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General Developmental Milestones Related to Feeding and Swallowing

0-3 Months
● Latches on to nipple or bottle
● Tongue moves forward and back to suck
● Drinks 2 oz. to 6 oz. of liquid per feeding, 6 times per day
● Sucks and swallows well during feeding

4-6 Months
● Shows interest in food
● Opens mouth as spoon approaches
● Moves pureed food from front of mouth to back
● Begins to eat cereals and pureed food. Smooth, pureed food (single ingredient only), like
carrots, sweet potato, squash, apples, pears

7-9 Months
● In a highchair, holds and drinks from a bottle
● Begins to eat thicker pureed and mashed table foods
● Enjoys chew toys that can massage sore and swollen gums during teething
● Stays full longer after eating
● Starts to look and reach for objects, such as, food that is nearby
● Shows strong reaction to new smells and tastes

10-12 Months
● Finger feeds self
● Eating an increasing variety of food
● Begins to use an open cup
● Ready to try soft-cooked vegetables, soft fruits, and finger foods (teething biscuits,
cooked pasta)
● Might be ready to start self feeding with utensils
● Enjoys a greater variety of smells and tastes

13-15 Months
● Increases variety of coarsely chopped table foods
● Holds and drinks from a cup

Chewing Developmental Milestones

0-4 Months
● Jaw provides compression to breast and/or bottle nipple.

4-6 Months
● automatic suck becomes more voluntary, vertical munching = cycles of alternating
mandibular elevation and depression.

7-12 Months
● may initiate rotary chewing, phasic bite has largely been integrated, jaw can be held
closed during chewing, can hold items between gums and teeth, lateral lingual
movements, sustained controlled bite.

15-18 Months
● coordinated vertical and diagonal movement of the jaw, bite hard substances with a
controlled bite, overflow movements may still be appreciated, child will likely open mouth
more wide than needed for the size of the bolus.

24 Months
● body remains still during controlled bites, open jaw to appropriately size for food, and
turn head to the side for a stronger bite when needed.

3 Years
● child can chew laterally with head in midline and the child refines a circular rotary
chewing pattern.

Atypical Feeding and Swallowing Impairments


● Jaw clenching: increased tone within the jaw
● Tonic biting: abnormal pattern for dealing with a bolus
● Jaw sliding: abnormal movement laterally
● Jaw jutting: abnormal positioning of the jaw anteriorly
● Jaw thrusting: abnormal opening of the mouth
Tips for Transitioning:
Baby Food
● Provide variety of textures, flavors and colors.
● Provide the foods on a variety of containers (i.e. shape, size, color)
● When transitioning to spoon feeding provide the child with appropriate-size bite

Finger Food
● When beginning to transition to finger foods start with smooth purees and gradually
increase the thickness
● Reduce distractions
● Place child in supported position (i.e. high chair)
● Introduce Co-Feeding
● Limit grazing
● Provide meals at regular intervals
● Cut foods into small bite-sized pieces

Table Food
● Provide different foods with colors, shapes, sizes, sounds, textures and flavors
● Provide meals and snacks several times a day with different foods being offered
across the day
● Introduce the use of a cup
● Food Chaining: explore different foods by transitioning in increments (i.e.
Mcdonald’s french fries to all types of fries to tater tots to potato wedges to baked
potato or mashed potatoes).

Tips for Chewing

● Hold food between teeth and


break off outside piece
● Thicken and add lumpy soft foods
● Increase awareness of teeth
through rhythmic biting
● Pacing: moderating the rate of
food by introducing food at
different rates; therefore,
controlling the time between bites
or swallow
● Use postural support (i.e. high
chair)
● Introduce a variety of foods with
different shapes, colors, textures,
smells, flavors etc.
Strategies to use at home: Helpful Tips to Use at Home

● Get your child involved in meal


planning. Read recipe books
together. Put your child in charge of
writing down a grocery list and go
shopping together. During trips to
the grocery store you can introduce
new foods and also teach your child
how to make healthy and nutritious
choices. Ask your child to help with
measuring out ingredients.
● Try to serve snacks and meals
● Meal Time Tips​: Keep baby on a around the same time each day.
regular feeding schedule as much as ● Schedule at least one meal together
possible. During feeding, make sure as a family. Research suggests that
the environment is calm and phones having dinner together as a family
and other screens are off or put on a regular basis has positive
away. Baby’s meal times can be effects on the development of
great bonding experience so give
children.
them your full attention. Make eye
● Give your children a 5-minute
contact with baby, talk to baby, or try
singing gently. warning before mealtime. A 5-minute
warning will give your children a
Encouraging a Healthy Diet moment to calm down, wash their
hands, and get ready to eat.
● Continue offering a variety of foods, ● Set up mealtime rules. Children who
even ones the child has rejected in are anxious, excited, or tired may
the past. have trouble settling down to eat.
● Keep healthy food in the house and
Sometimes a simple “food rules”
limit the availability of high-calorie,
chart on the refrigerator helps to
low-nutrient foods
● Involve kids in meal preparation -- keep things in order. Examples of
for example, let them tear lettuce for food rules include (1) come to the
a salad or help set the table table with clean hands, (2) help
● Create a structure for daily meals when asked, and (3) do not make
and snacks so kids don’t graze all bad comments about food served or
day long what others are eating.
● Set a good example by eating a
nutritious diet yourself
Recommendations at each milestone for Foods and Consistencies​:
For all milestones it is important to vary consistencies to allow for acceptance of a wide variety
of foods later in life.

0-5 months
Typical Foods​:
● Breast milk
● Formula

5-7 months​ ​(Baby Food):


Typical Foods and Consistencies:
● Plain fruits pureed
● Plain vegetables pureed
● Meats and protein foods pureed
● Rice cereal to occasionally thicken

7-9 months (Finger Food)


Typical Foods:
● Plain yogurt
● Bite-size,soft fruits and vegetables: bananas, avocados, cooked carrots
● Tender, bite-size meats and protein foods
● Snacks: soft crackers and cookies

10-24 months (Table Foods):


Typical Foods:
● Start with soft table foods
● Bite-size

Community Resources:
● Feeding Matters ​https://www.feedingmatters.org/
● Feeding Flock ​http://feedingflock.web.unc.edu/
● My Munch Bug​ ​http://www.mymunchbug.com/
● Ages and Stages ​http://www.agesandstages.net/
GI Resources
● GI Kids ​http://www.gikids.org/
Cleft Palate Resources:
● Cleft Palate Foundation ​http://www.cleftline.org/
References

American Academy of Pediatrics. (n.d.). Tips for Preventing Food Hassles. Retrieved from

https://www.healthychildren.org/English/healthy-living/nutrition/Pages/Tips-for-Preventing

-Food-Hassles.aspx

Eckman, N., Paul, C., Riegal, K., & Williams, K.E.. (2015). Teaching Chewing: A Structured

Approach. Retrieved from https://ajot.aota.org/article/article.aspx?articleid+1867108

Eicher, P. S., Fox, C., Kerwin, M.E., & Manno, C.J. (2005) Early Oral-Motor Interventions of

Pediatric Feeding Problems: What, When, How. Retrieved from

https://files.eric.ed.gov/fulltext/EJ846764.pdfe/

Feeding Milestones | Child Development Milestones. (n.d.). Retrieved from

https://pathways.org/topics-of-development/feeding/milestones/

Polikaitis, Rima I & Wesling, Michele. (n.d.) The ABC’s of Pediatric Dysphagia: Evaluation and

Treatment. Retrieved from https://www.asha.org/Events

/convention/handouts/2006/1202

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