- independent sitting
- doubled birth weight
- opens mouth wide
129
baby led weaning
- wean does not imply weaning from breast or bottle
- infants self-feed family foods of the appropriate size, texture, and shape
- emphasizes infants autonomy
- encourages families to eat with their babies
- this approaches encourages families to be comfortable with gagging, but caution that gagging can create negative association
- can be done in isolation or in combination with offering purees as well
130
baby led weaning: wean does not imply weaning from breast or bottle
term is from UK where wean refers to introducing supplemental foods to an infant
131
baby led weaning: infants self-feed family foods of the appropriate size, texture, and shape
- encourages them to set the pace and intake of the solid food items
- intake is of what is being offered in the family mealtime
132
baby led weaning: emphasizes infant's autonomy
infant puts the food in their mouths themselves and follows infant's cues
133
7-9 months: meltable solids and soft solids
- more refined movements of the tongue tip, lateral borders, and blade of the tongue
- increased closure of upper and lower lip as the jaw moves up and down during munching
- can bite down on soft food item but will use fine motor skills or feeder will have to apply downward pressure to break off a small piece of food
- child can now use tongue to move pieces from midline in mouth to L or R side to munch
- uses tongue and cheek to help food item of the gumline surface where the molar will eventually erupt
- munching transitions to more advanced chewing patterns
134
10-12 months: oral motor development liquids
- cup drinking > bottle/breast (more supplemental)/weaning
- APA recommends transitioning off of bottle by 18 months
- suck is consistent with open cup drinking if the child has had substantial experience drinking from up by this age
- beginnings of tongue tip elevation during swallow initiation are noted during cup drinking if this is their primary mode of drinking
- starts to sequence up to 3+ sucks and swallows from a cup
- straw drinking may also be mastered depending on exposure
- liquids are transitioned to primary source of hydration but not solely nutrition
135
10-12 months: oral development purees and soft solids
- mastery of spoon feeding is observed by this age
- easily closes lips around the spoon and uses the lips to strip the bolus from the spoon
- can handle chunky purees/purees with pieces
136
10-12 months: can handle chunky purees/purees with pieces
- increased coordination and independence of jaw and tongue movements
- oral motor coordination to separate "lumps and bumps" from smooth portion of puree
137
12+ months: oral motor development easy to chew and regular solids
- can sustain a bite on a cracker/soft cookie
- bite is controlled/smooth and refined motor process
- can handle coarsely chopped/bite sized
- chewing is up and down "munch" and a diagonal rotary chewing pattern
- lips are active during chewing and can remain closed to increased bolus control
- uses upper teeth to clean food off of bottom lips
- can transfer food from mid-tongue to lateral gumline/"molar surface"
138
14-16 months: motor and postural stability
- efficient finger feeding
- practicing utensil use (not yet efficient)
139
14-16 months: oral motor
- uses tongue to gather shattered pieces (think Doritos)
- sweeps pieces into a bolus with the tongue
- chews bigger pieces of soft table foods
- working on chewing foods increasing in texture "hardness"
- circle chewing is refining
140
18-24 months: motor and postural stability
- able to pick up, dip, and bring foods to mouth, moving towards efficiency of utensil use by 24 months +
- scoops purees with utensil and brings to mouth
141
18-24 months: oral motor
- better able to manage hard-to-chew foods
- circular chewing continues to develop
142
24-36 months: motor postural stability
- use fingers to fill a spoon
- increasing fork skill
- open cup drinking without spilling
- one-handed cup holding
143
24-36 months: oral motor
- circulatory jaw movements improve
- chews with lips closed
- working further on increasing speed, strength, and efficiency with bigger and bigger pieces of harder and harder to chew table food
- generally can accept and consume all table foods with some bite size modification by age 2
144
