Oral Motor/Feeding Milestones

Below is an overview of typical feeding development. Remember to consider your child’s motor skill development in relation to feeding skills and not just their chronological age.

Term babies: reflexes (rooting, gag, etc.)

0-3 Months (Newborn)

Feeding Skills

• Latches onto nipple or bottle
• Tongue moves forward and back to suck
• Sucks and swallows well
• Liquids only (milk/formula); cannot digest other types of food
• Oral reflexes begin to develop
• Feeding become more of a voluntary process
• Hand on bottle during feeding (2-4 months)
• Emission of crying sounds, vowel sounds, smiling and making gestures when talked to in "singsong" voice

Motor Development:

• Very little neck and head control
• Use facial expressions to indicate likes/dislikes
• Use both their hands and mouths to explore objects
• They will bring their hand to their mouth and will start to grasp objects and bring them to their mouth

What You Can Do:

• Babies need to be supported while being fed.
• Play with your baby through opening your mouth and waiting for them to imitate.
• Offer baby toys for them to practice grasping and exploring with their hands and mouth (be mindful of choking hazards – no small parts!).

4-6 Months (Supported Sitter)

Feeding Skills

• Shows interest in food & opens mouth when spoon approaches
• Begins to eat cereals and pureed food. Smooth, pureed food (single ingredient only).
• Moves pureed food from front of mouth to back
• Taste preferences rapidly learned
• Feeding in a more upright position
• Lateral tongue movement (horizontal movement of the tongue)
• Spoon feeding with thin, smooth purees
• Both hands are introduced to hold the bottle
• Finger feeding is introduced
• Munching patterns are developing (Vertical munching of easily dissolvable solids)

Motor Development:

• May keep one or both hands on the ground while sitting
• Stronger core and more control over their neck and head movement, which is important for introducing solids
• Turns head towards or away from food
• Reaches towards food when hungry

What You Can Do:

• Introduce a wide variety of tastes but do not force-feed – caution – introduce a new food every 3-4 days to help identify any possible allergies
• Present foods and wait for your child’s cues (ie. open mouth, turning head)
• Respect child’s refusal cues as well to help with development of their regulation
• Keep mealtimes fun; your child may refuse food in response to stressful mealtime interactions

7-9 Months (Crawler/Independent Sitter)

Feeding Skills

• In a highchair, holds and drinks from a bottle
• Begins to eat thicker pureed and mashed table foods.
• After the introduction of lumpy solids, infants can co-ordinate all of their mouth movements; sucking, biting, and up and down munching (Early chewing can develop before the teeth have erupted as the gums are hard from the teeth within them)
• Remains full longer after eating
• Strong reaction to new smells and tastes
• Cup drinking can be introduced slowly
• Eating lumpy & mashed foods
• Increased jaw stability allows for chewing easily dissolvable solids
• Development of rotary chewing (jaw moves in a circular motion to grind food)

Motor Development:

• Sits up without touching their hands to the ground
• Starts to look and reach for objects, such as, food that is nearby

What You Can Do:

• Ensure your child is well supported in their high chair, and place bottle in midline in front of them so they can practice picking it up to feed themselves.
• Offer chew toys that can massage sore and swollen gums during teething
• Allow your child to explore foods with their hands (it’s ok to get messy!) and to self-feed
• Offer child-size spoons for your child to explore and play with
• When first introducing thicker purees, mix with a thinner puree.

10-12 Months (Beginner Walker)

Feeding Skills

• Finger feeds self
• Eats an increasing variety of food
• Begins to use an open cup and can drink from a straw
• Ready to try soft-cooked vegetables, soft fruits, and finger foods
• Might be ready to start self feeding with utensils
• Enjoys a greater variety of smells and tastes

Motor Development:

• May begin learning how to use utensils during mealtimes
• Can start using an open cup
• Spills are expected and it will take practice

What You Can Do:

• Your child may be distracted by toys during mealtime. Keep mealtime fun by engaging with your child as they feed
• Continue to respect your child’s satiety cues (turning away, pushing or throwing food)
• Model using utensils and give your child time to try self-feeding on their own, use child-sized utensils with short thick handles – it takes practice!

12 Months and Up (Independent Walker)

Feeding Skills

• Increases variety of coarsely chopped table foods
• Holds and drinks from a cup
• Improved biting skills
• Uses tongue well to move food from side to side in the mouth
• Imitates adult eating
• Child has developed basic the oral motor skills needed for feeding
• Open Cup drinking can be normalized
• Self feeding is initiated (grasping spoon) with firmer foods (cheese,fruits, etc.)
• Drinking with 4-5 consecutive swallows
• Swallowing with lip closure
• Rotary chewing of a broad range of foods
• Up and down tongue movements persist

Motor Development:

• Fully walking and exploring everything, including food!
• Should be able to eat more of the same foods as adults and more easily use utensils.

What You Can Do:

• Continue to structure mealtimes and enjoy eating with your child – as they will imitate your eating behaviours.
• You are in charge of what your child eats; but they decide HOW MUCH.
• Work on feeding skills during play time and bath time (ie. using spoons & cups to practice scooping & pouring water)

By 24 Months (~2 Years)

Feeding Skills

• Swallows well from a cup
• Swallows food well with no loss of food
• Chews with jaw movements in all directions (round and round, up/down and side to side)
• Knows the difference between food and non-food items
• Scoops foods with a spoon, with some spills
• Starts to stab food with a fork and bring it to her mouth
• Shows clear likes and dislikes of some foods

Between the ages of 2 and 3 years of age:

Feeding Skills

• Eats the same foods as the rest of the family
• Feeds well with utensils
• Has definite food likes and dislikes & refuse certain foods
• Possibly start to become a “picky eater” (see post next week!)
• Wipes own mouth and hands with a napkin or cloth
• Starts to serve themselves at the table with some spills
• Pours liquids into cup from a small container

****Foods such as grapes and hot dogs must still be cut in smaller pieces to avoid choking. It is important to continue to make meal times a fun and enjoyable experience for your family. Children will continue to practice and “fine-tune” their feeding and motor skills. 

If you have any concerns with your child’s development of the above feeding milestones, please contact a Speech Language Pathologist (SLP) for a full evaluation. 

Red Flags for Feeding Difficulties 

If your child is exhibiting any of the following signs, it is important to reach out to a skilled and experienced Speech Language Pathologist (SLP)

• Arching body during feeding
• Coughing or choking during feeding
• Eyes watering during feeding
• Being very irritable/fussy during or after feeding
• Taking a really long time to feed (more than 30-45 minutes)
• Frequent spitting up/reflux 
• Frequent chest infections or pneumonia 
• Gurgly, hoarse, or breathy voice after eating
• Less than desired weight gain or growth
• Leaking food or liquid from the mouth
• Coughing, gagging, or vomiting during or after meals
• Overstuffing mouth with food
• Pocketing food in mouth 
• Refusing new textures of food
• Avoidance behaviors to specific foods and textures (gagging, vomiting, blocking the spoon with hands or closed lips, crying, pushing food away, etc)
• Abnormal bowel movements that last longer than a few days (diarrhea, constipation, loose stool)
• Skin reactions to foods (dry patches, hives, rashes) Note: If your child seems to be having a severe allergic reaction to a food (difficulty breathing, turning red, developing hives or rash on the face/chest), you should seek medical help immediately.

If you are concerned about your child’s feeding development, contact your Pediatrician and/or schedule an assessment with a Speech Language Pathologist/Feeding Specialist.