Stages of texture and introduction to solid foods

Question 1

Conditions that may lead to swallowing disorders

Answer 1

• prematurity
• reflux
• breathing difficulties such as asthma
• cleft lip or palate
• hypotonia
• meds that reduce appetite or make the baby drowsy
• Sensory issues
• Diagnoses: CP, cystic fibrosis, down’s syndrome, ASD

Question 2

Guidelines for introducing next textures

Answer 2

• Look for signs of readiness, such as…
  ~good head control (baby can hold head up and sit up straight while supported in high chair
  ~Baby opens their mouth when spoon approaches and can clear the spoon with lips
  ~Baby has mastered thin purees (can swallow then without gagging and choking, or tongue thrusting)
  ~Baby shows interest in what parents or other children are eating

Question 3

Three stages of baby food

Answer 3

1. Thin purees (4-6 months)
2. Thicker consistency (6-9 months)
3. Soft, chewable chunks (10-12 months)

Question 4

Tips for introducing new foods and textures

Answer 4

• introduce one new food every 3-4 days to help detect potential food allergies, and wait at least one month before proceeding to the next stage of solids
• let the child get messy
• tactile play with food between meals can increase comfort with new textures
• eat with the child, family meals can create positive mealtime relationship, allows parents to model good mealtime behavior, and promotes language development

Question 5

Tips for picky eaters

Answer 5

• present food in a variety of ways
• offer healthy foods with something fun to dip it in to encourage a variety of colors, textures and flavors.
• cut foods in shapes
• let child feed themselves
• encourage positive interactions with food using 5 senses (seeing, feeling, smelling, tasting and even hearing the sound of crunchier foods can help)
• offer targeted, healthy choices (sweet potatoes or peas? etc.)

Question 6

Texture progression

Answer 6

Stage 1: liquids, breastmilk or formula (birth-4/6 months)

Stage 2: Thin purees, 4-6 months (infant cereals, thin pureed fruits and veggies, beginning with single ingredient, then combined ingredients)

Stage 3: Thick purees (6-7 months) - gradually thicken familiar thin purees by adding less water, or adding baby cereal, homemade applesauce, yogurt, meats pureed in a blender, pureed soups, mashed veggies and fruit. ** start introducing some lumps into food at 8 months

Stage 4: meltable/dissolvable solids (9 months)- gerber puffs, cheerios, graham crackers, mum mums

Stage 5: soft cubes (10 months)- needs munching pressure to break it apart (ripe fruit, avocado, peaches, sweet potatoes, banana)

Stage 6: soft solid, single texture (11 months)
- pasta without sauce, scrambled eggs

Stage 7: soft solid mixed texture (12 months) - these are challenging (mac and cheese, lasagna, fish sticks)

Stage 8: Hard solid single texture (13-14 months) - raw fruit and veggies, dried fruit, bite-sized pieces of meat- always with supervision

Stage 9: hard solid mixed texture (15-18 months) - offer whatever the family is eating as long as it’s safe for the toddler and in bite size pieces

Question 7

Why should I start introducing new textures?

Answer 7

It is important to introduce new textures and lumpy foods before a child is 9 months of age because studies have shown that delayed introduction of lumpy textures can lead to feeding difficulties and can affect a child’s food acceptance at a later age.

Question 8

4 phases of swallowing

Answer 8

1. pre-oral/anticipatory phase: “getting ready” phase; swallowing starts with the anticipation of food being introduced into the mouth. salivation is triggered by the sight and smell of food (as well as hunger)
2. Oral phase: oral preparatory and oral voluntary- the food or liquid is manipulated in the mouth into a bolus and propelled backwards to exit to oral cavity
3. Pharyngeal phase: this phase begins with the initiation of the swallow reflex (involuntary)
4. Esophageal phase: this moves the bolus through the esophagus into the stomach (involuntary)

Question 9

Signs a child may be having trouble with swallowing (dsyphagia)

Answer 9

1. difficulty coordinating sucking and swallowing
2. gagging
3. arching or stiffening body during feeding
4. drooling while eating
5. Trying to swallow a single mouthful of food several times
6. coughing or choking
7. wet or raspy sounding voice during or after eating
8. frequent respiratory infections
9. spitting up or vomiting frequently

Question 10

What tongue movements are needed for different food textures?

Answer 10

1. Soft-mechanical movement: needed for soft texture (soft exterior but maintains shape), needs munching/grinding pressure to break apart
2. Hard mechanical movement: harder textured exterior food, requires grinding/rotary chewing to break apart

Question 11

What does adequate sensory processing look like with feeding?

Answer 11

• child is not averse to having food on face or hands
• child eats a wide variety of tastes and textures
• child engages in messy play activities without distress

Question 12

Behaviors which indicate sensory processing difficulties (sensory modulation)

Answer 12

• Hypersensitivity (over-reactive): gagging, increased head extension, lip retraction, tongue thrusting, jaw thrusting, and bite reflex
• Hyposensitivity: decreased coughing, overstuffing and pocketing, drooling, decreased awareness of food residuals, inability to safely detect hot and cold.

Question 13

Behaviors which indicate sensory processing difficulties

Question 14

Behaviors which indicate sensory processing difficulties

Question 15

Behaviors which indicate sensory processing difficulties