The Basics of Feeding: A Workshop in Pediatric Dysphagia. Part II. Stacy Antoniadis, MA, MPH, CCC/SLP Lisa McCarty, MS, CCC/SLP Julie McCollum Daly,BS, OTR/L Cindy Straub, BS

Typical Feeding Development and Nutrition

Birth to Two Months Motor –Flexion –Disorganized movements –A Total Neck Reflex (ATNR) - 2 months

Birth to Two Months Oral Motor Skills and Intake –Sucking/suckling pattern –Tongue moves back and forward –Middle portion of lips active –Lower lip & mandible move together

Birth to Two Months Self-Feeding Skills –Rooting reflex –Gag reflex –Hands to mouth

Three to Four Months Motor –Weight bearing on forearms to counteract gravity, begins pushing downward to elevate head –Improved head control –Hands together - supine –Increased back extension –Hands to knees –2-handed symmetrical reach –Ulnar palmar grasp

Three to Four Months Oral Motor Skills and Intake –Increased lip movements –Up/down pattern of suck –Little loss of liquid –Introduction to cereals/pureed –Introduction to cup - maybe

Three to Four Months Self-Feeding Skills –Recognition of nipple/bottle –Pulls feeder’s hand to mouth –Hand to mouth while holding object –Pats bottle with one/both hands

Five to Seven Months Motor –Extended arm weight bearing –Independent sitting –Increased mobility –Manipulates toys

Five to Seven Months Oral Motor Skills and Intake –Stable jaw until spoon in mouth –Increased activity of upper lip –Cereals and pureed foods –Mouths and gums solids –Munching –Drinks from cup when held

Five to Seven Months Self-Feeding Skills –Holds bottle independently –Recognizes spoon/opens mouth

Eight to Ten Months Motor –Creeps –Equilibrium reactions –Transitional movements –Pulls to stand –Cruises –Uses hands for functions –Thumb and finger grasps inferior pincer 3-jaw chuck

Eight to Ten Months Oral Motor Skills and Intake –Cheeks/lips dimple –Increased tongue lateralization –Vertical chew begins –Ground junior and mashed table foods –Wary of new foods; spits out

Eight to Ten Months Self-Feeding Skills –Takes from spoon, controlled –Finger foods to mouth –Reaches for spoon –Bangs spoon

Ten to Twelve Months Motor –Independent walking –One hand holds/another manipulates –Neat pincer grasp

Ten to Twelve Months Oral Motor Skills and Intake –Lip movement variety –Bites with front/sides of mouth –Uses tongue to move food –Coarsely chopped table foods

Ten to Twelve Months Self-Feeding Skills –Holds cup, some spillage –Brings filled spoon to mouth

Eighteen Months Motor –Refinement of fine and gross motor skills

Eighteen Months Oral Motor Skills and Intake –Mature chew pattern/rotary chew –Lip control to recover food –Active upper lip –Little lip activity in cup drinking –Chopped table foods, most meats, some raw vegetables –Food preferences

Eighteen Months Self-Feeding Skills –Independent self-feeding –Scoops food with spoon, prefers finger feeding –May give up bottle –May drink from straw

Twenty Four Months Motor –Further refinement of gross motor skills –Advanced fine motor skills

Twenty Four Months Oral Motor Skills and Intake –No drooling –Controlled, sustained bite –Pointing of the tongue –Upper lip active with drinking –Upper lip controls spoon feeding –Graded opening of jaw –Can handle most solids

Twenty Four Months Self-Feeding Skills –Brings spoon or fork to mouth with palm up

Nutrition Basics Dietary guidelines Food group pyramid Vitamin and mineral requirements Growth –length for age –weight for age –head circumference