FEEDING
 

IS IT AGE-APPROPRIATE?

When parents and therapists consider purchasing feeding equipment or mouth toys for a child with feeding and mealtime difficulties, they frequently ask, “Is it Age Appropriate?” This question can mean many things to different people. Let’s look at the concept and how it applies to different types of equipment and different groups of children.

Age Appropriateness–The Typically Developing Child

Appropriateness of most equipment typically refers to the following areas:

Size
The size of a spoon or toy must fit the size of the mouth or hand of the infant or young child for whom it is designed. Thus, an adult-size teaspoon would not be age appropriate for a 6-month-old infant. A large toy that is difficult to pick up would not meet the needs of a 4-month-old infant who is just learning to grasp and release objects.

Skills
Feeding equipment and oral-motor toys and tools should be matched to a child’s developmental level. Spoons are typically introduced when the infant is ready to begin pureed foods at 6 months. Straws may be introduced between 9-12 months when the older baby is developmentally ready to use this emerging skill. Toys with strong contrasts in texture and parts are more developmentally appropriate for infants and toddlers who are increasing discriminative mouthing skills between 6 and 12 months. Children who are beginning to hold a spoon to feed themselves will benefit from utensils that are easy to hold and dishes that make it easier for them to learn to scoop the food. This process may begin by 12 months and continue through the toddler period.

Social and Emotional
The child’s social and emotional level is also considered in the definition of “age appropriate”. Since most young children have completed the transition from the bottle or breast to cup drinking between 12 and 18 months, bottle drinking would not be considered age-appropriate for a 3 year old. Although parents are encouraged to wean their children from pacifiers by the time they are a year old, many toddlers will continue to use their pacifier past this age. Some pacifiers are designed for 18-24 month-old children. However, beyond this age, most developmental specialists suggest that children are substituting sucking the pacifier as a way of meeting their emotional needs.

Construction
Products are designed to meet safety criteria for the infants or children for whom they were created. For example, a mouth toy designed for infants under 24 months would be sturdy enough to withstand the biting and chewing that is typical of the infant and very young child. Pressure from the gums and early teeth is relatively gentle and unsustained. These infant toys would not be developmentally age-appropriate for older children with a full set of teeth and strong desires to bite and chew.

Age Appropriateness–The Child with Feeding and Oral
Sensorimotor Difficulties

A discussion of age appropriateness for the child with feeding and oral sensorimotor difficulties is much more complex.

Size
Size is still a factor in selecting appropriate equipment. The spoon, cup or toy must fit the size of the child’s mouth and hands. However, many children with feeding difficulties are not the same size as their typical counterparts. A child of 18 months may have the same weight, mouth and hand size as a non-disabled 6-month-old. The most appropriate spoon for a 3 year old who is just beginning to take pureed foods may be a smaller spoon designed for the 6-month-old infant. Although the older child has a larger mouth size, the smaller spoon delivers smaller amounts of food per spoonful that is more appropriate.

Skills
Because of developmental delays and diffculties in the progression of feeding skills, equipment should be matched to the skill-development age of the child, rather than the chronological age. A four-year-old who has had limited mouthing experience would begin to explore mouth toys with less sensory complexity. Although these are typically introduced to infants at 3 months, they are highly “age-appropriate” for the older child in a therapy or home setting.

When a child has feeding and oral sensorimotor difficulties, equipment may be selected for 2 separate reasons. The equipment may fit the child’s current skills and daily needs. For example, a very flat spoon makes it easier for the child to use the upper lip to remove the food. Yet, equipment may also be selected to provide a gentle challenge and stimulate the child to move to a more skillful level. In this instance, a spoon with a slightly deeper bowl may be more appropriate.

Products may be too challenging for a child’s size or skills if the child needs to use them independently. However, the same product may be quite appropriate for the child’s existing skills and challenges if an adult holds it and guides the child’s response. For example, a mouth toy may be inappropriate to give a child who has a strong biting pattern. However, the same toy may be quite appropriate in helping the child learn to explore the toy with the tongue and lips when guided by an adult.

Social and Emotional
The criteria for social and emotional appropriateness vary considerably among children. Children with sensory processing difficulties, for example, often discover that rhythmical sucking on a bottle or pacifier enables them to remain calmer and more focused. These youngsters may remain appropriately at an earlier stage of oral activity as a strategy for dealing with their sensory difficulties. A child may need the pacifier during times of sensory stress or when winding down for sleep at night. These would be considered appropriate to the child’s needs during a period when other ways of resolving the underlying sensory issues are addressed.

Emotional appropriateness includes the child’s feelings of success and pleasure when using a product. Appropriate products are pleasurable to the child. Some children love the sensory feel of a firm plastic toy or spoon and don’t care for those that are less rigid or soft. Others prefer objects that are soft or toys of a particular color. A child who loves a particular story character such as Winnie the Pooh, or Big Bird may be pleasurably drawn to a cup or mat that features their fantasy friend.

The social environment in which the equipment is used also plays a role. Specific mouth toys may be quite acceptable and appropriate at home, but not age-appropriate in a preschool or kindergarten classroom.

Construction
Children with feeding delays and difficulties are typically older when they are introduced to most feeding and oral-motor equipment. Many feeding and oral-development toys designed for younger children are quite appropriate for older youngsters. However, adults must be alert to the construction of the item in relationship to the child’s sensory and motor abilities and needs. For example, the NUK Massage brush was designed for gumming and oral stimulation to prepare the older infant and toddler for tooth brushing. Although the tip of the brush is attached securely to the handle, the chewing stimulation of an older child with teeth can loosen it. Without adult supervision and guidance, the tip could become loosened and come off in the child’s mouth.

Making an Appropriate Selection

Guidelines for selecting age appropriate equipment provide a general framework. This can help weed out products that do not fit a child’s current needs or provide the just-right challenge for future progress. It is important to remember that these are guidelines, not a fixed recommendation or prescription for every child at a specific age or developmental level.

Each child’s individual situation, including personal preferences, should be taken into consideration in deciding whether the equipment fits. The following questions can help parents and professionals make specific choices among the wide variety of selections that are available.

  • What is my goal or purpose for purchasing this type of product?

    • Daily use at the child’s current skill and developmental level?

    • Stimulation of a new or more mature response?

    • Fun and personal enjoyment?

  • Does the size of the product fit my child and the purpose for which I’m buying it?

  • What skills does my child have now that meet the prerequisite skills for using this type of product?

    • Do my child’s current skills fit with independent use of the product?

    • Do my child’s current skills fit with guided use of the product?

  • What new skills can this type of product help my child develop?

    • Is my child ready to move into this next step?

    • Are there component skills that are missing?

    • Would a different type of product be more appropriate?

  • Does this type of product support my child’s current emotional needs?

    • Does the product help organize sensory responses?

    • Does the product help my child be more independent?

    • Does the product help my child be more successful?

    • Does the product match my child’s personal interests and preferences?

  • Does this type of product support my child’s current social needs?

    • Is the product appropriate in my child’s home environment?

    • Is the product appropriate in my child’s therapy environment?

    • Is the product appropriate in my child’s school environment?

    • Are there environments where the product would be not be age appropriate?

  • Does the construction of the product meet overall safety needs for my child?

    • Is it safe for independent use by my child?

    • Is it safe for guided use when an adult is supervising my child?

About the Author

Suzanne Evans Morris is a speech-language pathologist who specializes in the development of feeding programs for infants and young children. Suzanne maintains a professional practice that includes direct clinical work, continuing education workshops, development of clinical materials and clinical research. She is the director of New Visions, which sponsors innovative workshops for the teaching of feeding-related skills, and provides family-oriented clinical services. She is the coauthor of Pre-Feeding Skills: A Comprehensive Resource for Mealtime Development ,2nd edition, the Mealtime Participation Guide and the Homemade Blended Formula Handbook.

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This paper is a working draft and multiple copies may not be reproduced
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© Suzanne Evans Morris, 2008 (Revised) All Rights Reserved

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