Self Feeding

Question 1

Development of Self-Feeding Skills

Answer 1

• Self-Feeding: opportunity to learn autonomy
• Context: social & cultural expectations
• Western society: emphasis on independence at young ages

Question 2

Self-Feeding Developmental Progression

Answer 2

In Western society:

• 6 months: child tries to hold own bottle; takes sip from cup when cup is held
• 8 months: child can hold and feed self a cracker or teething biscuit
• 8-12 months with hands free for play and refinement of grasp is developing, hands are free for self-feeding bite-size pieces of food
• 12 months: finger feed independently, may play and hold a spoon while being fed or attempt to use spoon, but is messy; cup drinking small amounts without lid, larger amounts with lid. Use of bilateral motor skills to hold onto a cup
• 15-18 months: spoon- feeding with “sticky” foods with minimal spillage; Emerging use of one hand to stabilize bowl while other hand scoops
• 24 months: independent spoon feeding with sticky foods; cup drinking without lid, use of straw; improved ability to use of one hand to stabilize bowl while other hand scoops
• 2.5 to 3 years: use of fork; able to spoon-feed foods that have a liquid texture
• Preschool-kindergarten: beginning use of butter knife for spreading
• School-Age child: Learning to cut with a knife. Use of one hand to hold fork while other hand cuts with knife

Question 3

Issues in Self-Feeding

Answer 3

Issues can be due to:

• Delay in cognitive development
• Motor control problems that affect control of upper extremity to mouth
• Orthopedic impairments that reduce ROM and ability to get hand to mouth
• Behavioral issues

Question 4

Intervention Strategies

Answer 4

If issue is due to cognitive development:

• Assess what the child can do now.
• What is child’s developmental stage?
• What is the next step?
• Consider appropriate foods.

If issue is due to motor control problems:

• •Positioning to improve posture, stability of trunk and UE
• Hand-over-hand facilitation of hand to mouth skills; gradually decrease assist
• Practice pouring & scooping with spoon and “stabbing” with fork during play activities:
• Practice dipping finger foods into dips to practice motions needed to use a fork
• Adaptive equipment: splints, tray height, bowls, handles, plate guards, lids, straws, dycem, splints, mechanical feeders, etc.

If issue is due to Orthopedic Impairments:

• Positioning to improve posture, stability of trunk and UE
• Adaptive equipment: splints, tray height, bowls, handles, plate guards, lids, straws, dycem, splints, mechanical feeders, etc.

If issue is due to behavioral problems:

• Identify the behavior. Is it a sensory-based behavior or not? What is the context & what might be happening in the context that could be affecting behaviors for self-feeding?
• Manipulate food textures to deal with sensory issues
• Use a behavioral diary
• Practice feeding at non-meal times to take the pressure off of meal-time, if necessary
• Is time to complete feeding an issue?
• Behavior modification (work with psychologist)