top of page

Developmental Milestones in Feeding

Updated: Jul 21, 2023

Reflexes:

  • Gag Reflex: In an infant, the gag reflex is at the tip of the tongue due to the nipple needing to be at the back of our mouth for breastfeeding or bottle feeding. The gag reflex moves back as the infant ages and explores different objects by placing various objects in their mouth. As the gag reflex moves towards the back of the mouth, the reflex is desensitized allowing the child to move on to the next feeding stage.

    • 6-9 Months: gagging occurs less than 25% of the time when lumps contact (mouthing toys, food) with the posterior third of the tongue

    • Adult: Gag reflex is retained, and can be done under volitional control

  • Rooting Reflex (3-4 Months): newborn babies automatically turn their face towards the stimulus and begin to make sucking motions with the mouth when the cheek or lip is touched. The rooting reflex helps to ensure successful breastfeeding.

  • Phasic Bite/Chewing Reflex (4-6 Months): The “clench” reflex. The reflex is initiated when pressure is applied to the baby’s gums. The response is a rhythmic closing/opening of the jaw with no lateral movement of the jaw. This reflex usually diminishes between 9-12 months with a controlled, sustained bite.

  • Tongue Reflexes: Diminishes at 5 months old

    • Transverse tongue reflex: In 28 weeks gestation, the tongue develops to move towards the side of stimulation. By 6-8 months, the reflex begins to diminish as the infant gains control of the reflex.

    • Tongue protrusion: When an object or food touches the tip of the tongue, the reflex signal to push the object/food away from the mouth. This reflex protects from choking on things they do not know how to chew yet. By six months, the reflex diminishes. It is important this diminished before the introduction of spoon-feeding.

  • Suck-Swallow-Breathe (4-7 Months): Sucking involves the coordination of several different muscles to achieve a rhythmic oral motor pattern. You need the suck-swallow-breathe pattern to feed/eat functionally.

  • Visual Demonstration of Reflexes: YouTube Video (HelpMe Feed Foundation, 2020)

Physical/Oral Motor Development:

**Gross motor skills must develop before oral motor skills***

  • 32 Weeks Gestation: air sacs in the lungs develop, more surfactant is produced, and changes in blood vessels and lungs prepare to breathe outside of the womb

    • **If a baby is born preterm: breathing can be difficult, leading to the baby to focus more on breathing and not eating = causing feeding difficulties

  • Birth-3.5 Months:

    • Head and trunk support needed for feedings

    • Roots for nipple

    • Sucks

    • Swallows liquids

  • 4-7 Months:

    • Visually recognizes food and the bottle

    • Attempts to secure a tiny object with a few fingers or a whole hand

    • Hand-to-mouth play

    • Adequate trunk control for independent sitting for 3-5 seconds

    • Lateral tongue movements start to emerge

  • 7-9 Months:

    • Infant drinks from a cup held by an adult

    • Can close lips around the spoon and clean it after bites

    • Wants to help with feeding

    • Begins finger-feeding, raking grasp to pick up small food

    • Trunk control and weight shifting

  • 9-12 Months:

    • Begins to experiment with drinking liquids from a sippy cup

    • Straw drinking initiated at 12 months

    • Holds cups and drinks with some spilling

    • Begins to take controlled bites of a soft cookie

    • Begins to move food from one side of the mouth to the other side

    • Independent finger feeding using a pincer grasp to pick up small dissolvable solids

    • Holds a spoon but cannot hold it independently

  • 12-15 Months:

    • Holds the cup with both hands

    • Takes a few sips without help

    • Dips spoon in food

    • Holds spoon, brings to mouth and lick, but it is messy and spills; usually cannot prevent it from turning over before it gets to mouth

    • May bite on the cup to stabilize the jaw

    • Learning to make controlled bites on a hard cookie

  • 16-36 Months:

    • The child becomes the feeder; the parent is no longer the feeder (wean off, do not completely shut off in feeding your child in one-day)

    • Scoops food with a spoon and feeds self

    • Holds cups and drinks with minimal spillage

    • Holds spoon, scoops food, and gets food safely to mouth, chews well

    • Efficient use of straw (if already introduced)

    • Gives up bottle entirely and drinks from a cup (18-24 months)

    • Wants to feed himself/herself

    • Stabs food with a fork

    • Can chew with lips closed

    • **Pacifier should not go beyond 2-3 years in order to have good alignment of the teeth that is needed to chew**

  • 3-4 years:

    • Swallows food in the mouth before taking another bite

    • Serves self at the table

    • Refills a cup with some spilling using a container with a handle or spout

    • Holds cup with one hand while holding straw with another hand to drink

  • 4-5 years:

    • Puts appropriate amount of food in the mouth and can chew with lips closed

    • Can spread soft substances with a plastic/child-safe knife

  • 5-6 years:

    • Can cut foods with a knife under supervision (dull knife or slightly serrated)

    • Can cut with a fork and knife

Chewing Patterns:

  • Sucking (Begins as a Newborn): holding the food at the front of the mouth and sucking on it, no jaw movement

  • Munching (4-7 Months): up and down jaw movement

  • Tongue Thrust/Protrusion: pushing the food out with the tongue

  • Diagonal (9-12 Months): jaw jetting to the right or left, side or down, not making a complete circle

  • Emerging Rotary Chew (15-18 Months): starting the beginning of a consistent circular swing but not a full complete circle

  • Circular Rotary Chew (24 Months): The jaw moves in a circular motion to chew food

  • Check out this video to help remember the milestones: Infant Feeding Milestones

Food Progression Development:

  • Birth - 3 Months: Thin liquids

    • Breast milk or formula

    • Typically complete a 5-7 oz oral feeding in 20-30 minutes. If it is taking longer than 30 minutes or multiple attempts of feeding with breaks are needed, that would indicate concern

  • 4-6 Months: Thin puree

    • Cream of wheat, pudding, apple sauce, blended meats, vegetables, and fruits, stages 1 and 2 of baby food

    • Munching patterns on meltable solids and soft cubes begin to emerge

    • Begin transition from liquids to solids (If recommended)

      • Guide to Starting Solids: YouTube Video (Hubbard, 2022)

      • "Go by what your baby can DO, not by how old he/she is" (Satter, 2000)

  • 5-6 Months: Thick puree or blended

    • Blended meats, vegetables, and fruits (mashed bananas, applesauce, yogurt).

    • Transitioning to thicker smooth foods can be an important step for children with feeding issues

  • 6 Months: Mashed Lumpy

    • Mashed potatoes, soft fruits, mashed hard-cooked eggs, mashed carrots or squash, oatmeal, Stage 3 jarred baby food

  • 7-9 Months (Ground)

    • Crumbled/ground meat, scrambled eggs, cottage cheese, small pieces of toasted bread crumbs, crackers broken into smaller pieces, graham crackers

    • Food can be ground in a food chopper, not a blender, and retains some lumps for chewing foods.

  • 8-10 Months: Soft Chopped

    • Small pieces of food of one type of food: pasta, mac and cheese, soft fruit pieces, cooked carrots, graham crackers

  • 12 Months: Medium Chopped

    • Medium chopped is the same as soft chopped, just bigger but not big enough to choke on

    • Portion sizes are approximately the same size as a clenched fist

  • 15 Months: Mashed foods, chopped table foods, some raw veggies, and meats

    • Increase intake of solid foods, 3 meals a day with 2-3 snacks per day

    • Offers milk in a cup

    • Trying to wean from bottle and encourage cup drinking to elevate nutritional needs to support brain growth, needs nutrition-dense foods

  • 18 Months: Firm foods, table foods

    • Pieces of meat (chicken), hard cookies, bread, tortilla

    • Offer bite-sized pieces, offer fist-sized portions

  • 24 Months: Mixed

    • Toddler meat, soup with pasta and vegetables, sandwich

  • 24-36 Months: Very firm, regular diet

    • Unaltered hot dogs, nuts, seeds, chunks of meat or cheese, whole grapes, popcorn, and raw vegetables. Food can be cut up or left whole.

    • They should be biting and ripping food easily and have a complete rotary chew

Signs Your Baby is Ready for Food:

  • Can sit up alone or with support

  • Can hold his/her head up straight with neck

  • Mouths with fingers and toys

  • Opens mouth when he/she sees something coming to mouth

  • Turns head away when he/she does not want it and stay open when he/she does want it

  • Keeps tongue flat and low for spoon feeding

  • Closes lips over spoon

  • Communicates eager and excitement physically or socially when it comes to mealtimes

  • Willing to play with food such a finger painting, mashing, or smearing it

  • Reaches for utensils


References

Adler, L., & Freeborn, D. (Eds.). (n.d.). Breastfeeding your high-risk baby. Health

Encyclopedia - University of Rochester Medical Center. https://www.urmc.rochester.edu

/encyclopedia/content.aspx?contenttypeid=90&contentid=P02386

Basco, K. K. (n.d.). Pediatric feeding disorders - summit professional education. Summit

Education. https://summit-education.com/course/CFEEKB.1/pediatric-feeding-

disorders#VIDEO/ONDEMAND.CFEEKB.1

Developmental milestones. SOS Approach to Feeding. (n.d.).

https://sosapproachtofeeding.com/developmental-milestones-free/

Fraker, C., Fishbein, M., Cox, S., Walbert, L. (2007, November 2). Food chaining: The proven

6-step plan to stop picky eating, solve feeding problems, and expand your child’s diet.

Hachette Books.

G. (2017, December 19). Mastication chewing animation[Video]. Youtube.

https://www.youtube.com/shorts/7RfRNmJlX3k

HelpMe Feed Foundation. (2013, September 3). Breastfeeding tips: Newborn feeding

reflexes[Video]. Youtube. https://www.youtube.com/watch?v=WqJ_4un7I7w

Hubbard, J. (2022, July 6). Baby’s first food - The complete guide to starting solids[Video].

Youtube. https://www.youtube.com/watch?v=LAfn4s8Jcps

Morris, S. M., & Klein M. D. (2000, January 1). Pre-feeding skills: A comprehensive resource

for mealtime development. Pro-ed International Publisher.

Rappaport, K. (2013, September 3). Early feeding cues rooting[Video]. Youtube.

https://www.youtube.com/shorts/YzGWrCzQqQQ

Satter, E. (2000). Child of mine: Feeding with love and good sense. Bull Publishing Company.

Sensory Solutions. (2017, May 7). Oral motor for chewing and swallowing. Sensory Solutions.

https://sensorysolutions.org/home/blog/oral-motor-chewing-and-swallowing/

Toomey, K. A., Ross, E. S., Kortsha, B. C., Beckerman, L., Fitzpatrick, K., & Lagerborg, D.

(2017, November). When Children Won’t Eat: Picky Eaters vs. Problem Feeders.

Assessment and Treatment Using The SOS Approach to Feeding.

Typical development of feeding skills - San Diego occupational therapy. San Diego

Occupational Therapy. (n.d.). https://sandiegooccupationaltherapy.com/wp-content

/uploads/2012/01/TypicalDevelFeeding.pdf

Recent Posts

See All

Σχόλια


bottom of page