Feeding Development
Babies are born with hard-wired reflexes to help them self-regulate for feeding. When children experience difficulties with gaining control of these reflexes we see developmental delays and disorders arise. Now, not all children reach these developmental milestones at the same time. We have to remember that these are reflexes that babies have to survive. Every child is unique and that is where we come in to play! We will help with preventing dysfunction, promoting optimal development, and diagnosing and then treating feeding and swallowing disorders.
There are three major anatomical features to look at when looking at oral motor and feeding skill development. Those are the jaw, tongue, and lips. Each plays a crucial part in the development of feeding and swallowing skills.
0-3 Months
Sucking begins well before they are born as early as the second trimester. Around 37 weeks gestation most infants are fully ready to support their nutritional requirements orally. This involves a coordinated suck/swallow pattern. Your child will have fatty sucking pads, lips, tongue, and palate that function as a unit. Your baby is also born with a Suck Swallow Reflex where they swallow when food, liquid, or saliva reaches their throat. It continues as an essential reflex throughout their lives. The Rooting Reflex helps your baby for successful feeding. It starts when the corner of your baby's mouth is stroked or touched. Your baby will turn his or her head and open his or her mouth to follow and root in the direction of the stroking. Your baby also has reflexes to protect their airway. Those are the Phasic Bite Reflex where your baby will bite down in response to any object being placed intra-orally, a Tongue Thrust when your baby's lips are touched they will protrude their tongue and a Gag Reflex which is on the front third of the tongue. You will also find certain anatomical features inside your baby’s mouth like a cupped tongue which provides a channel for the backward movement of liquid and the Lateral Tongue Reflex where your baby moves his tongue to the side where he or she receives touch, food, or taste.
4-6 Months
Around 4-6 months you will begin to notice changes in your child’s anatomy and reflexes. Your child’s rooting reflex decreases by 4-6 months, their phasic bite decreases by 5 months, and a munch chew pattern is active between 5-6 months. When a munch chew pattern develops there is a decrease in the coordination of suck/swallow/breath as suckling becomes more active instead of reflexive. Your baby’s Gag Reflex is moving back/slightly and less sensitive and suckling begins in anticipation of the spoon, suckling to swallow food/liquid. You will also find a decrease in sucking pads by 6 months.
7-9 Months
During this period, more dissociation will be seen with your child’s tongue, jaw, and lips. The Suckling Reflex is reduced and the gag reflex continues to move on the back third of the tongue. The Lateral tongue reflex also resolves by 6-8 months. You will see mixed tongue movements in/out, up/down. Tongue protrusion is also observed to facilitate swallowing. Your baby will demonstrate active lip movements/jaw lip dissociation for spoon feeding, and lip closure for swallowing purees begins. At this time, cup drinking may begin, however, your baby may need some jaw support. A munch chew pattern with food occurs when placed on the lateral molar ridge and you will see some active transfer of food side to center, center to side. Some diagonal jaw movement can be observed. Teething then begins at 5-9 months.
10-12 Months
Between 10-12 months there is a significant gain in lip movement and control. Your baby will demonstrate lip closure for swallowing liquids and a true suck appears (sucking on a straw) with improved coordination during drinking. Your baby’s upper lip will move down and forward and their lower lip will move in to remove food from a spoon. You will also notice your baby cleaning his/her lower lip with his/her teeth.
Your baby’s rotary chew pattern is beginning to develop at this time as well with active lip, and cheek movement. And your baby’s gag reflex moves back toward the pharyngeal wall.
13-15 Months
Between 13-15 months your child is beginning to develop speech. They have emerging jaw, lip, and tongue blade/tip dissociation. There is an increase in jaw stability for biting, some lip closure during chewing, and your baby can maintain a continuous suck during cup drinking.
16-18 Months
Your child is now experiencing continued increases in dissociation of jaw/lip/tongue movement and smoother integration of tongue, lip, and jaw movements. These skills include some internal jaw stability (chewing texture), controlled bite without associated head movement, reduced tongue protrusion to support swallowing, and good control of liquids.
19-24 Months
Refinement of all oral motor skills for feeding is developed during 19-24 months. You will notice your child using a rotary chew pattern and then a diagonal chew pattern. They will use his/her tongue to clean their lips, can straw drink with long suck sequences, and can chew with lips closed. They demonstrate tongue retraction for swallowing and can chew meats.
25-36 Months
By 3 years old your child will have a mature swallow pattern and the motor plan they will have as an adult including internal jaw stabilization, tongue tip elevation for swallowing, appropriate jaw grading for biting and chewing, gradual refinement of tongue movements, and circular rotary chew pattern.
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Feeding Therpay: A Sensory Motor Appraoch Lori Overland M.S., CCC-SLP, C/NDT
Morris, S. E., Klein, M.D. (2000). Pre-Feeding Skills:A Comprehensive Resource for Mealtime Development. Pro-Ed.
Overland, L., Merkel-Walsh, R. (2013). A Sensory Motor Approach to Feeding . Talk Tool
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For more information about feeding, developmental milestones and introduction to solids and please check out the following:
