Developmental Feeding Milestones ASHA
While it is common knowledge that “Speech-Language Pathologists” treat speech and language disorders in all ages, you might not have realized SLPs also treat feeding and swallowing disorders across the lifespan. Because we have had extensive knowledge about the anatomy and physiology of muscles used for breathing, swallowing, and speech, SLPs are typically a part of the feeding therapy team from infants to adults.
While every child is demonstrates variability in milestone achievement, research across the years has shown children typically progress through these milestones in the following ways: transitioning between foods (from breast milk/iron rich-formula; to smooth, single-ingredient purees; to combination foods (purees with more than one ingredient); types of utensils used to feed (from bottles to spoons and forks to open cups and straws); and independence in self feeding (from holding hands on the bottle, feeding selves with fingers, and into independent use of utensils). The primary eating milestones are generally considered to be nippling (drinking from the bottle or breast feeding), eating from a spoon, drinking from an open cup, sipping from a straw, biting foods, thoroughly chewing foods, and self-feeding***.
When these milestones are not met in an appropriate amount of time, such as a baby has difficulty drinking from a bottle, transitioning to solid foods or cup drinking, demonstrates a lack of proper chewing skills, or refuses foods outright, an evaluation from a speech-language pathologist may be warranted to assist in your child’s feeding skills.
Checking In On Development
Below is a general checklist about typical feeding and swallowing milestones in young children. As always, these skills build off from one another, as a continuous sequence of motor learning. As the child develops one motor skill, she begins to learn the gross and fine motor skills required to acquire the next. Consult your pediatrician if you note concerns in any of these areas, and see if feeding therapy may be necessary for your child.
Remember to always consult with your pediatrician for introducing new foods, possible diet restrictions, potential allergies to foods. Additionally, it can be helpful to consult with a registered dietitian if you have concerns with your child’s growth or receiving adequate nutrition and hydration.
***You might have noticed that drinking from “sippy” and “spouted” cups is not listed in these milestones. While these cups may protect the floor, they do not promote continued development of oral motor skills.
| Age | Oral Motor Skills | Developing Gross Motor Skills | Feeding Milestones | Appropriate Foods/Textures to Introduce |
|---|---|---|---|---|
| Birth – 2 Months | Baby uses coordinated suck-swallow-breathe pattern during breast and bottle feeds, to efficiently consume calories | Efficient suckle of bottle nipple | Breast and/or formula provides all of baby’s nutrition | |
| 2-4 Months | -Tongue and jaw move together | Head control is improving each month | Begins to put their hands on the bottle during feeding | |
| 4-6 Months | -Baby’s tongue begins to move without the lips -Baby’s automatic suck is more voluntary -Baby develops phasic bite and vertical munching pattern | -Sits upright with assistance -Holds head steady without assistance -Begins to bring hands to mouth | -Open cup drinking can be introduced around 6-12 months -Baby is able to use upper lip to clean a spoon | -Breast milk or formula continues to provide a majority of the baby’s nutrition -Introduce infant cereals, thin pureed foods off a spoon |
| 6-8 Months | -Gag response declines as mouth becomes used to solid foods -Child develops lateral placement of foods | -Child has greater postural stability and is able to sit up mostly on their own | -Open cups can be introduced from 6-12 months -Helps adult with spoon | -Breast milk or formula continues to provide a majority of the baby’s nutrition -Introduction of lumpy mashed solids -Introduce easy dissolvable finger foods |
| 8-10 Months | -Lip seal emerges for cup drinking -Rotary chew may begin to emerge | -Stands while holding on to something -Puts toys in mouth | -Open cups can be introduced from 6-12 months | -Breast milk or formula continues to provide a majority of the baby’s nutrition -Mash with harder/lumpier solids |
| 10-12 Months | -Baby can use a sustained, controlled bite | -Open cups can be introduced 6-12 months -Wean bottle feeding around 12 months old | -Breast milk or formula continues to provide a majority of the baby’s nutrition | |
| 1-1 1/2 Years | -Tongue tip elevation | -Pulls to stand up -Gets into a sitting position without help | -Holds cup with both hands -Grabs and holds spoon with both hands for self-feeding | -Solid foods become child’s primary nutrition source |
| 1 1/2 – 2 years | -Tongue tip elevation -Rotary chewing pattern is refined -Lateral placement of foods is refined | -Child self-feeds a majority of foods -Can chew a wide range of textures -Able to chew with mouth closed -Child has more control of cup drinking | -Solid foods are child’s primary nutrition source -Children should be able to eat most all food by this time | |
| 2 years and beyond | -Child refines all skills | Child refines all skills | Child is able to chew and eat fruits, veggies, meats, and grains | |
The above information was gathered from a variety of research-based sources, including the Center for Disease Control and Prevention, WIC, and the following articles:
References
Arvedson, J. C. (2006). Swallowing and feeding in infants and young children. GI Motility online.
Arvedson, J. C. (2000). Evaluation of children with feeding and swallowing problems. Language, Speech, and Hearing Services in Schools, 31(1), 28-41.
Butte, N., Cobb, K., Dwyer, J., Graney, L., Heird, W., & Rickard, K. (2004). The start healthy feeding guidelines for infants and toddlers. Journal of the American Dietetic Association, 104(3), 442-454.
Delaney, A. L., & Arvedson, J. C. (2008). Development of swallowing and feeding: prenatal through first year of life. Developmental disabilities research reviews, 14(2), 105-117.
Edwards, D., Gould, C., Mayfield, E., Simon, M., (2013) Pediatric jaw development: information you can chew on – ASHA. [Presentation PDF], 1-73.
McCarthy, J. L., (2008). Feeding infants and toddlers. [Presentation PDF] 1-19.
Paul, D., & Roth, F. P. (2011). Guiding principles and clinical applications for speech-language pathology practice in early intervention. Language,speech, and hearing services in schools.
Sheppard, J. J. (2008). Using motor learning approaches for treating swallowing and feeding disorders: A review. Language, speech, and hearing services in schools.
Other additional information can be found at:
https://www.asha.org/public/speech/swallowing/Feeding-and-Swallowing-Disorders-in-Children/#signs
https://www.cdc.gov/nutrition/InfantandToddlerNutrition/index.html