Transcript basic feeding skills for kids from 0

FEEDING SKILLS AND
NUTRITIONAL NEEDS OF
THE BIRTH TO THREE
POPULATION
 This is a 3 part inservice. The first will
address feeding skills development and
dietary needs, the second will address
red flags and when to refer to SP or OT,
and the 3rd will discuss bottle nipples,
utensils, and feeding tools.
Objectives
 Provide information on feeding skill
development in the birth to 3 population.
 Provide information on the nutritional
needs of the birth to 3 population as
supported by Primary Children’s
Feeding Clinics.
Birth to 3 Months
Breast feeding
 Bottle Feeding
 BREAST FEEDING
BOTTLE FEEDING
 Every 2-3 hours
 15 – 30 minutes
 Amount the child is
Every 3 hours
15 to 20 minutes
3-4 ounces at this time of
formula.
Typical formula is usually
attempted first
(similac/enfamil)
Specialty formulas will be
tried by pediatrician if
baby is vomiting,
irritable, seems to be in
pain (soy based,
elemental formulas)
Some mothers may
choose to bottle feed
pumped breast milk
taking is unknown
 Weight monitored
closely
 Children with cleft
palate will not be able
to breast feed
 Much more difficult
than bottle feeding
Newborn Feeding Skills
 The newborn infant is physiologically set up to
drink well and safely from the breast.
 Rooting reflex
 Sucking reflex
 Cheek pads
 Physiologic flexion
 Gag Reflex
Spontaneous suckling occurs with cupped
tongue, jaw depression and rhythmic sucking
while breathing after 15 -20 sucking bursts
Sucking a pacifier occurs at twice the rate as
nutritive sucking
 The newborn to 3 month old infant can
eat in a reclined position because their
oral structures are set up to protect them
from aspirating.
 At 2- 3 months the infant has a period of
lower muscle tone and the physiologic
flexion starts to diminish. At this time the
infant’s suckling patterns may seem less
efficient and more liquid may be lost at
corners of mouth.
 Reflux typically increases at this time in
all infants.
Gastro-Esophageal Reflux
Disease (GERD)
Treatment for GERD Zantac or Prevacid to decrease the
acidity of stomach contents.
 The child may still vomit but the stomach
content will not burn their esophagus.
 Avoid too much handling after meals
 Avoid positions that encourage too much
hip flexion after meals
3-5 months
 Sucking pattern is emerging at 3 months as the
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predominant pattern of getting liquid from the
bottle or breast by 6 months.
By 3 months the child has a long sequence of
suck/swallow/ breath -20 sucks in a row.
The child is now eating 6-8 ounces of breast
milk or formula per feed , every 3 hours and
can sleep through the night.
The control and strength the infant is gaining
through their neck and trunk are the base of
support for improved oral motor skills.
Infants need to be breast fed and bottle fed
in more upright positions.
 The infant is bringing objects and their
hands to their mouth more which helps
move the gag reflex back in their throat.
 Jaw strength and stability increase, lips
and cheeks are becoming more active ,
and tongue is developing more
variability in movement.
6 months
 As the infant develops the ability to sit
independently (though they still may use
their own hands for support)they are
able to eat from a spoon while seated in
supportive high chair.
Beginning spoon feeding
Infant sucks and suckles
food from spoon.
Tongue movements are
forward and back so some
food may be lost.
Gagging can occur with
new tastes and textures
up to 10 months of age.
Breast fed infants should
start with rice cereal as they need the iron supplement.
Begin 1st or 2nd food fruits or vegetables 2x per day.
SPOON FEEDING IS FOR THE PURPOSE OF TEACHING THE
CHILD TO EAT FROM A SPOON AND DOES NOT PROVIDE
ANY NUTRITIONAL VALUE.
7- 9 Months
 The infant has developed the ability to
sit without hand support and plays freely
in sitting.
 Spoon feeding should occur 3 times per
day.
 Provide a cup of breast milk or formula
at meals. They can take 1-2 sips from a
non spouted cup at this time.
7-9 months
 Finger foods can be offered at this time.
Start with something the child can hold
onto and place in their mouth like Biter
Biscuits or Zwiebac crackers.
 Meltable solids that can be held while
the child explores their mouth with this
item (towne crackers, graham crackers).
10-11 months
 The baby now has improved grasp and release patterns so
they can pick up smaller objects to place in their mouth.
 They can move tongue from side to side in their mouth to
place and retrieve foods
 Soft cubed foods can be provided: gerber fruits or veggies,
bits of muffins or nutragrain bars, cubed sized avacado,
overcooked squash, banana
10 months
 Bottle or breast feeding every 3 hours
 4 meals per day
 Meal time should include smooth pureed
food or baby food (not 3rd’s), some type of
finger food and a cup of breast milk or
formula.
 They can begin eating foods with milk in
them (if they do not have a milk allergy) but
should not be drinking milk as it does not
provide the same nutritional value as
formula or breast milk.
12 months
 The babies lips actively close around spoon with
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eating.
They can take 4-5 swallows from a cup at one time.
Jaw pressure is controlled on soft foods.
They are eating soft table foods 4-5 times per day.
They should move to a formula that is appropriate
for children 12+months if they do not have a lot of
variety in their diet
Whole milk can be used as a primary source of
nutrition if they have variety in their food choices
and their weight is appropriate for height and age.
(They should have tripled their birth weight by 12
months)
Things to Remember
 No honey, karo syrup or molasis before
12 months due to the risk of botulism
poisoning
 No eggs (except cooked into things)
prior to 1 year and then start with egg
whites and then move to yoke.
 No peanut butter before 2 years of age
(unless the child’s allergist has already
tested them for peanut allergy). Some
doctors are recommending no peanut
butter before 5.
When can a baby transition from a
breast or bottle to a cup?
 When their parents want them to.
 When they can drink their necessary
amounts from a cup.
13+ months
 TODDLER DIET
 5 Scheduled meals per day, offered every 3
hours.
 At each meal the toddler should be offered 1
tablespoon of protein, starch and fruit or
vegetable for each year of age they are.
 4-6 ounces of milk or toddler formula at each
meal and snack (The child receives the
majority of their nutritional needs from milk
or formula through 24 months of age)
Toddler foods are still very soft and can be
eaten without many teeth.
 As the child matures we want to add
more variety of foods to their diet.
 We would like children to have at least
10 different protein, starch and fruit or
vegetables that are consistently part of
their diet.
 Advancing a child’s diet in taste and
texture too quickly can contribute to
difficulties eating/accepting foods.
 Foods provided to a child should match
their existing oral motor skills.
 As children get older their foods should
be selected based on their feeding
skills, the foods nutritional value, and
the child’s taste preference.
 1 tablespoon of each protein, starch and
fruit or vegetable for each year of age
they are.
 20-30 ounces of whole milk until 2 and
then 2% (unless milk allergy where they
should be on a toddler formula).
Scheduling Meals and
Establishing Mealtime Routines:
 Children who graze will eat less.
 Children learn optimally within a routine
 Promotes appetite
 Decrease Anxiety with predictability
 This is essential to good nutrition and
good eating habits.
 No in between meal snacks and drinks.
 Children who graze will not take tastes of
new foods because they are not hungry
Medical Diagnoses that Impact
Feeding
 Prematurity
 Poor state control
 Oral structure differences
 Overall weakness
 Environmental impacts
 RespiratoryConditions
 Cardiopulmonary Problems
Craniofacial Abnormalities
 Cleft Lip
 Cleft Palate
Syndrome Related Craniofacial
Disorders
 Pierre Robin Sequence
 CHARGE association
 DiGeorge Syndrome
 Mobius Syndrome
 Beckwith Weideman Syndrome
 Goldenhars Syndrome
 Kabuki Syndrome
 Crouzon’s Syndrome
Gastrointestinal Issues
 Constipation
 Breast fed infants may stool every 3-6 days
before being considered constipated
 Bottle Fed infants stool every day to every 3
days before being considered constipated
 Toddler s should stool daily most of the time
 If this is not the case families encourage
families to contact their pediatrician about a
dosage of miralax
 GERD
 Esophageal Dysmotility
 Short Gut/Necrotizing Enterocolitis
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(NEC)
Bowel Obstruction
Liver Disease
Food Allergies/EE/EoE
TEF
Dysphagia
 Diets need to be modified based on the
results of a swallow study.
 Some of these children will not be
allowed to eat orally until dysphagia is
resolved (typically by time)
 Oral stimulation will need to continue
until ready to eat.
Extended Periods of Tube
Feeding
Why do infants/children get
tubes?
 They cannot get their nutritional needs
orally due to:
 Dysphagia
 Oral Motor Skills or strength that do not
support eating enough
 Ex: children with cerebral palsy, very young
children with down syndrome
 Physiologic or structural issues (stomach,
esophagus,oral) that do not support eating
enough or allow a child to eat a large amount
at any one time.
Specific Diagnoses where feeding
skills are impacted
 Cerebral Palsy
 Down Syndrome
 Seizure Disorder
Specific Diagnoses where
nutritional needs are impacted:
 Autism Spectrum Disorder
 Their feeding problems emerge from
sensory issues
 They limit their diet to create a routine that is
consistent and safe.
 Their food restrictions do lead to oral motor
delays-they do not have the same variety to
encourage acquisition of improved skills