Helping Children Learn Good Feeding Skills

Feeding skills for most children progress through several developmental steps — from sucking through being spoon-fed soft foods, to chewing solid foods they feed themselves.

This process depends on a number of factors, including natural reflexes, development of oral, fine, and gross motor skills, and the foods and environment in which foods are presented.

Parents have no control over their children's reflexes and can only try to positively influence motor skill development. Parents (and caregivers) do have control over the types of foods and the environment in which foods are presented.

In order for parents to help children learn good feeding skills, it is important to understand that each child develops at a different pace, and children with special needs are no exception. Their rate of development may differ from other children at the same chronological age. That is, a two-year-old with oral motor skills may not be ready for the same kinds of food as another two-year-old. Parents and caregivers who understand a child's developmental stage will be able to match the child's food needs with their feeding skills.

The Importance of Positioning

Children with developmental delays often want to eat, but may have trouble getting food to their mouths, swallowing, or chewing. Proper positioning while eating is essential for successful feeding. A child in the proper eating position might look like this:

• Head is upright and slightly forward;
• Body is upright;
• Arms are forward (resting comfortably on a high chair tray or table, if applicable);
• Hips and knees are bent to a sitting position (with the aid of a seat belt or non-slip seating material, as needed);
• Feet are resting flat on a firm surface; and
• The person offering the food is facing the child at the child's eye level.
  

Food Types and Texture Make a Difference

Any child learning to eat wants to be successful. Providing young children with foods they can chew and swallow will help them achieve that success. Most foods can be altered in texture to support a child's abilities. Foods can first be offered in pureed form, then mashed, ground, or chopped, and finally cut into bite-size pieces when a child is able to eat regular table foods.

Health care providers who work with children with special health care needs can help parents know what foods (types and textures) match their child's physical abilities.

Changing Nutrition Needs

Most dietitians and pediatricians recommend starting solid foods between four and six months of age, when infants are showing signs of developmental readiness (e.g., good head control, reduced tongue thrusting) and are consuming up to 26 or more ounces of breastmilk or formula per day.

Single grain infant cereal, single vegetable purees and single fruit purees (Stage 1) are usually the first foods introduced. These foods provide iron and vitamins A and C, which need to be given in foods at this age.

Later, purees of beans, egg yolk, tofu, meat, or poultry are introduced. These foods provide protein. As feeding skills develop and a baby progresses to eating table foods, more foods are introduced. Sometimes, children with special needs do not develop feeding skills at the same age or rate as other children. However, their nutritional needs continue to change as they get older. These children may need help from a dietitian to get proper nutrition for their age from foods with a texture they can easily eat.

How much is enough?

Often, parents wonder how much their child should eat. It is important to follow the child's cues as to how much food to offer at any given time, and not to force a child to eat. Children don't always eat the same amount every day.

It is normal for children to have some changes in appetite, depending on their health, activity level, and rate of growth. Some children grow in spurts, and may have an increased appetite for several weeks, then slow down. Medications and physical discomfort also can influence a child's appetite. However, on average, a child should consume enough food to maintain a normal rate of weight gain.

For more information about nutrition for children with special health needs, contact your health care provider or the dietitian at your local health district.

Dietary Guidelines for All Children Under Age 2

Babies grow and develop very rapidly in the first two years of life. They need a diet that supplies energy and nutrients to promote this rapid growth. Thus, dietary guidelines for babies are different than guidelines for older children and adults.

Build to a variety of foods.

• Breastmilk or iron-fortified infant formula is all a baby needs for the first few months of life (until the baby weighs about 15 pounds).
• Most babies are ready to start infant cereals at 4 to 6 months.
• New foods should be added one at a time to be sure that a baby is not allergic to the new food. Wait 3 to 5 days before trying another new food.

Pay attention to a baby's appetite to avoid over-feeding or under-feeding.

• Feed a baby when he/she is hungry.
• Watch for signs from a baby (turning head away from food) that tells you they are full.
• Do not force a baby to finish food or formula.
• Most babies eat when they are hungry. They will not overeat or undereat during the first year of life unless they are pressured to do so.
• Children grow faster in the first year than at any other time. Birth weight should triple and length double in the first year.

The American Academy of Pediatrics recommends that breastfeeding continue for at least 12 months and thereafter for as long as mutually desired by mother and infant.

Babies need fat.

• Babies need to eat foods that contain fat to meet energy needs and to grow and develop normally. Fat also helps the brain and nerves develop.
• Breastmilk contains the appropriate amount of fat for babies to grow. Infant formulas attempt to imitate breastmilk.
• After 12 months, whole milk should be given until age two years. (Cow's milk is not recommended for infants less than 12 months of age.)

Choose grains, vegetables and fruits, but avoid high-fiber foods.

• The natural amounts of fiber and nutrients in grains, vegetables, and fruits are what babies need beginning at 5 to 7 months of age as part of a healthy diet.
• High-fiber diets, while good for adults, do not give babies enough calories and other nutrients to grow well.

Babies need sugars in moderation.

• Sugar has not been shown to cause hyperactivity, diabetes, obesity, or heart disease.
• In large quantities, sugar can cause tooth decay and keep children from eating more nutritious foods.

Choose foods with iron, zinc and calcium.

• Full-term babies are born with a supply of iron that lasts up to 4 to 6 months after birth. After that, iron must be supplied in the diet. Breastmilk and iron-fortified formula provide iron. Start iron-fortified baby cereals at 4 to 6 months.
• Babies also need good sources of zinc and calcium for best growth in the first two years. Meats and beans are good sources of zinc. Milk and cheese are good sources of calcium after baby turns one. These minerals are important for healthy blood, proper growth and strong bones.

Information for this article was taken from the 1999 edition of Nutrition Strategies for Children with Special Needs. Supported in part by Project #MCJ-069345 from the Maternal and Child Health Bureau (Title V, Social Security Act), Health Resources and Services Administration, Department of Health and Human Services. The 1999 edition of Nutrition Strategies for Children with Special Needs was revised and expanded by the USC University Affiliated Program, Children's Hospital Los Angeles (CHLA) under the direction of: Anne Bradford Harris, M.S., M.P.H., R.D., Project Coordinator
Elaine M. Blyler, M.S., R.D., F.A.D.A., Project Consultant
Marion Taylor Baer, Ph.D., R.D., Project Director

Additional Resources

(Note: You'll find these articles at different web sites. Use the "back" button when you're done to return to this page.)

For Parents of Children with Special Health Care Needs

mchneighborhood.ichp.edu — Developing an individualized care notebook for your child.

http://www.familyvoices.org/ — Information about children with special health needs.

Nutrition Information

American Dietetics Association — Daily nutrition tips.

www.navigator.tufts.edu/ — Tufts University rates web sites for content, usability, reliable nutrition information. Nutrition information for parents, kids, adults.

www.homefoodsafety.org/ — Preventing food poisoning at home.