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

Nutrition Basics

• Dietary guidelines

• Food group pyramid

• Vitamin and mineral requirements

• Growth– length for age– weight for age– head circumference