Feeding and Swallowing Clinic

Spoon-feeding and Cup and Straw Drinking

Children typically make the transition to spoon feeding at approximately 4-6 months of age. Children with special needs often have problems and need assistance.

In cases where there is a problem, transitioning strategies are frequently helpful:

               
  1. First introduce taste change such as different flavor juices from the bottle.
  2.   
  3. After manipulating taste, thicken formula with baby cereal, commercial thickeners, or thin strained baby food with water. Use a cross-cut nipple so that there will be flow but the viscosity of the food has been changed for the child.
  4.            
  5. Once the thickened food has been introduced in bottle, transition by providing the food to the child via nipple, finger or favorite mouthing toy.
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  7. Continue to thicken food until the baby food consistency has been achieved.
  8.            
  9. Introduce food via spoon to the child.
  10.            
  11. Remember to use small quantities and gradually take the child through the various steps.
  12.          

Oral Preparation/Transport Observations - Spoon Feeding

               
  • Head control steady, slightly forward at midline
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  • Brings head forward to spoon
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  • Opens mouth to presentation of food
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  • Keeps tongue on floor of oral cavity
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  • Brings upper lip down and forward over spoon
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  • Holds jaw stabile
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  • Pulls lower lip inward under spoon
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  • Clears excess food off lips with tongue
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  • Keeps lips closed during swallowing
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  • Limb function
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Abnormal Reflex Patterns which may present:

               
  • Suckle-swallow reflex
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  • Bite reflex
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  • Gag reflex
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  • Jaw Thrust
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  • Tongue thrust
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  • Withdrawal such as head turning
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Cup and Straw Drinking

Cup drinking readiness is generally present in the child at approximately 6-7 months of age. There is some trunk control which enables the child to begin such feeding behavior.

         
  1. At first, children generally suckle the liquid as if given via breast of bottle and it can be confusing to the child because of the difference in oral placement between the breast and bottle.
  2.      
  3. When children begin using a cup, jaw support is often necessary. Children will often rest their tongue under the bottom rim of the cup or bite the cup to maintain cup placement stability. As the child becomes more comfortable with the cup, tongue position and other temporary strategies are eliminated. By 2 years of age the child should be able to hold a cup and drink without major problems.
  4.      
  5. Children with special needs often need help with the initiation of cup drinking. Jaw stability is important, as is a gradual introduction to cup drinking. It is a messy experience and should be done on a very gradual schedule.
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  7. There are many different types of cups that are available for use with kids and you need to choose that is best for the child. Cups with spouts minimize spillage and are good for the initial introduction of cup drinking; however, the child needs to be transitioned from a spout. Wide-mouth cups are helpful for some children, while nosey or cut-out cups minimize the need for a change in head position while drinking. Usually it will be necessary to experiment with different cups to decide on the appropriate one for a specific child.
  8.      
  9. Straw drinking is a skill that generally emerges at 2 to 21/2 years of age, but some kids pick up on straw drinking earlier. Some special needs kids can use a straw much better than a cup and it is the selection of choice. Positioning is important for straw use and gradual introduction so that the child can develop appropriate strength and coordination skills.
  10.    

Preparation/Observations for Cup drinking - Cup, Sippey Cup, Nosey Cup, Straw

         
  • Head steady, slightly forward in midline
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  • Brings head forward to cup
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  • Forms lip seal on cup
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  • Keeps tongue within oral cavity
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  • Keeps jaw and lower lip stable
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  • Moves upper lip to draw in liquid
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  • Able to take sequence of sips
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  • Adjusts rate of flow by pulling back head
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  • Limb function
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Abnormal patterns which may present:

         
  • Suckle-swallow reflex
  •      
  • Bite reflex
  •      
  • Tongue thrust
  •      
  • Lip retraction
  •      
  • Jaw thrust
  •      
  • Withdrawal such as head turning
  •    

References

Averdson, J. (1997). Feeding and Swallowing Disorders in Children. Tucson, AZ: University of Arizona Telerounds Program.

Morris, S.E. & Klein, M.D. (1987). Pre-Feeding Skills. Tucson, AZ: Communication Skills Builder.

Wolf, L. S. & Glass, R. P. Feeding and Swallowing Disorders in Infancy. San Antonio, TX: Therapy Skills Builder.