The Basics of Feeding: A Workshop in Pediatric Dysphagia. Part II.

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The Basics of FeedingA 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

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Typical Feeding Development and Nutrition
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Birth to Two Months

• Motor
• Flexion
• Disorganized movements
• A Total Neck Reflex (ATNR) - 2 months

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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

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Birth to Two Months

• Self-Feeding Skills
• Rooting reflex
• Gag reflex
• Hands to mouth

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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

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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

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Three to Four Months

• Self-Feeding Skills
• Recognition of nipple/bottle
• Pulls feeders hand to mouth
• Hand to mouth while holding object
• Pats bottle with one/both hands

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Five to Seven Months

• Motor
• Extended arm weight bearing
• Independent sitting
• Increased mobility
• Manipulates toys

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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

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Five to Seven Months

• Self-Feeding Skills
• Holds bottle independently
• Recognizes spoon/opens mouth

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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

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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

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Eight to Ten Months

• Self-Feeding Skills
• Takes from spoon, controlled
• Finger foods to mouth
• Reaches for spoon
• Bangs spoon

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Ten to Twelve Months

• Motor
• Independent walking
• One hand holds/another manipulates
• Neat pincer grasp

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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

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Ten to Twelve Months

• Self-Feeding Skills
• Holds cup, some spillage
• Brings filled spoon to mouth

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Eighteen Months

• Motor
• Refinement of fine and gross motor skills

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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

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Eighteen Months

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

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Twenty Four Months

• Motor
• Further refinement of gross motor skills
• Advanced fine motor skills

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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

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Twenty Four Months

• Self-Feeding Skills
• Brings spoon or fork to mouth with palm up

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Nutrition Basics

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