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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honey-bear-juice-bottle

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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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.

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G-Tube Advice

I am a mother to a baby who is 6.5 months old, corrected age.  He was born at 29 weeks gestational age.  Because of being on a high level of O2 support for a long period of time, being intubated several times, and experiencing reflux, he has had an aversion to liquids and was not able to learn how to suck on a bottle effectively.  A g-tube was placed before he left the NICU.  He is now fed exclusively through the g-tube, but his speech therapist and I are making progress on his oral acceptance of liquids and solids.  However, his oral mechanics still do not allow him to process more than .1 to .2 ml for each swallow.  He has marked tongue thrusting.

Regarding tools —  at this point we are making use of the Baby Grabber and are using a 1 ml syringe for liquid practice.  We have attempted to use several sippy cups without much success so far.  His speech therapist has not suggested any other tools/devices at this point.  Could you suggest products that we could use for feeding practice, tongue placement/mechanics, and general oral work that will help us work towards g-tube independence?  Our speech therapist cannot provide them, so we are looking to purchase just a few items that will have maximum usage and effect.

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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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How do you assemble the Z-Vibe and Z-Grabber?

There are three internal components for the Z-Vibe and Z-Grabber – a heavy spring, a Vibe Battery, and a motor/spring assembly.  To turn the unit on, simply twist the tip into the handle just until it starts to vibrate.  Any further will not increase the vibration, but significant over tightening (although hard to do), may damage the motor.
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1.  Put the motor into the handle first (spring end last)
2.  Then the battery (positive end last – look for the + sign)
3.  Then the heavy spring
4.  And finally the Switch Tip (the tip that matches the handle of your Z-Vibe / Z-Grabber)
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z-vibe-assembly-1.

This order can also be reversed:  you can put the spring in first, followed by the battery (positive end first), followed by the motor (spring end first).  As long as the parts are in the order as pictured above, they’ll work.
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Vibration will always be slightly greater on the end that contains the motor, so although the motor only has one speed, you can play with the intensity by how it’s assembled.  If you assemble it in the direction of the arrow as pictured, vibration will be greater towards the Probe Tip end of the handle.  If you assemble it in the opposite direction, vibration will be greater towards the Switch Tip end..
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How to Improve a Weak Suck

I am looking for suggestions for our 2-year-old son with epilepsy. He currently functions at a 6 month level.  He can eat by mouth (only stage 2 or 3 baby foods), but lacks a suck.  He can swallow well, but we have to use a syringe to get liquid into his mouth first.  I do have the Z-Vibe with the Cat and Mouse Tips, but since his mouth is so tiny, they haven’t really helped. Can you suggest any others?  

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