Typical progression of feeding and eating skills in children

Question 1

birth to 3 months

Answer 1

• Primary means of nutrition by bottle or breast feeding.
• Takes ~2-4 oz of formula or breastmilk every 3 to 4 hours depending on weight.
• There are ~30cc per 1 oz
• Dominated by oral reflexes that are present for protection and survival
• The jaw, tongue, and lips move as a unit and do not move independently from each other.
• Participate in oral motor play by sucking on hands and non-food items (rattles, clothes). This is a means of exploration and self-calming for the baby.

Question 2

4-6 months

Answer 2

• Baby can sit with support and should demonstrate head control. This allows a baby to feed in a more upright position (45 to 90 degrees).
• Primary means of nutrition by bottle.
• Takes ~7-8 oz of formula or breastmilk every 4 to six hours depending on weight.
• Up and down jaw movement develops – “munching”
• Baby begins to transfer food front to back for swallowing (sagittal plane movement)
• Soft, smooth solids are introduced by spoon. Typically starts with rice cereal mixed with formula and then progresses to Stage I baby foods by 6 months.
• Baby accepts food from swallow with poor bilabial seal and suck-swallow movement.
• First self-care skill is holding a bottle while eating.

Question 3

7-9 months

Answer 3

• The older infant has good head control and typically can sit unsupported.
• The infant is typically able to sit in a highchair for meals.
• Begins to try self-feeding by picking up small soft, teething foods (ie. cheerios) with gross grasp and inferior pincer grasp
• Lips begin to show bilabial seal but cannot maintain while munching on food.
• Jaw movements are dissociated from tongue and lip activity.
• The tongue begins to show lateral movements in order to collect and move bolus of lumpy foods for munching and swallowing.
• Can use tongue to transfer food from side to center and center to side during munching.
• Begins to eat ground or finely chopped food and small pieces of soft food.

Question 4

10-12 months

Answer 4

• Child starts to develop good eye-hand coordination and integrate hand skills with feeding.
• Nutrition primarily is from spoon feeding and liquids (weaning from bottle, takes 1 at bedtime but begins to drink primarily from a sippy cup).
• Demonstrates lip closure while swallowing liquids and solids (bilabial seal).
• Demonstrates a graded bite and has no difficulty eating lumpy foods (ie. stage III baby foods, oatmeal, grits)
• Demonstrates a controlled bite to eat a soft.
• Ability to bite through harder items is dependent on maturity of teeth
• Beings to eat table foods that are coarsely chopped
• May begin to learn to suck through a straw, but very primitive

Question 5

13-15 months

Answer 5

• Sits in a highchair or special toddler seat at the table
• Drinking skills are more refined, less spillage
• Begins to use adult-like diagonal chewing movements
• Cheek muscles help tongue keep food over molars for chewing
• Choking and coughing rarely occur during long sequences when drinking an ounce or more of liquid.
• The child can control his/her drooling when attempting new motor skills
• Holding spoon and using more consistently for self-feeding

Question 6

16-18 months

Answer 6

• The child may sit at the family table is seating is high enough to be up at table.
• Child should be able to feed themselves using a cup, spoon, and finger feeding
• Minimal loss of food during chewing
• When drinking from a non-lidded cup, uses external jaw stability by biting the rim of the cup
• Better overall control of food and liquid with minimal spillage

Question 7

19-24 months

Answer 7

• Should demonstrate skilled eating patterns
• Tongue can clean lips
• Child can transfer food across the midline of his tongue proficiently
• Child can drink from a straw
• Food selection is based on personal tastes and preferences which varies among experience and cultural and ethic backgrounds.
• Food selection should not be based on a lack of coordination and skill!
o RED FLAG – if a child is eating only soft solids (ie. pudding, yogurt, grits, oatmeal) and not eating table foods there is may be some problem with motor skills needed for chewing!