Question & Answer - Feeding, Eating, & Drinking
What do parents need to know when feeding their children from birth to 12-months of age?
Interview with Diane Bahr (DB) by Dr. Teresa Signorelli (TS) of Kids A to Z with Dr. T (October 2014)
The following is a summary of a radio interview with Diane Bahr by Dr. Teresa Signorelli of Kids A to Z with Dr. T. You may listen to the actual interview by clicking on the “radio interview” link in the previous sentence.
In the interview, we discuss some information from the book Nobody Ever Told Me (or My Mother) That! Everything from Bottles and Breathing to Healthy Speech Development. This book was written as a resource for both parents and professionals (e.g., speech-language pathologists, occupational therapists, orofacial myofunctional therapists, lactation consultants, pediatricians, dentists, nurses, early interventionists, and others). It contains many detailed checklists and practical techniques that parents and others can use to keep kids “on track” in feeding, speech, and mouth development.
TS: Would you tell us who you are and what you do?
DB: I’m a speech-language pathologist, specifically trained in feeding therapy, with 35 years of experience. I’ve authored two books Oral Motor Assessment and Treatment: Ages and Stages and Nobody Ever Told Me (or My Mother) That! Everything from Bottles and Breathing to Healthy Speech Development. I’ve taught undergraduate, graduate, continuing education, and parent education courses. I’m also the co-owner of Ages and Stages®, LLC (Resources for Feeding, Speech, and Mouth Function) where our mission is to provide the best possible feeding, speech, and mouth development information for families and professionals. Our goal is to prevent feeding, speech, and mouth development problems when possible by helping parents keep their children “on track” developmentally.
TS: What is the most common question you find parents often ask about feeding?
DB: “When can I feed my child regular foods, and how much do I feed them?”
TS: What are parents often surprised to learn regarding feeding as their children develop?
DB: Parents are often surprised that:
-Children can eat regular foods much earlier than baby food jars recommend.
-Baby food, particularly Stage 1 baby food, contains a lot of water, which is good for hydration but may not provide adequate nutrition.
-Children who aren’t introduced to appropriate food tastes and textures “on time” often become picky eaters.
-Children frequently don’t seem to like a food the first time they experience it.
-Children need to see others eat and drink as role models.
TS: Tell us about how feeding develops in early child development, hitting major milestone ages as appropriate. For example:
-Birth to 3 months
-3 to 6 months
-6 to 9 months
-9 months to 1 year
DB: Feeding development evolves in 3-month periods from birth to 24 months. I’m going to tell you about some of the milestones I’ve listed in charts in my book Nobody Ever Told Me (or My Mother) That! Everything from Bottles and Breathing to Healthy Speech Development. Pages and chapters listed below refer to those in my book.
During the birth to 3-month period (pp. 46-48) a baby:
-Roots to find the breast and/or bottle (if the parents use paced bottle feeding, pp. 25-26)
-Is fed breast milk and/or formula
-Moves from reflexive suckling to long bursts of purposeful sucking (e.g., 20+ without a pause)
This is a significant period of mouth development (Chapter 8). The mouth is shaped through feeding and mouthing experiences. For example, when the breast is drawn deeply into an infant’s mouth, it helps to keep the hard palate’s nice broad shape. Unfortunately, bottle feeding doesn’t offer the same advantage. This is a time when some children develop high, narrow palates which may require remediation later on through orthodontic or orthotropic work.
During the 3 to 6-month period (pp. 47-51), a baby’s mouth continues to develop. The baby:
-Develops a three-dimensional suck (where the tip and sides of the tongue move upward giving the tongue a nice bowl shape, the lips are puckered, and the cheek and jaw muscles begin to do the work that the fat pads were previously doing). The fat pads in the cheeks usually go away during this period.
The baby’s mouth and digestive systems are getting ready for the introduction of non-wheat baby cereals, pureed and well-mashed foods, and soft non-wheat baby cookies (e.g., arrowroot) between 4 and 6 months (pp. 181-182). Teeth may begin to emerge between 5 and 6 months with increased biting and chewing experiences on toys and appropriate first foods.
During the 6 to 9-month period, a baby can be introduced to many new feeding experiences. This is the time when spoons, open cups, straws, taking bites of appropriate foods, and chewing are best introduced. You’ll find specific guidelines and techniques for teaching these activities in my book (Chapter 6).
When introducing new foods, it’s a good idea to introduce one new food at a time watching for any reactions that may indicate sensitivities (e.g., wheezing, sneezing, coughing, stomach pain, reflux, belching, diarrhea, or rash). Information on sensitivities and other health concerns can be found in Chapter 3 of the book.
Parents also want to know how much soft solid food to feed a child (pp. 186-188). The rule of thumb is 1 tablespoon per year of age for the recommended number of servings in each food group. Depending on the food guidelines you follow, this could mean 6 servings of grain, 5 servings of fruits and vegetables, 2 servings of meat or protein, and 2 to 3 servings of dairy (once the child can have dairy).
During the 6 to 9-month period (pp. 202-205) babies:
-Open their mouths just enough for the spoon to enter
-Start using the upper lip to clear food from the spoon
-Can pick up pieces of food with the fist and pass food from one hand to the other
-Begin moving the jaw just enough to match the shape and size of the food in the mouth
-Use their lips and cheeks to hold food within the mouth
-Begin to move their tongues toward food placed on the gums
-Begin getting a couple more teeth with appropriate chewing and biting experiences
Therefore the baby is ready for a number of foods between 6 and 8-months (pp. 182-183):
-Milled, blended, or well-mashed fruits and vegetables that are well-cooked with soft lumps and given from a spoon
-Wheat-free baby cereal, wheat-free soft cookies and crackers
-Cooked sticky rice
-Sips of water and very diluted fruit and vegetable juices in an open cup (held by an adult) or a straw cup in addition to breast milk and formula
Between 7 and 10-months, you can introduce (p. 183):
-Chopped cooked fruits and vegetables, including canned fruits but not citrus
-Mashed cooked beans and tofu
-Wheat and corn products
During the 9 to 12-month period (pp. 206-207), babies:
-Begin to hold and bang the spoon
-Begin to pick up small pieces of food with the thumb and fingers
-Can break off cookie and cracker pieces with their hands when cookies or crackers are held by their jaws
-Move the jaw in an increasingly mature manner to match the shape and size of the food
-Move food from the center of the tongue to the gums for chewing
-Can drink from a straw-cup or from an open cup (held by an adult) with consecutive swallows (i.e., swallow after swallow)
During the 9 to 12-month period (pp. 183-184) you can introduce:
-Soft, cut-up cooked and raw foods while slowly introducing citrus
-Cooked fruit and vegetable strips
-Soft, chopped meats (e.g., stewed meats)
-Casseroles with noodles, pasta, and rice
-Bread, toast, crackers, and dry cereal
-Eggs (yolks at 9 months, whites at 12 months)
-Soft cheese strips, cottage cheese, and baby yogurt
During the first year, the baby’s jaw, lips, and tongue are growing and changing significantly. Much of this growth is facilitated by the parent providing good and appropriate feeding and mouthing experiences for the baby. Good biting and chewing experiences are important for jaw and tooth development (Chapters 4 and 8).
As you have heard, many feeding skills develop in the 6 to 12-month period. Therefore, if children are not exposed to a variety of tastes and textures in the 6 to 12-month period, they may become “picky eaters.” And, I have seen this frequently in my clinical practice.
Feeding development continues through 24 months. By 24 months a child’s feeding skills are just about the same as yours and mine. The 12 to 24-month period is a time for the refinement of the feeding skills begun in the first year. You can find these and others specifics about the critical learning period for feeding (i.e., birth to 24-months) in my book (Chapters 2 and 6).
TS: Let’s talk about some of the feeding trouble we might see developmentally. What is the most common problem?
DB: In my opinion, the most common problem is that parents aren’t sure when and how to introduce spoon-feeding, cup-drinking, straw-drinking, as well as different food textures and tastes. Then parents may have children who become picky or selective eaters, a detriment to good nutrition and overall health. This is information that feeding therapists know, but the typical parent or pediatrician doesn’t likely know. This is not the parent’s or pediatrician’s fault as they are typically not provided with specific instruction in these areas. Again, this is one reason I wrote my book which contains specific instructions on how and what to feed a child as he or she progresses through the various feeding stages (Chapters 2 and 6).
TS: What should parents do if they suspect a problem?
DB: If the problem is considered minor, parents can refer to books such as mine. If the problem is significant, parents should work with their pediatrician and a feeding specialist.
TS: What other allied health professionals are also involved in helping children feed safely and adequately?
DB: If a mom is having difficulty with breastfeeding, I would recommend an International Board Certified Lactation Consultant (IBCLC) certified by the International Lactation Consultant Association (ILCA). Feeding therapists usually come from the fields of speech-language pathology and occupational therapy. Some are board certified by their associations; however, many feeding therapists have been trained by other feeding therapists and have gotten their experience “on the job.” Information about the various allied health professions and teams who work with children who have feeding problems can be found in Chapter 9 of my book.
TS: You have a wonderful website and networking program for families and related professionals called “Ages and Stages” that provides resources for feeding, speech, and mouth function. Would you talk to us about this?
DB: As previously mentioned, our mission is to provide the best possible feeding, speech, and mouth development information for families and professionals. We do this through blogs, Q & A’s, and other formats. Our goal is to prevent feeding, speech, and mouth development problems when possible by helping parents keep their children “on track” developmentally through the application of evidence-based feeding information. As a speech-language pathologist, I have worked with many children who have disabilities, but I noticed that parents of typically developing children also needed the information we have (as feeding therapists) to keep their kids “on track.” On our website where we offer free age guides and topic guides to go along with my book in addition to a lot of other free information.
TS: You also have a number of publications and host trainings. Would you tell us about these projects too and how to access them?
DB: In addition to my two books, I have written a number of journal and popular articles for parents, families, and professionals. These are listed on my website. I also teach a two-day professional workshop entitled Treatment of Feeding, Speech, and Mouth Function in Pediatrics which is available online. In addition, I teach an E-course on the topic of newborn and infant mouth development entitled Everything You Need to Know about a Baby’s Mouth for Good Feeding, Speech, and Mouth Development. Information on all of these projects can be found on my website.
TS: Finally, as we close our show would you list your top “Five Fabulous Facts for Families” to provide safe, healthy, and pleasant feeding experiences for their children?
DB: -Introduce one new food taste or texture at a time, and don’t be concerned if your child doesn’t like the food the first time he or she tastes it. It may take 10 to 15 presentations of a new food before a child begins to show interest in it.
-Don’t make negative comments or faces when feeding your child. Babies understand more than you think. However, if the food tastes “yummy,” say something about that.
-Be a good role model, and eat something (like a snack) with your baby. Children are great imitators and learn by seeing others do the same activities.
-Give your child a good variety of foods, so he or she doesn’t get “stuck” in eating the same foods over and over. For example, homemade baby foods can be made by grinding and storing foods you previously had during a meal.
-BE INFORMED, and introduce food tastes, textures, and utensils “on time.” Keep your child “on track” in feeding development.
In closing, I would like to thank YOU, Teresa, for giving me the opportunity to speak with parents about feeding on your show. I would also like to emphasize that parents should always speak with their pediatricians about the methods and resources they are using. In my book I make it clear that I am educating parents and not giving medical advice. I also believe that parents know their children best and should trust their own judgment once they have the information they need.
Bahr, D. (2010). Nobody ever told me (or my mother) that! Everything from bottles and breathing to healthy speech development. Arlington, TX: Sensory World.
Permission granted by Dr. Teresa Signorelli of Kids A to Z with Dr. T for printing this summary of the radio interview with Diane Bahr.