by Bri Dandrea
A constant in a new mom’s life is feeding their newborn, and from there, oral development continues. The baby starts to hold their own bottle, feed themselves, and eventually, they start talking. Then once they figure out how to talk, good luck!
Oral motor skills are an important part of a child’s development. The skills are broken down into suck, swallow, bite & chew. They move through these stages within the first 2 years of their life, allowing them to increase from liquid foods to solid foods.
In the first months of a baby’s life they are able to eat due to the primitive reflexes that are present. Primitive reflexes are actions directly from the central nervous system in response to stimuli. For instance if you place your finger on a baby’s cheek they will turn their head toward the touch and start a sucking motion. The reflexes are responsible for the suck, gag, swallow; jaw, tongue, and lip movements. As the child grows the reflexes start to integrate into skills that the child has control over using.
This chart below will walk you through the different stages of oral skills, self-feeding skills, and appropriate types of food for ages up to 2 years.
0-3 Months
- Liquids only
- Use sucking pattern reflex
- No bite or chew
5 Months
- Liquids & start of pureed food
- Use sucking pattern
- Primitive phasic bite and release reflex is used to scoop puree off spoon
- Can start to take puree or cereal from spoon
6 Months
- Continue with liquid & puree foods
- Can introduce sippy cup, open cup, or straw with small sips
- More coordinated sucking/swallow patterns
- May start helping to hold bottle, but this can start from 6-8 months
- Increased up/down jaw movements for chewing later
8-9 months
- Soft foods, mashed foods, meltable solids
- Strong sucking pattern
- Munching type movement & voluntary biting
- Will hold and suck on cracker
- Grabs at spoon
9-13 months
- Finger feeding
12 months
- Easily chews food (like soft meat, or chopped table food)
- Consistently uses a cup
- Starts to dip a spoon in food and brings the spoon to their mouth
- Spills are common & they frequently miss their mouth
15-18 months
- Scoops food with spoon
- Brings food to mouth with spoon
18 months
- Will eat chopped table food, raw fruits, most cooked meats
- No loss of food as lips easily close
- Increased chewing pattern
24 months
- Will eat most table food
- Use adult drinking pattern
24-30 months
- May start to use fork to stab pieces
- Proficient with spoon use
This is a general list and is not all inclusive of milestones and deficits.
The list above is a general overview of developmental milestones & oral-motor skills. With these there is potential for disorder. Dysfunction can present itself through medical, oral, sensory, or behavioral factors. Premature infants and children with developmental delay often have feeding/swallowing problems. When feeding becomes persistently difficult, we start to worry about nutritional intake. When a child has small amounts or no intake, we start to worry about lack of weight gain and adverse health outcomes. These worries are with the most intense cases.
Therapy can help build and refine these skills with different interventions depending on the deficit. Picky eating, difficulty using utensils, sucking patterns, chewing patterns, sensory difficulties, and lip closure are all skills occupational therapy can help improve.
Bri Dandrea, OTR/L
Occupational Therapist, Pediatric Specialist, LSVT-BIG