Efficient and competent feeding skills ensure that every developing child acquires the right nutrition that propels their growth and development. The ability of a newborn to feed well soon after birth can be attributed to their reflexive responses to locate the source of nutrition and to integrate sucking, swallowing and breathing. As children mature, they progress from suckling(immature form of sucking) to mature chewing and self feeding by the age of 3 years. However, integration of several integral skills are necessary for the child to develop mature feeding patterns.
Newborn oromotor reflexes act as the foundation for nutritive sucking and swallowing, that form the basis of all growth and development. The important newborn reflexes that prepare the child for the process of
feeding include:

1. Rooting reflex: The rooting reflex reaction, which helps an infant to locate the source of nutrition is elicited on stroking a corner of the child’s mouth and resulting in the child turning his head
   toward the stimulus to open the mouth with tongue thrust movements .
2. Suck-swallow reflex: It appears at or soon after birth where the child’s mouth opens and sucking movements begin when light touch is applied to the corners or centre portion on the lips
3. Tongue thrust reflex: The child’s ability to feed from the breast or bottle is made possible by the tongue thrust reflex (seen from birth to 4-6 months), where the infant’s tongue extends out of the mouth when the lips are touched.
4. Gag reflex: This protective reflex in infants that helps in protecting an infant from choking is elicited when any object such as a spoon or a piece of solid food is placed way back in the mouth.
   Introduction of solid foods is delayed until 4-6 months as the reflex integrates only by 4 months of age.
   Integration of these reflexes results in the involuntary oral movements evolving into voluntary movement patterns.
   What are Pre-Feeding skills?
   Pre-feeding skills are foundational abilities that help a child to develop mature feeding patterns. The acquisition of normal motor skills that lead to postural stability and mobility, the integration of newborn
   reflexes, normal development of the child’s sensory systems influence the development of feeding skills. Pre-feeding skills include oro motor skills which progress from suckling, sucking liquids from a cup to
   efficient lip, tongue and jaw movements for chewing. Along with development of oro motor skills for feeding, integration of sensory information obtained from the oral structures are necessary for acquisition of normal feeding skills.

DEVELOPMENTAL SEQUENCE OF FEEDING SKILLS:

Birth

6 months

● Motorically and cognitively more active participants in the feeding process
● Babies can eat and drink in upright position with the help of a high chair
● Can independently hold a bottle
● Reach for objects with hands and explore them through mouthing
● Recognize and eagerly await approach of spoon or bottle
● Pureed foods can be introduced
● Able to drink small amounts of liquid from a cup with a spout
● Able to munch soft cookies using lower central incisors

9 months

● Babies can sit upright without support and actively explore any object within their reach through mouthing
● Able to take foods for biting and chewy solids
● Lacks awareness of edible and non-edible items
● Increased lip activity and, up and down movements of tongue during sucking
● Tongue can be moved laterally

12 months

● Activity level increases and child is able to pick small food items using fingers
● Food can be transferred from center to sides of mouth when chewing
● Able to drink from straw
● A more controlled bite is attained
● Able to drink from an open cup

15 months

● Controlled and coordinated chewing
● Less spilling during drinking
● Tip of the tongue can be elevated independently

18 months

• Develops self-feeding skills
• Can handle spoon, cup or eat with fingers independently
• Capable of chewing with lips closed
• Minimal loss of food from mouth

2-3 years

Understanding of these pre-feeding skills can help in monitoring the acquisition of feeding skills and in identifying deficits in oromotor skills that may lead to different feeding issues in children. Deficits in these skills can affect feeding, lead to inadequate nutrition and, reduced growth and development in the child.

The different causes of feeding problems can include:
● Premature birth or low birth weight
● Structural impairments such as cleft left and palate
● Muscular weakness
● Breathing difficulties
● Neurological disorders such as cerebral palsy, meningitis
● Autism Spectrum Disorders
● Sensory issues.

Seeking the help of a speech-language pathologist (SLP) can help in treating feeding difficulties. An SLP may work to:
● Improve muscular stability and strength of oral structures
● Improve range of movements of tongue and jaw
● Promote proper chewing of different types of foods
● Improve lip strength and closure
Involvement of other professionals like occupational therapists can help in remediating the feeding problems caused by sensory issues.

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REFERENCES:

1. Morris, S. E., Klein, M. D., & Satter, E. (2000). Pre-feeding skills: a comprehensive resource for mealtime management. Pro-ed.
2. Walsh, Robyn & Overland, Lori. (2019). Functional Assessment of Feeding Challenges in Children with a Diagnosis of Ankyloglossia. 10.13140/RG.2.2.31401.95841