SOS

Motor/Postural stability:

Motor/Postural stability:

• Beginning hand-to-mouth play
• Increased reaching skills
• Reaches for bottle or spoon when hungry

Oral-Motor

• The rooting, palmomental, and phasic bite reflexes are integrating.
• Loss of central pattern generator that supports sucking rythyms.
• Opens mouth when spoon approaches
• Tongue used to move purees to back of mouth for the swallow
• Munching, lateral, and diagonal jaw movements.
• Lateral tongue movements

Sensory

• Preference for salty flavors emerges

Sensory

Motor/Postural Stability

• Trunk control sufficient for independent sitting for greater than 3-5 seconds.
• Stable head contrl in sitting (no head bobbing)
• Transfers toys and food from one hand to the other
• Holds bottle in both hands

Oral-Motor

• Able to bring upper lip down to draw food off of the spoon.
• full lip closure emerges.
• Consistent tongue lateralization seen when foods are presented to the sies of the tongue.
• Active movement of foods from side of mouth to central tongue groove and back
• Mature tongue lateralization emerging
• Diagonal rotary movements

Motor/Postural Stability

• Trunk rotation and weight shift
• Beginning to move in and out of positions
• Voluntary release patterns
• Uses fingers to rake food toward self, emerging pincer grasp.
• Puts finger in mouth to move food and keep it in
• Introduction of cup drinking
• Pokes food with index finger
• Uses fingeers to self-feed soft, chopped foods.

Oral-Motor

• Circular rotary jaw movements
• abe to transition to slight more texture (small bumps)
• With assistance, able to break of pieces of meltable foods
• "Chewing" (munching) of softer foods.
• Clearing food off of lips emerges
• Simple tongue protrusion may occur
• More controlled biting, isolated from body movements
• Full transfer of foods from sides across midline

Oral-Motor

Motor/Postural Stability

• Typically "co-feeding" with a parent.
• Grasps spoon with whole hand.
• Holds and tips bottle.
• Holds cup with 2 hands.
• Efficient finger-feeding.
• Utensil use not yet effective for adequate intake volume.

Oral-Motor

• Chews and swallows firmer foods without choking
• Chews foods that produce juice
• Able to keep most bites in mouth during chewing.
• Uses tongue to gather shattered pieces
• Sweeps pieces into a bolus with the tongue
• Chews bigger pieces of soft table foods
• Working on chewing foods increasing in difficulty

Motor/Postural Stability

• Able to pick up, dip, and bring foods to mouth
• Increasing utensil use (not efficient until after 24 months)
• Scoops purees with utensil and brings to mouth

Motor/Postural Stability

Oral-Motor

• Working on increasing speed and efficiency
• chewing strength improves
• Better able to manage hard-to-chew foods.

Oral-Motor

Motor/Postural Stability

• Use fingers to fill spoon
• Increasing fork skill
• Open cup drinking without spilling
• One handed cup holding

Oral-Motor

• Circulatory jaw movements improve
• Chews with lips closed
• Working onfurther increasing speech, strength and efficiency with bigger pieces of harder to chew foods.

Oral-Motor

Picky Eaters

• Decreased range/variety of foods but will et at least 30 foods.
• Foods lost due to “burn out” are usually regained after 2 weeks
• Tolerate new foods on a plate and usually can touch or taste.
• Eats at least 1 food from most food texture and nutrition groups.
• Adds new foods to repertoire in 15-25 steps
• Typically eats with family, but frequently eats different foods than family.

Problem Feeders

Restricted range or variety of foods, usually <20

Foods lost are NOT re-acquired

Distressed with the presentation of new foods

Refuses entire categories of food textures and nutrition groups.

Adds new foods in >25 steps

Usually eats different foods than family and often eats

Red Flags

• Poor weight gain
• Choking, gagging, coughing during meals
• Vomiting
• More than one incident of gastro-nasal reflux
• History of a traumatic choking incident
• History of eating and breathing issues with ongoing respiratory issues
• Inability to transition to baby food purees by 10 months
• Inability to accept any table food solids by 12 months

Red Flags

• Inability to transition to a cup by 16 months
• Has not weaned off most/all baby foods by 16 months
• Aversion/avoidance of all foods in specific texture or food groups
• Food range <20 foods, especially if foods are being dropped.
• In infant who cries and/or arches at most meals
• Family is fighting about food/feeding

Reasons Children Won't Eat

1. Pain

2. Discomfort

3. Immature motor, oral-motor, and/or swallow skills

4. Sensory Processing Problems

5. Learning/Behavioral

6. Nutritional

Tolerates

• Being in the same room

• Being at the table with the food on the other side of the table

• Being at the table with the food ½ way across the table

• Being at the table with the food just outside of the child’s space

• Looks at food when directly in child’s space

Tolerates

Interacts

• Assists in preparation/set up with food

• Uses utensils or a container to stir or pour food/drink for others

• Uses utensils or container to serve self onton own plate/space

• Uses utensils/napkin/tool to manipulate food in own space

• Uses another food to interact with food

Smell

• Odor in room

• Odor at table

• Odor in child’s forward space

• Leans down or picks up to smell

Smell

Touch

• One finger tip

• Fingertips, fingerpads

• Whole hand

• Arm, trunk/chest

• Shoulder, neck

• Top of head

• Chin, cheek

• Nose, underneath nose

• Lips

• Teeth

• Tip of tongue, top of tongue

Taste

• Licks lips or teeth, tongue tip taste

• Full tongue lick

• Bites off piece and spits out immediately

• Bites piece, holds in mouth for “x” seconds and spits out

• Bites piece, chews “x” time and spits out

Taste

Eating

• Bites and chews, swallows some and spits some

• Chews and swallows whole bolus independently

Eating

Requirements

NUTRITION

1 protein

1 starch

1 fruit/vegetable

+1 higher calorie drink

TEXTURES

1 Hard Munchable

1 Meltable Hard Solid

+1 Puree

Requirements

SENSORY

Each food is linked to the food before AND the food after by the sensory properties

(Color,Shape, Taste, Texture, Temperature, Consistency)

Food Rules

and

Considerations

Making a Food Hierarchy

Make sure each food presentence is connected to the previous food by at least one sensory property:

• Size
• Shape
• Color
• Texture
• Taste
• Temperature

Making a Food Hierarchy

EXAMPLE 2

• Cheeto
• Carrot Stick
• Orange Yogurt
• Dried papaya spears
• Dried Papaya chunks
• Mandarin Orange
• Cheese slice (moon shape)
• Peach sandy
• Fruit

EXAMPLE 1

• Pringle
• Jicama
• String Cheese
• White veggie straw
• Green veggie straw
• Green Applesauce
• Snap pea Crisp
• Green licorice
• Green Drink
• Orange drink

Hard Munchables

8-9 months

Hard Munchables

• Raw Carrot Sticks
• Celery sticks
• Bagel Strip

GOAL: Oral exploration only

Meltable Hard Solids

9-9.5 months

Meltable Hard Solids

• Towne crackers
• Graham cracker
• Fruit loops
• Baby mum-mum
• Snap pea crisp

*Meltables with dissolve with spit only; no or minimal pressure needed

Soft Cubes

10 months

Soft Cubes

• Avocado
• Over cooked squash
• Gerber graduates fruits
• Boiled potatoes
• Bananas
• Peas

*Soft cubes turn into puree with up and down pressure=munching on

Soft Mechanical

Soft Mechanical

12 months

Mixed texture

• Macaroni and cheese
• Microvable childrens meals
• Soft chicken nuggets
• French fries,
• Lasagna

11 months

Single texture

• Fruit breads
• Muffins
• Soft small pastas
• Thin deli meat
• Scrambled eggs
• Soft pretzels

*Soft mechanical are foods that break apart in the mouth easily

Hard Mechanical

15-18 months

Hard Mechanical

• Cheerios
• Thin pretzel sticks
• Ritz cracker
• Saltine crackers
• Hard cookies
• Fritos