“My 11-month-old shows no interest in feeding herself. Is that normal?”
“My toddler spills sooooo much every time she tries to feed herself yogurt. It’s so messy!”
“My preschooler hates using his fork. He throws it every time I try to get him to use it!”
“My middle schooler still needs me to cut his food for him. It’s so annoying!”
Does any of this sound familiar to you?
Some of the above scenarios are typical. Some are cause for concern. So when exactly are kids expected to graduate to the next level with self-feeding, anyway?
I’m teaming up with the “Functional Skills for Kids” bloggers this month to share tips with you on the topic of mealtime. So today I’m here to share with you about the developmental progression of eating and self-feeding skills!
HOW EATING & SELF-FEEDING RELATE TO OCCUPATIONAL THERAPY
Eating and self-feeding are known as “Activities of Daily Living” (ADLs) in the Occupational Therapy world. They are important “occupations” that allow us to take care of our bodies. When a child struggles with eating (manipulating food/fluid within the mouth) or feeding (setting up, arranging, and bringing food/fluid to the mouth), Occupational Therapy practitioners can analyze the child’s performance and determine what it is that’s contributing to the child’s mealtime challenges. Is it difficulty with hand-eye coordination or fine motor skills needed for finger-feeding or using utensils? Difficulty with coordinating movements of the jaw, tongue, and lips to efficiently chew and swallow? Difficulty sitting in one place long enough to attend to and complete a meal? Difficulty assuming and maintaining a position that will provide enough postural stability during mealtime? These are all factors an OT practitioner can consider when evaluating a child’s mealtime challenges and designing an appropriate treatment plan.
DEVELOPMENTAL PROGRESSION OF EATING & SELF-FEEDING SKILLS
So how do you know if your child’s development of eating and self-feeding skills are on-track or not? Here are some general guidelines to help you out!
- Baby suckles in anticipation of spoon coming near
- Gag reflex present
- Brings hands to mouth with toy or object
- Pats and/or places both hands on bottle or breast when drinking
- “Munching” chew pattern
- Attempts to secure tiny object (piece of food) with a few fingers or whole hand, makes contact but often unsuccessful
- Baby can close lips around spoon and clean it after bites
- Gag slightly less sensitive
- Begins to bite soft solid food voluntarily (soft cookie)
- Begins to hold own food for voluntary bite
- Begins to move food from side to center of mouth & center to side
- Can hold own bottle when drinking
- Can begin to drink/suckle from an open cup when given jaw support (adult holds cup)
- Uses “raking” or “scooping” motion with fingers to secure pieces of food, usually successful
- Begins to use thumb and side of index finger (“inferior pincer” grasp) to pick up small food items and self-feed
- Begins to take controlled bites of soft cookie
- Baby demonstrates a true “suck” & can drink from straw
- Begins to drink from open cup with more jaw control (adult holds cup)
- Begins to move food from one side of mouth to other (beginning of “rotary” chew pattern)
- Begins to use thumb and tip of index finger (“neat pincer” grasp) to pick up small food items and finger-feed at least half of a meal
- Holds spoon to play, bang, mouth, drop
- May bite on cup to stabilize jaw
- Starting to close lips while chewing
- Learning to make controlled bite on hard cookie
- Dips spoon in food
- Brings spoon to mouth, turns spoon over but obtains some food
- Improved control of liquid within mouth
- By 18 months, can hold own open cup to pick up, drink, and set down with some spillage
- Chews food completely with “rotary” jaw movements (jaw & tongue work together to move food around mouth)
- By 24 months, feeds self with spoon with some spillage (“sticky” food such as mashed potatoes, thick oatmeal, pudding)
- Can use tongue to clean lips
- Can drink from straw with lips (vs. biting straw while drinking)
- Can chew meat competently
- Can transfer food from one side of mouth to other (across midline)
- By 30 months, can drink from small open cup using one hand
- By 30 months, holds spoon with fingertips, hand in “palm up” position
- By 36 months, can pour liquid from a small container with control
- By 36 months, can use a fork to pierce soft foods and bring to mouth
- By 36 months, can wipe mouth with napkin when given reminders
- Swallows food in mouth before taking another bite
- Serves self at table (can pour and scoop without spilling)
- Refills a cup with some spilling, using a container (8 ounces or less) with a handle and spout
- Holds cup with one hand while holding straw with other hand to drink
3 1/2 to 4 1/2 Years:
- Can open at least 5 different kinds of food containers without assistance (e.g., milk carton, juice with straw, jar, food bag, etc.)
- Can prepare simple foods for eating (e.g., peeling, pouring, unwrapping, putting in straw)
4 to 5 Years:
- Puts appropriate amount of food in mouth and can chew with lips closed
- Can spread soft substances with a plastic/child-safe knife
5 to 6 Years:
- Can cut foods with a knife under supervision (dull knife or slightly serrated, not sharp)
5 1/2 to 6 1/2 Years:
- Can cut with a fork and knife (entire process of holding utensils, controlling and cutting food, and bringing to mouth)
While every child develops and progresses at their own rate, it can be helpful to have an understanding of when particular milestones are expected and what the natural progression is. You may find that your child is actually more ready to take their self-feeding skills to the next level than you thought!
MORE HELPFUL INFORMATION RELATED TO KIDS & MEALTIME
Here’s some more information in this month’s series to help you support the kids in your life!
Fine Motor Skills For Mealtimes | Therapy Fun Zone
Postural Control, Gross Motor Development and Mealtime |Your Therapy Source
Attention, Behavior, and Mealtime Problems | Sugar Aunts
4 Ways to Modify Meal Times for Fussy Eaters | Your Kids OT
Mealtime Skills, Rituals & Play – Nurturing a Love for Food | Kids Play Space
15 Tips for Picky Eaters | The Inspired Treehouse
Visual Perceptual Skills Needed for Independent Feeding | Growing Hands-On Kids
American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain and process (3rd ed.). American Journal of Occupational Therapy, 68(Suppl. 1).
Case-Smith, J. & Humphry, R. (2005). Feeding Intervention. In J. Case-Smith (Ed.), Occupational therapy for children, 5th edition (481-520). St. Louis, MO: Elsevier Inc.
Teaford, P., Wheat, J., Baker, J. (Eds). (2010). HELP 3-6 Assessment Strands [Curriculum Based Assessment, 2nd Edition]. Palo Alto, CA: VORT Corporation.
Warshaw, S. (2007). HELP strands 0-3 [Curriculum Based Assessment]. Palo Alto, CA: VORT Corporation.