Please Take a Bite!! Decreasing Challenges during MealtimesApril 4, 2014

Presented By:

Amanda Beamer OTR/L Pinnacle Health Infant Development Program

Kera Fringer, M.S. CCC-SLP Pinnacle Health Infant Development Program

Joanne Kliss, M. Ed.,OTR/LCapital Area Intermediate Unit

Kristen Owen, D.PT Pinnacle Health Infant Development Program

Please Take A Bite!

A Review of Feeding MilestonesAnd

Strategies for Successful Mealtimes

Amanda Beamer OTR/Labeamer@pinnaclehealth.org

Nutrition Formula Feeding Guidelines

Age Avg. # of

Feedings per day

Avg. Amount per Feeding

Birth-1 wk 6-10 2-3 oz.

1 wk-1 month

7-8 2-4 oz.

1-3 months 5-6 4-5 oz.

3-6 months 4-5 6-7 oz.

6-9 months 3-4 7-8 oz.

9-12 months

3 7-8 oz.

Milestones for 0-4 Month Olds

Feed only breast milk or Formula by bottle or breast

Feeding occurs at breast, cradled in caregivers’ arms, side lying, or facing feeder

Recognizes nipple or bottle by sight and turns his head toward the nipple

Brings hands to mouth and sucks on fingers Coordinates suck, swallow breathe at 2-3

sucks before swallowing

0-4 Month Old Strategies Create a calm and quiet environment Never prop a bottle; encourage baby to hold the bottle by

guiding their hands to the bottle; feeding time is a great time to bond with your infant

As your infant gets older try to keep them awake during their feedings and do not put them to bed with their bottle

6 wet diapers per day is a good sign that your infant is getting adequate amounts of formula/breast milk

If changing formulas you may try titrating the new formula into the old formula; discuss all formula changes with your doctor

Provide stimulation around your child’s mouth by introducing textures on your fingers and massaging around their mouth

If your infant is showing leakage during feedings alternate his position

Bottle feedings should not last more than 20 minutes

4-6 Month Milestones

Iron fortified rice cereals begin to be introduced if your child is able to sit with support

Begins to accept mild fruits and veggies in puree form

Continues breast/bottle feedings Spoon is introduced Chewing patterns begin to emerge Begins to pat bottle with one or both hands Opens mouth when spoon is presented

**Always check with your pediatrician before offering new foods

4-6 Month Old Strategies When beginning infant cereals start with a thinner

consistency and work up to a thicker consistency Allow your child to begin closing their mouth on

the spoon to remove the food Explore a variety of spoons that are smaller than

an adult sized spoon, shallow spoons work well Apply slight pressure to the back of the tongue to

prevent tongue thrust Face your child when feeding them and show

excitement when he accepts a bite Allow your infant to explore new foods with their

hands, by placing some on his tray before mealtime

Add a spoonful of pureed fruit/veggies to your infant cereal to begin to change taste

Alternate between a consistent taste and new taste when introducing a new taste

Allergies

When beginning to introduce foods from a spoon, it is time to start looking for signs of allergic reactions

It is best to begin with rice cereals because there are less allergens

Introduce a new food and wait three days before introducing the next new food

Signs of Allergies Rash Diarrhea Runny nose Vomiting

**Speak with your child’s pediatrician about any allergy concerns; every child is different

6-9 Month Old Milestones

Primary nutrition continues to be from formula/breast milk

Begins to accept finely chopped, soft fruits and veggies when your infant has teeth

Able to sit in a highchair with some assistance Begins to accept a cup held by an adult Chews using a side to side tongue movement Clears food from a spoon At 9 months begins to swallow with lips closed Begins to feed himself dissolvable solids using

fingers

6-9 Month Old Strategies

Gradually add lumps and fork mashed fruits and veggies to purees

Don’t give up when your child refuses a food; continue to offer it.

Make mealtimes happy and use positive praise Portions are small. May want to offer smaller

meals/snacks more frequently. Open cups can be introduced to assist in lip closure.

Can try in the bath tub to prevent spilling and use of a small medicine cup

Offer hand over hand help to help child bring dissolvable solids to their mouth

Remove valve from sippy cups

9-12 Month Old Milestones

Whole cow’s milk can be introduced at 12 months (discuss with your child’s pediatrician)

Able to sit in a high chair Takes teething biscuits, dissolvable solids,

ground/mashed foods At 9 months swallows with mouth closed Improved ability with cups Reaches for spoon and will bang spoon when

grasping Finger feeds many soft foods Begins to hold cup/sippy cup

9-12 Month Old Strategies Add fork mashed fruits and veggies to puree, slowly

decrease puree that is added Alternate between textured bite and non-textured

bites Make slow changes to textures if your child is

hesitant with new foods If your child is resistant to the spoon, you may need

to take a break from the spoon. Use other foods as a spoon.

If your child is not showing interest in accepting foods by spoon; promote the feeling of hunger by limiting drinks before mealtimes. Offer liquids after the meal.

Try to avoid stage three foods; ground and fork mashed soft foods provide more nutrients and help to avoid surprise textures.

12-18 Month Milestones May begin to reject the

bottle/breast Improved use of the cup Accepting soft table foods Feeds self with fingers Begins to self-feed using a

spoon Use upper lip and front

teeth to clear food from spoon

Bites through soft foods Drinks from a straw Picky eater concerns may

develop

12-18 Month Old Strategies Begin to offer straws; juice boxes; self-priming straws Help your child scoop food and guide to his mouth using

hand over hand help and by positioning yourself behind your child so your child can see their hand holding the spoon

Place food on their fork and allow them to bring to their mouth

Use spoons and forks in play Create a calm environment Keep objects familiar and a consistent routine Keep your child’s tray simple and serve small portions so

your child does not become overwhelmed Embrace the mess, encourage touch and play in new

foods. Use fun and positive words to describe the foods they are touching.

Always include a food that is consistent.

12-18 Month Olds

• Mealtimes should be limited to 20-30 minutes• An egg timer can be

introduced to end the meal• Snack times are a good

time to work on new food introduction, so that the mealtime is not disrupted

Bottle Weaning

Toddlers between the ages of 15-18 months are more likely to become attached to objects

Around 9 months offer bottles after meals and snacks, except in the morning and at bedtime

Around 11 months remove one bottle and offer a snack instead

Around 12 months the bottle should primarily be in the morning and at bedtime

First bottle to eliminate should be the lunch bottle; offer your child’s milk in a cup instead

At breakfast begin to wean the morning bottle and offer a breakfast of table foods with in 30 minutes of waking

Bottle Weaning Continued If your child is over the age of 2 ½ you may want to try

having the “bottle fairy” visit your home Prevent your child from walking around your home with

the bottle or falling asleep with the bottle; this may harm their teeth

Do not offer juices or flavored milks from bottles; limit these liquids to sippy, open or straw cups

Always offer sippy, straw and open cups at meals beginning at 9 months

After your child is weaned; remove all bottles Redirect your child to an exciting activity when they

request the bottle If your child is older begin to warn your child that it is

about time to be a “big boy” and give up his bottle Make night time bottles less inviting by adding water

to milk

18-24 Month Old Milestones

May give up bottle Efficient with cup Takes harder and chewy table foods May sit in a booster seat or child

sized table Efficient rotary chew Bites through a variety of foods Brings spoon to mouth with palm up

18-24 Month Old Strategies Allow your child to help choose

foods at the grocery store Allow your child to help in the

kitchen; give them their own bowl to mix

Use positive reinforcement and first, then statements

Eat meals as a family so your child can have positive role models

Offer foods on fun divided plates or in muffin tins

Offer dipping sauces Have a consistent meal routine

24+ Month Milestones

Mature chewing pattern Drinking and swallowing skills are

complete Uses cup efficiently Eats regular table foods Use a fork and spoon efficiently

Calorie Boosters

Butter/Vegetable Oil (35-40 calories/tsp) Wheat Germ (25 calories/tbsp) Powdered Milk (25 calories/tbsp) Powdered Cheese Cream Cheese (50 calories tbsp) Heavy Whipping Cream (50 calories/tbsp) Avocado (75 calories per ¼ avocado) Pediasure (speak with pediatrician) Carnation Instant Breakfast

Resources and References

www.sleeplady.com www.gerber.com www.similac.com Klein, Marsha Dunn and Delaney, Tracy. Feeding and

Nutrition for the Child with Special Needs. www.Amazon.com

Benders Spoons by Boon Munchkin Trainer spoons Learn and Turn Adjustable Spoon and Fork Beaba Rotating Spoon Suction Bowls