Encouraging Feeding Independence for Children

Perspectives from a Speech-Language Pathologist and Occupational Therapist

By Brittany Medeiros, CCC-SLP and Carol P. Oakes, OTR/L, Spaulding Outpatient Center Lexington

Independent eating is an important activity of daily living that is encouraged in many cultures. It allows children to develop self-worth, pride, motor skills and social and emotional growth. There are also safety concerns that can be lessened when a child is able to feed themselves. With self-feeding, a child can make different food selections and set the pace and quantity of eating. Additionally, choosing the right cup or utensil for your child can help promote safe, efficient, and independent eating and drinking when going back to school, as well as across settings.

Safe and Independent Drinking

• Transitioning from bottle to cup: If your child is transitioning from a bottle to cup, consider straw cups rather than sippy cups to allow for mature development of the oral motor structures (e.g., lips, cheeks, tongue). Sippy cups or hard spouted cups can inhibit the tongue’s ability to move in ways necessary to become a mature eater. When a child uses an immature swallowing pattern beyond age expectations, other oral motor skills can also be impacted or delayed. Cups with short, thin straws encourage a child to use their lips and facial muscles to drink while using a mature and safe swallowing pattern necessary for adequate feeding development.
• When learning to use an open cup: If your child is transitioning away from a sippy cup and/or straw cup, consider starting with small cups and/ or cups with a cut out for the nose, to ensure safe swallowing when drinking liquids. Small cups allow for less liquid to be consumed at a time and cups with cutouts allow for drinking without needing to tilt back the head, thus minimizing the chance of liquid entering the airway and causing choking. Other cups, such as ones with a hole to drink from or to insert a straw, are also good transitional ideas when moving from bottle to open cup.
• Cups to minimize spillage but maximize independence: Consider flip-top water bottles with straws so that a child can open, access and close their water bottle or cup independently. Place rubber bands around juice carton or cup for easier grip and positioning. Cups and bottles with specialized openings and weighted bases can aid in independence.
• Cups for thickened liquids: If your child typically drinks thickened liquids, consider silicone, shorter/wider straw-top cups to allow the flow of thicker liquids while promoting also mature oral motor skills and mature swallowing patterns.

Safe and Independent Eating

• Increasing food clearance from spoon while reducing “over stuffing”: Try spoons with shallow bowls; a shallow bowl makes it easier for a child to clear food from a spoon while limiting the amount of food on the spoon at a time, thus reducing “overstuffing” and the potential for choking.
• Increasing awareness while eating: Consider the use of textured spoons and forks which combine oral-sensory stimulation with eating, providing increased awareness and input to the lips and tongue. Use of textured utensils can also promote and support the transition of smooth pureed textures to more textured foods.
• Universal Cuff: Fun-colored silicone adaptive aids (universal cuff) can be helpful if the child has limited hand mobility.
• Bowls: Drawing outlines for plate, utensils, and cup help with visual organization. Suctioned curved plates and bowls with raised sides assist in loading a fork or spoon with food.

Lunch Boxes or Snack Containers

• Practice: Practice different lunch box hardware with your child.
• Fasteners: Are zippers (with or without a zipper pull) easier than a metal clasp? A loop could be sewn on a Velcro bag, making it easier to open.
• Opening containers: Some lunch boxes are compartmentalized, allowing the child to only open one lid and have food neatly separated. Reusable snack containers could be easier to open as opposed to plastic ones. Reusable food wraps instead of interlocking mechanisms work well for packing, storing, wrapping and forego any closures for children with limited fine motor skills. Finally, parents could partially pre-open bags before sending their child off to school. Clothespins and snack clips could also be used.

Other Considerations to Encourage Independent Eating

• Positioning: The optimal seating for safe eating is upright in a sturdy seat with 90-90-90 positioning. This means creating a 90-degree angle at the hip, at the knee, and at the ankle. Creating a good base of support throughout the body significantly benefits oral motor skill development.
• Bite size: Ensure bites are not too big or too small so that your child doesn’t fatigue due to a bite size that’s too small and/or choke due to bite sizes that are too big.
• Food texture/utensil use: Ensure that the texture of food and the size of utensil are appropriate for your child’s skill level.
• Alternating liquids and bites of food: Using liquid washes to ensure clearance of food from oral cavity and potential of choking.
• Rate of food presentation: Limiting large bites and chances of “over stuffing” foods into oral cavity.
• Calories: Choose calorically dense and hydrating foods for your child throughout the day to promote adequate nutrition and weight gain.

Improving Fine Motor Skills

Work on hand strength and manual dexterity to improve fine motor skills by trying these activities:

• Tearing paper: Pinching, moving one hand forward as the other moves back against resistance.
• Breaking sticks: Find some sticks on a nature walk; hold the stick upright and snap the tip off.
• Stretching non inflated balloons: Mimics the motion of opening a snack bag.
• Peeling tape: Stick small pieces of tape to the table and have kids try to pinch, grasp and pull them off.
• Plastic container match-up game: Remove lids from containers and mix them up; find the matching lids and twist or snap them back on the correct containers.
• Lego/Duplos: Develops grasp strength needed for pulling, twisting and pinching lunch and snack containers
• Velcro: Pulling against Velcro is a great hand strengthener.
• Rubber bands: Stretching and pulling against the resistance of the bands, making a rubber band ball or completing geo boards.

In conclusion, independent eating and drinking is a skill that takes time and practice. Providing your child with the appropriate tools can help foster safe and independent eating and drinking across different settings.

If you are concerned about your child’s oral motor skills or safe swallowing while eating, please contact one of our Pediatric Outpatient sites.