Speech Language Pathologist Ensign Little Elm, Texas, United States
Abstract: Pre-feeding skills include the gross motor, fine motor, and cognitive skills that precede pediatric feeding and swallowing development. Pre-feeding skills can be utilized in the evaluation and treatment of pediatric feeding and swallowing disorders to assess current feeding abilities, facilitate further development of feeding skills, and provide comprehensive feeding therapy.
Description: The topic of pre-feeding skills was established by Morris and Klein (2000) and can be described as the gross motor, fine motor, and cognitive skills that develop around six months of age. Pre- feeding skills facilitate the oral-motor development necessary for an infant to safely and efficiently consume solid foods. These skills include the infant signaling that they are hungry, sitting upright, opening the mouth, bringing food towards the mouth, leaning toward food, taking social pauses, and exploring the sensory element of food.
The introduction of solid foods, defined as anything other than milk, to an infant is recommended by the American Academy of Pediatrics to begin at no sooner than six months of age. According to Bahr (2018), at six months of age the infant’s oral-motor skills and digestive system is getting ready for baby cereals, or soft crunchies, and pureed, or well-mashed, foods. This readiness is determined by the gross motor and fine motor development that also happens around this time. The infant should be sitting up to put them in a position to be able to eat from a spoon or drink from a straw or cup. The infant should also be able to hold open their jaw and tongue in anticipation for food. Furthermore, the infant should demonstrate increased biting and chewing activity through appropriately mouthing toys. More specifically, according to Franker and Walbert (2003), an infant’s jaw movement around six months should decrease and lips should be more firmly approximated in order to safely swallow thicker consistencies of food. These gross motor and fine motor skills align exactly with the pre-feeding skills described by Morris and Klein (2000).
Why would a speech-language pathologist care about pre-feeding skills? How could the knowledge of pre-feeding skills aid in the assessment of current feeding abilities, creation of a comprehensive care plan, and the implementation of effective evidence-based techniques in feeding therapy?
These questions, and more, are essential in the continual development of the field of speech-language pathology. While pre-feeding skills may not answer all of the questions, it can be a powerful tool to scaffold on in the evaluation and treatment of pediatric feeding and swallowing disorders. Speaking from personal experience, the knowledge of pre-feeding skills can help speech-language pathologists to determine what a patient’s “next step” is or what skill to target next in therapy in order to facilitate diet upgrades and feeding skill development. It can also support speech-language pathologists in considering a more holistic and comprehensive picture of a patient, that may include the involvement of other therapeutic disciplines or referrals to different medical specialists.
Presentation Format & Methods: Powerpoint with interactive components and videos.
Supporting Research: Reference 1: Morris, S. E., & Klein, M. D. (2000). Pre-feeding skills: A comprehensive resource for mealtime development (2nd ed.). PRO-ED, Inc.
Supporting Research: Reference 2: Carruth, B. R. & Skinner, J. D. (2002). Feeding behaviors and other motor development in healthy children (2-24 months). Journal of the American College of Nutrition, 21(2), 88–96. https://doi.org/10.1080/07315724.2002.10719199
Supporting Research: Reference 3: Bahr, D. (2018). Feed your baby & toddler right. Future Horizons, Inc.
Supporting Research: Reference 4: Franker, C. & Walbert, L. (2003). Evaluation and treatment of pediatric feeding disorders: From NICU to childhood. PRO-ED, Inc.
Supporting Research: Reference 5: Giannì, M. L., Sannino, P., Bezze, E., Comito, C., Plevani, L., Roggero, P., Agosti, M., & Mosca, F. (2016). Does parental involvement affect the development of feeding skills in preterm infants? A prospective study. Early Human Development, 103, 123–128. https://doi.org/10.1016/j.earlhumdev.2016.08.006
Learning Objectives:
Define pre-feeding skills
Identify gross motor, fine motor, and cognitive developmental milestones important for feeding development
Describe pre-feeding skills as it relates to pediatric feeding development
Describe consideration of pre-feeding skills as it relates to the evaluation and treatment of pediatric feeding and swallowing disorders