FEEDING- Introducing Solids

Conditions that may lead to feeding and swallowing disorders

• Being born prematurely or having a low birth weight
• Reflux
• Breathing difficulties such as asthma
• Cleft lip or palate
• Hypotonia- affecting oral-motor skills
• Medicines that reduce appetite or make the baby drowsy
• Sensory issues
• Diagnoses- CP, Cystic Fibrosis, Down’s Syndrome, ASD

During the early stages of introducing solids, the goals are to improve oral motor skills, establish safety, maintain positive associations with eating and to develop a diet with a wide variety of foods.

4 Phases of Swallowing
1. Anticipatory Phase: This is the “getting ready” phase
2. Oral Phase: Oral Preparatory and Oral Voluntary- This is where the food or liquid is manipulated in the mouth into a bolus and propelled backwards to exit the oral cavity.
3. Pharyngeal Phase: This phase begins with the initiation of the swallow reflex.
4. Esophageal Phase: This moves the bolus through the esophagus into the stomach.
** The Pharyngeal and Esophageal Phases are involuntary.

Introducing new textures
Before introducing new textures, first look for signs of readiness:
• Good head control- Baby can hold their head up and sit up straight while supported in a high chair
• Baby opens their mouth when the spoon approaches and can clear the spoon with their lips
• Baby has mastered thin purees – can swallow thin purees without gagging or choking, or tongue thrusting
• Baby shows interest in what parents or other children are eating
.

3 Stages of baby food — from purees to finger foods
Stage 1: Thin Purees (4 to 6 months).
Stage 2: Thicker consistency (6 to 9 months).
Stage 3: Soft, chewable chunks (10 to 12 months).

Texture Progression

NOTE: Pureed food feels safe for parents who worry about babies choking on whole foods. It is however important to introduce new textures and lumpy foods before a child is 9 months of age because studies have shown that delayed introduction of lumpy textures can lead to feeding difficulties and can affect a child’s food acceptance at a later age. 

Development of chewing

Hard Munchables
Typically introduced at 8 months. These are hard textured foods for oral exploration only- NOT FOR CONSUMPTION. Examples: carrot stick, lollipop, hard dried fruit sticks, celery sticks, bell pepper strips. Once a child can move their tongue around the hard munchable, they are ready to transition to textured table food. Moving hard solid food around their mouth helps to increase sensory awareness of the mouth and further develop their tongue movement.

Development of tongue movements
• Soft Mechanical – soft texture (soft exterior but maintains its shape), needs munching/grinding pressure to break it apart.
• Hard Mechanicals- harder textured exterior food, requires grinding/rotary chewing (circular chewing pattern) to break apart.

Chewing foods
Chewing requires a combination of lip, tongue and jaw movement. After the introduction of lumpy solids, infants can coordinate all of their mouth movements; sucking, biting, and up and down munching.  Chewing efficiency develops in response to different textured foods being offered. 

Tips for introducing new foods and new textures 

• Introduce one new food every 3-4 days to help detect potential food allergies. Wait approximately one month before proceeding to the next stage of solids.
• Let the child get messy.
• Tactile play with food between meals can increase comfort with new textures.
• Eat with the child, family meals create a positive mealtime relationship, allows the parents to model good mealtime behavior, and promotes language development.

Tips for picky eaters
• Present food in a variety of ways. Try new containers, cups, utensils, toothpicks or even a muffin tin with several choices.
• Offer healthy foods with something fun to dip it in to encourage a variety of colors, textures and flavors. Some dip ideas are ranch salad dressing, hummus, nut butters or chocolate hazelnut spread.
• Cut food in shapes, use cookie cutters or arrange food in a shape.
• Let your child feed themselves. It will be messy!
• Encourage positive interactions with food using the five senses: seeing, feeling, smelling, tasting and even hearing the sound of crunchier foods can help them enjoy eating.
• Offer targeted, healthy choices: do you want your sandwich cut in squares or triangles? Do you want sweet potatoes or peas?

Advantages of using a fresh food feeder to introduce solids

• You can introduce baby to new flavors, with a significantly reduced risk of choking.
• It provides opportunities for babies to explore sensory input all around the mouth, rather than just the front of the mouth like most teething toys. This is so important for oral development.
• It can teach babies to move their tongue side-to-side (lateralization) as the feeder moves from one side of the mouth to the other while they chomp with their whole jaw.
• You can use it to introduce foods to toddlers who are picky eaters, so they can try the flavor without having to deal with the texture or actually touch the food.

Sensory processing 

Adequate sensory processing
• Child is not averse to having food on face or hands during meals.
• Child eats a wide variety of tastes and textures.
• Child engages in messy play activities without distress.

Behaviors which typically reflect sensory processing difficulties