Question & Answer - Feeding, Eating, & Drinking

How can parents help their children eat and drink safely and successfully while avoiding the risk of choking?

ANSWER FROM Donna Edwards, MA, CCC-SLP, BRS-S & Diane Bahr, MS, CCC-SLP, CIMI

“Food is one of the frequent culprits resulting in choking, morbidity, and mortality in the pediatric population” (Edwards & Martin, 2011, p. 88). Every year, an average of 12,435 children (between birth and 14 years-of-age) are brought into the emergency room with “nonfatal food-related choking” episodes in the United States (Chapin, Rochette, Annest, Haileyesus, Conner, & Smith, 2013, p. 275). And, almost 40 percent of the cases are children under one year-of-age. These statistics do not include fatalities or those children with choking episodes that are not brought to the emergency department.

Children are, age appropriately, impulsive with food as they learn feeding skills, and many feeding skills develop during the first year of life. Safety is a priority to help children gain feeding skills comfortably and successfully. And, there are several steps parents and other caregivers can take to keep children safe during feeding development.

Learn about Feeding Development

Feeding is a complex developmental process, and parents are often not equipped with the information they need to help their children progress safely through the stages of feeding - despite all of the information on the Internet. So, parents and caregivers need an accurate and detailed checklist (based on developmental research) such as those developed by Bahr (2010, pp. 181-186) or Morris and Klein (2000, pp. 697-711).

Additionally, not all children develop at the same rate. So, a functional way of determining feeding expectations for children is to observe their skill development as they move from one milestone to the next. This approach is particularly useful for children who are at risk for developmental disabilities.

Be Sure You are Speaking the Same Language

Pediatricians do their best to provide parents with general feeding guidelines. However, parents and pediatricians may not be “speaking the same language.” For example, physicians often refer to pureed foods, like infant cereal, as solids. However, parents may think the term solids means “foods that require chewing.” There is a big difference between the management of baby cereal and the management of chewed foods. There is also a developmental progression from easily chewed foods to foods that require extensive chewing.

Supervise Children with Food and Liquid

Children need supervision to reduce the risk of overfilling their mouths and to avoid negative experiences such as gagging and choking. Careful supervision of oral intake can help a parent or caregiver make sure that foods are sufficiently chewed and a child’s mouth is cleared of food. Feeding children at family meals is a natural opportunity to supervise them. This also provides a child with crucial role models needed to learn feeding processes, as well as important mealtime social skills. Foods should not be offered while children are being transported in a vehicle.

Check Perceptions about Feeding Transitions

Parents have perceptions about the feeding transitions. For example, when a child drinks from a sipper cup or from a straw, this may seem like a successful transition from bottle drinking or breastfeeding to more mature drinking skills. Similarly, when a child consumes table foods, this may be perceived as a successful transition from pureed baby foods to adult foods. However, the quality and safety of new feeding skills is just as important as the transition itself. Therefore, check to see that a child is safe and comfortable with all feeding transitions.

Be Aware of Situations that Place a Child “At Risk” for Choking

Look at each child as an individual in terms of his or her own feeding development with regard to choking risk. If a child does not have the chewing skills expected at a chronological age, avoid offering foods that are too challenging for current chewing skills. Cut foods to appropriate sizes until the child can manage larger food pieces. Control portion sizes to reduce the chance that a child will overfill his or her mouth. Pay attention to the shape, size, and quality of food (e.g., width of food, ability of food to dissolve in the mouth, etc.).

Don’t Get Caught in the Baby Food – Table Food Gap

One must consider that marketing can influence our food selections for our children. An example is the gap between baby foods and table foods. Baby food labeling generally does not reflect typical feeding development and transitions. Baby foods are mostly convenience foods. They do not help parents and children make the transition to table food. That transition is left to parents. A detailed, developmental feeding checklist can help parents with this process (Bahr, 2010, pp. 181-186; Morris & Klein, 2000, pp. 697-711).

Don’t Get Caught by Utensil Marketing (Cups, Bowls, and Spoons, O My!)

Marketing can also influence the utensils we purchase to feed our children. For example, sipper cups were originally meant to transition a child from a bottle to a regular cup. Today, they are labeled with many ages and come in many forms. While sipper cups can reduce liquid spillage and are transportable, they encourage a persistent immature sucking pattern similar to bottle drinking and can leave sugary liquids in the mouth increasing possible tooth decay. Similarly, some spoons on the market are too wide or too deep and don’t encourage good lip movement for clearing the spoon.

Questions?

Feel free to contact Donna Edwards (edwardsd@childrensdayton.org) or your local feeding specialist if you have questions or concerns regarding feeding skill development. Donna is board certified in swallowing by ASHA’s Special Interest Division 13. Additionally, Diane Bahr’s parent book (listed below) contains research-based feeding development checklists and specific instructions to teach appropriate spoon feeding, cup and straw drinking, as well as taking bites of food and chewing.

References

Bahr, D. (2010). Nobody ever told me (or my mother) that! Everything from bottles and breathing to healthy speech development. Arlington, TX: Sensory World.

Chapin M. M., Rochette L. M., Annest J. L., Haileyesus T., Conner K. A., & Smith G. A. (2013, Aug. 1). Nonfatal choking on food among children 14 years or younger in the United States, 2001-2009. Pediatrics. 132(2), 275-281. doi: 10.1542/peds.2013-0260.

Edwards, D. K., & Martin, S. M. (2011). Protecting children as feeding skills develop. Perspectives on Swallowing and Swallowing Disorders (Dysphagia), 20(3), 88-93.

Morris, S. E., & Klein, M. D. (2000). Pre-feeding skills: A comprehensive resource for mealtime development (2^nd ed.). Austin, TX: Pro-Ed.