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Objectives
Cognitive Development Gross & Fine Motor Development Oral Motor Skills Sensory Development Taste & Olfactory Milestones Some Myths about Mealtime (scattered
throughout)
Myths about eating interfere with understanding and treating feeding problems.
Myth #1
Birth:
Vision best at 7+ inches Prefers sharp visual contrasts Turns head to moving objects Prefers human voice Sleeps 20 hours/day Short visual memory Control of eye muscles (2 months) Regular feeding expected Chooses faces over objects
3-4mos
Searches/localizes for sounds Able to focus visually Visual/oral exploration Visual memory up to 7 seconds Senses unfamiliar places Identifies mom in gathering of people
6-7 mos
Coordination of vision and grasping objects Oral/tactile exploration Reaches to retrieve objects Starts to search for lost toys Imitates actions Cause/effect of movements (emerging) More interactive
9-10 mos
Prefers complex toys Recognizes color/form Actions become intentional Depth perception emerges Identifies body parts by pointing
12-15 mos
Symbolic play emerges Object permanence Uses simple objects (tools) Reaches without looking Following simple instructions Ambulatory
2 to 5/7 years
pre-operational thinking Pre-logical thinking and magical thinking Connections between events are made based on closeness in time (arent necessarily true)
5/7-9/11 yrs
Concrete operations Logical thinking Still can not complete reverse operations
Myth # 2
Eating is instinctive
2 -3 mos
steady head control achieved
4-6 mos
beginning of hand to mouth play (independent and exploration of objects); increased reaching skills, reaches for spoon when hungry
6-7 mos
Trunk control sufficient for independent sitting for greater than 3-5 sec Stable head control in sitting (no head bobbing) Transfer toys and food from one hand to the other
8-10 mos
Trunk rotation and weight shift Beginning to move in and out of positions Voluntary release patterns Uses fingers to rake food toward self Puts finger in mouth to move food and keep it in
10-12 mos
Independent sitting in a variety of positions Pincer grasp developing Pokes food with index finger Uses finger to self-feed soft chopped foods
14-16
Efficient finger feeding Practicing utensil use versus effective use for volume Typically co-feeding with a parent
18-24 mos
Able to pick up, dip, bring foods to mouth Increasing utensil use (not efficient until after 24 mos) Scoops purees with utensil and brings to mouth
Myth #3
Eating is easy!
Preterm-Term
Organizing physiological system Maturing coordination of suck/swallow/breathe Development of flexion Maturing muscle tone Maturing motor modulation Organizing state stability and transitions
Birth to 3 mos
Soft palate & epiglottis are in contact (babies are obligate nose breathers likely due to obstruction) Larynx & hyoid cartilage are higher in the neck and closer to the base of the epiglottis Suction is created with tongue cupping and jaw movement to generate negative pressure
4-6 mos
Opens mouth when spoon approaches or touches the lips Initial difficulty moving food back; which is active rather than through changes in pressure Tongue used to move purees to back of the mouth for the swallow
4-6 mos
Tongue moves back and forth as food is introduced Suckling foods rather than phasic biting Able to keep foods in mouth vs being re-fed Munching pattern may appear near 6 mos
Nutrient adequacy of exclusive breastfeeding for the term infant during the first six mos of life (WHO)
Iron endowment (from mother) meets needs for 6 mos in term infants; Outside source of iron needed to prevent iron deficiency after 6 mos; Zinc is more bio-available in breast milk; Zinc stores need to be replenished by 6 mos
WHO source Nutrient adequacy of exclusive Breastfeeding for the term infant during the first months of life http://whqlibdoc.who.int/publications/9241562110.pdf see also: Zlotkin, S.H. (2002), Iron, Zinc, and Calcium; fundamental nutrients for infants and young children. Pediatric basics, 97, 12-20.
7-9 mos
Lip closure supports movement of bolus to pharyngeal area Able to bring top lip down on spoon to remove foods (clear the bowl)
Spoon technique
Use infant feeding spoon (small bowl, long handle) Parent brings spoon straight-on, into the front of the mouth (not sideways) Parent stops spoon when just inside the lips, with spoon tip approximately at the tip of the tongue (or slightly further in, if need to work on tongue cupping) As child closes lips around the spoon, parent draws spoon straight back (no dumping, scraping onto the palate)
7-9 mos
Consistent tongue lateralization seen when foods presented to sides of tongue; Mature tongue lateralization emerging Active movement of foods from side of mouth to central tongue groove and back
7-9 mos
Able to transition to slightly more texture (small bumps) With assist, able to break off pieces of meltable foods Chewing (munching) of softer foods
10-12 mos
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 occurs, without difficulty
*gross motor crossing midline milestones?
12-15 mos
Chews and swallows firmer foods w/o choking Chews foods that produce juice Able to keep most bites in mouth during chewing
16-24 mos
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 texture hardness
16-24 mos
Working on increasing speed and efficiency Chewing strength improves Better able to manage hard-to-chew foods
Myth #4
Sensory Development
Flavor facts
Flavor of amniotic fluid reflects flavor of mothers diet
(detected by fetus in the 2nd trimester)
Flavor of mothers diet in the last trimester impacts newborns responses to similar foods after birth
(eg. orients to garlic as newborn if Mother ate regularly in last trimester)
Olfactory Milestones
Eating
is the
The End