Transitioning from Bottle to Cup/Straw Feeding

I am an OT and a new mom to my 6-month-old daughter. We have just started introducing solid foods, but she drinks from only a bottle. I was wondering if you had any tips for transitioning from bottle to cup.  I have heard mixed reviews regarding sippy cups…
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I am not against using the right sippy cup as an intermediate step to teach cup drinking.  However, I find that many parents are not using them as a transition cup, but rather as a convenient, no-spill option.  Their convenience leads to prolonged use – usually to the exclusion of cup and straw use.  And without cups/straws, the lips, cheeks, tongue, and jaw may not learn to function correctly.  When drinking from a straw, the lips are extended and maintain a good seal, the tongue is retracted, and the cheeks assist.  Straws exercise the oral musculature, promoting proper development for feeding and articulation.
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Now, your daughter is a little too young for straw drinking, but you can teach her cup drinking first.  The Pink Flexi Cup is the easiest way to go.  It has a cut-out section for the nose so that you can more easily see what is going on as she drinks.  Make sure she is sitting upright with her head straight (not tilted back or forward) and her feet supported.  Pour some liquid inside the cup and squeeze so it flows toward the middle of the cup.  Show her the liquid and then place the edge of the cup up to her mouth.  Allow a couple drops to touch her lips.  This will teach her that liquid also comes from a cup, not just a bottle.  Once she understands this concept, she should easily learn to drink from a cup with practice.  When liquids are too thin for early learners, you can use baby food or applesauce instead.  Or a combination of juice and baby food for the right consistency.
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At about 8 months of age, you can start working with her on straw drinking.  ARK’s Bear Bottle makes this transition very easy.  It comes with a special valve that keeps the straw full of fluid, thereby making drinking easier for beginners or individuals with poor oral motor skills.  Simply squeeze the bear’s belly until the straw is full of fluid.  Then give it an extra squeeze onto a napkin so she can see that liquid comes out of a straw.  Place the straw just inside her mouth and squeeze a small amount of liquid into her mouth.  Repeat until she gets the idea that she needs to suck to drink.  When she is ready, squeeze the fluid only partially up the straw, stopping a short distance below the top.  Because the liquid isn’t as high in the straw, it will require slightly more effort to drink.  Once she becomes comfortable drinking from this distance, lower the level of liquid again and repeat.
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Finger Feeding Tips for Toddlers

Finger feeding is a very important step towards 1. feeding independence and 2. setting the stage for healthy eating habits.  Finger feeding typically starts at about 8-10 months, but of course there are always exceptions.  A friend of mine didn’t start with her baby until 11 months of age for example.

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In order to be ready for finger feeding, your child needs to be able to sit up completely on her own, without support.  Another indication of readiness is when she begins to grab the spoon out of your hand as you feed her.  Or if she shows an interest in what you are eating and tries to grab food from your plate.
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Finger Feeding Tips for Toddlers

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To start, make sure that she’s not in motion, crawling around, etc.  She must be seated.  Allow her to place her hand over yours to assist in spoon feeding.  You can also give her a spoon of her own to use, but still feed her with yours to make sure she’s eating a full meal.  Take turns between feeding yourself and feeding her, which helps reinforce good social skills at the same time, such as turn-taking, eye contact, etc.
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Mealtime Sensory Strategies to Help Decrease Texture Aversion and Hypersensitive Gag

Before mealtime:

•  Play with sensory-stimulating toys, such as koosh balls, peanut balls, bubbles, play-doh, massagers, any toys/books with interesting textures, etc.

•  Give the child sensory input through physical sensory-stimulating activities, such as bouncing on a ball, jumping, swinging, etc.
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In preparation for mealtime:

•  Put the child in a highchair/booster seat.

•  Brush the child’s legs, arms, hands, etc. (there is a protocol for this that your occupational therapist can show you).

•  Use the “rough” side of a washcloth to wipe the child’s hands and face prior to the meal.

•  Offer the child a Z-Vibe before food is presented to help “wake up” the mouth.
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During mealtime:

•  Use textured spoons or Spoon Tips for feeding.

•  Use the Z-Vibe for feeding.  The Animal Tips in particular create a friendly / familiar environment, and they can be used to scoop food, explore textures with the tongue, and introduce new textures to foods.
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•  Maroon Spoons add a smooth texture to familiar foods.
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Please remember that each child is different and there is no “one way” to decrease these aversions.  Helping a child to eat/touch/tolerate textures can be a long process and therefore “trial and error” is often the best way to “figure out” each individual child.  Parents, hang in there!  For more information on oral sensitivities / defensiveness, click here and here.
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Good luck!

Leila
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Leila N. Bressler, M.Ed., CCC-SLP is a pediatric speech-language pathologist who has been working with the Birth to Three population for almost ten years.  She has worked in the school setting and the clinical setting in both Georgia and South Carolina.   Leila is also a mother to a toddler and feels that she has learned most of her knowledge from her daughter.
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How to Teach Biting and Chewing Skills

For infants, learning how to bite and chew is a crucial stage of feeding development.  At approximately 5-6 months of age, babies begin using their fingers and teethers for oral exploration using a bite and release pattern.  The development of biting and chewing continues from this point on, with the baby refining the movements of the jaw, tongue, and lips.  When infants miss a part of this developmental process, intervention may be necessary to develop the ability to bite and chew.

 

Teach Biting & Chewing Skills

1.  One of the ways I like to begin is to provide the child with the opportunity to mouth ARK’s oral motor chew tools (the Grabber, Y-Chew, Probe, and/or Animal Tips).  These tools were specifically designed to increase oral awareness, to provide stimulation and tactile sensation, and to exercise the lips, cheeks, tongue, and jaw.  Through oral exploration, the child just might begin to bite on his/her own, and from there you can progress to chewing.

Continue reading How to Teach Biting and Chewing Skills

Feeding Tips and Tricks for Cleft Babies and Preemies

This wonderfully informative guest post comes from a dear family friend.  We thank her for sharing her story and hope that others may benefit from her insightful advice.


My daughter Sarah was born with a very wide unilateral (one side) cleft lip and palate.  Feeding became an immediate issue for us as she did not take to the typical bottle for cleft babies, the Haberman feeder.  She was also immediately stricken with severe reflux.  We spent five days in the hospital.  By the second day, the nurses were insisting we begin feeding by tube, even though Sarah had begun to take a little milk with the one other main bottle available for cleft babies, the Mead Johnson Disposable Cleft Lip/Palate Nurser.
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One nurse decided that she could help Sarah feed more easily and sat up with me all night to give Sarah frequent, small feedings.  Sarah began to feed better, even though reflux continued to be a problem.  Our plastic surgeon had the idea to cut one section from the cross cut of the Mead Johnson bottle to help the milk flow more easily.  This was very important because while having the instinct to suck, the cleft left Sarah without any suction ability.  This frustrated her and made feeding more difficult.  With the notch cut from the bottle’s nipple, the milk flowed well, and we could keep up with her natural sucking rhythm.  We left the hospital on the fifth day after she was born.
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Continue reading Feeding Tips and Tricks for Cleft Babies and Preemies

Tips to Accepting Different Food Textures

1.  Change the individual’s toothpaste.  It can be a change in flavor or a change in brand.  A different brand may have a different texture, one that is perhaps a little more gritty.  Also, changing the toothbrush to one that is a little harder or softer will get a different texture inside the mouth.
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2.  Massage the gums with a clean finger.  This adds sensory input into the mouth and works on acceptance of textures.
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3.  Feed the individual with the Z-Vibe or Textured Spoon Tip.  You can also try a Textured SpoonDuoSpoonTextured Grabber, or Y-Chew.  All of these tools have textured surfaces that work on oral sensitivities.
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4.  Make small alterations in the foods that the individual already accepts.  For example, if he/she likes biscuits, you can put a little mayonnaise (or some other kind of spread) on them.  It shouldn’t be more than 1/4 of a teaspoon, VERY little.  This may be a good starting point to add different flavors and textures.  Adding these to something he/she already eats is easier than introducing a whole new food.  You can also vary the kind of biscuits.  Maybe you could bake some together?
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5.  Play with the food to help them become more comfortable with foods.  Use this Pinterest board for inspiration.  There is a lot of room to be creative here!

Continue reading Tips to Accepting Different Food Textures

Strengthening Mouth Muscles

My daughter’s speech therapist suggested we have my daughter sip thick liquids (i.e. yogurt, chocolate pudding, etc.) through a straw to work on strengthening mouth muscles.  I have not been able to find straws thick enough to work.  Do you have a suggestion?


Straws are a great way to help individuals learn how to keep the lips closed, how to keep the tongue inside the mouth, how to improve cheek strength, etc. However, it may be difficult for your child to drink pudding or yogurt through a straw.  Perhaps your therapist may have meant for you to add pudding or yogurt to a drink in order to thicken it?
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Personally, I have found that straws from McDonald’s have a large circumference, and they may just do the trick for you.  You may also be able to find straws in Target or Wal-Mart with a wider circumference to accommodate thicker substances.
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Since it is a goal for your daughter to work on strengthening her mouth muscles, I would also like to suggest our Lip Bloks (pictured above).  Lip Bloks are essentially mouthpieces that can be inserted into the top of most standard drinking straws.  They come in three different sizes: ¾ inch, ½ inch, and ¼ inch.   You start with the longest (¾”) size, and then as soon as it becomes easy for your daughter to use that length, you progress to the next length level (½”).  When this becomes effortless, you progress to the final ¼” level.  The orange and purple Lip Bloks shown above are made out of a flexible material so that you can cut the stem to any custom length level.  The time frame between levels can vary for each individual, from one week or even longer.
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One of the children on my caseload is non-verbal, has sensory issues, autism, and can not close his lips due the position of his teeth.  I used a Lip Blok with him for 8 weeks, and the change was incredible.  His tongue is now closer to being inside his mouth, he no longer makes a suckle noise when he drinks through a straw, and he can now maintain closure with his lips.  Lip Bloks can achieve all of this by working the mouth muscles naturally.  Your therapist, however, should also be able to provide additional direction.
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For more oral motor exercise ideas, click here.
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