Introduction of Spoon Feeding in Infants and Children with Trisomy 21
Parenting a child with trisomy 21 comes with its own set of joys and challenges. One essential aspect of caring for your little one is introducing solid foods. Spoon feeding can be a delightful journey for you and your child and promotes healthy growth and development.
In this article, we will guide you through the process, addressing readiness cues and spoon options, introducing and progressing spoon feeding, discussing potential concerns, and ensuring a positive feeding experience for your child.
Readiness cues
Knowing when your child is ready for spoon feeding is crucial. Look for signs such as:
- Head control: Ensure your child can hold their head up steadily, a vital skill for safe and effective swallowing.1
- Trunk stability: Ensure your child is well-supported in an infant seat or highchair. Your child’s seating position must be stable. If they can balance independently, a highchair can be used. Feet should be supported to give a stable base as this encourages better head, trunk and arm function. If your child needs help to sit, they will require additional supports to hold them in a stable more upright position.1 Being comfortable and well supported is vital for your child as this will allow them to focus all their attention on feeding! You can discuss safe seating for eating with your child’s physical therapist (PT) or occupational therapist (OT).
- Interest in food: When your little one starts showing curiosity about what you are eating or tries to grab food from your plate, it may be a sign they are ready to explore different tastes.5,6
Spoon options and presentations
Choosing the right spoon and how you introduce food can enhance the feeding experience.
- Spoon selection: Choose a spoon with a shallow bowl to make it easier for your little one to eat. There are various options, from silicone to rubber-tipped, allowing you to find the one that suits your child best. A spoon with a shallow bowl will make it easier for your child to close their lips on the spoon and eat the contents.3,5
- Early spoon presentations: Offer a dry spoon to practice, once or twice per day. A dry spoon is a spoon with nothing on it. Sit your child in their supported seat. Present the small, flat-bowled spoon to their lips, offering it into their mouth as they will tolerate. Look for active mouth opening for the spoon and early suckle movements when the child moves their tongue from the front to the back of their mouth. If they show any fussing and gagging with the dry spoon, wait to move on to the next step.3,5
- Dipped spoons: Offer beginning tastes of puree by spoon, 1-2 times per day, as tolerated. Dip the spoon into a smooth puree, shaking the excess off so that the spoon is just barely coated. Present the spoon to your child’s lips, then into their mouth as they will tolerate. Go slowly, allowing them to fully manipulate and swallow each “bite” before offering the next. Stop if they begin to refuse, lose interest or cough/sound congested as they eat and swallow.3,5
- Advancing volume on the spoon: Work to increase the amount of food on the spoon.3,5
- Your child does not need a full spoon for each bite. If they are losing food out of the front of their mouth, it is likely the bite size is too big. Start with a ¼ spoonful and slowly increase. Early spoon feeding is about learning the skill and enjoying the meal-time experience rather than how much they consume.
- Wait for the child’s lips to close and clear the spoon to let the mouth do the work. You want your child to be as active as possible while feeding, this is especially important for babies with trisomy 21 who often have poor muscle tone in the lips.
- Avoid emptying the spoon into your child’s mouth by scraping it across their gums and pausing to pull the spoon out. It is usual for a child with trisomy 21 to push food back out with their tongue when you place it in their mouth when spoon feeding is first introduced. This is because babies “eat” using the same mouth movements which they use when sucking the bottle or breast. This forward and backward movement can result in the food going into the mouth and then back out again. Don’t worry if this happens, your child will soon learn to control the food from the spoon and pass it backward instead of forward.2,5
- You can give slight downward pressure to the tongue as you give the spoon. This will encourage your child to move their tongue more toward the back.
Progressing spoon feeding
When it comes to presenting food, start with single-ingredient purees like mashed bananas or sweet potatoes. Add a new taste every 3-4 days to allow your child time to experiment and check for food intolerances.2 Gradually progress to thicker textures as your child becomes more accustomed to the spoon-feeding experience.5,6 Remember to keep a positive atmosphere during meals, making it an enjoyable time for bonding.
Potential concerns
While spoon feeding is usually safe and beneficial, there are some considerations for parents:
- Feeding challenges: Feeding difficulties can include oral motor difficulties (e.g., trouble latching to the nipple, immature chewing), oral sensory processing problems (e.g., oral aversion, gagging, overstuffing the mouth), challenges with self-feeding or mealtime participation.3,4
- Swallowing difficulties: Swallowing problems can occur throughout the phases of swallowing. Swallowing problems may lead to coughing and aspiration where food may enter the airway.3,4
- Choking hazards: Be cautious of introducing foods that pose a choking risk, such as small, hard pieces. Always cut foods into appropriately sized pieces and supervise your child during meals.
- Sensory sensitivities: Children with trisomy 21 may have sensory sensitivities. Pay attention to your child's cues and introduce new textures gradually to avoid overwhelming them.3
Ensuring a positive experience and follow-up
Keep track of your child's feeding progress to ensure they are receiving adequate nutrition. Early spoon feeding is about learning a new skill and the main source of their nutrition will still come from breast/chest feeding and/or bottle!
Monitor their weight gain, explore new flavors, and adjust the texture of foods as they become more comfortable. Regular check-ups with your pediatrician can provide added guidance and support for your child's unique nutritional needs.
Additional support can be sought from a pediatric speech-language pathologist or occupational therapist who specializes in feeding and swallowing. Continue to watch if your child is showing any distress cues while eating such as coughing, congestion, noisy breathing, or gagging. If they show any difficulties, you should seek further evaluation.
Creating a positive feeding environment
In conclusion, introducing spoon feeding for infants and children with Down syndrome is an exciting and rewarding experience. By recognizing readiness cues, choosing appropriate spoon options, and being mindful of presentations, you can create a positive feeding environment for your little one. Embrace the journey, celebrate small victories, and remember that every child is unique – let their individual preferences guide your feeding approach.
To have your child’s feeding and swallowing skills evaluated through CHOP, please call 267- 425-3333 to schedule an appointment in the Martha Escoll Lubeck Feeding and Swallowing Center at Children’s Hospital of Philadelphia (CHOP).
Susan L. Biedermann, MA, CCC-SLP, is a speech-language pathologist at Children’s Hospital of Philadelphia, with more than 30 years of experience, specializing in swallowing/oral motor feeding, trisomy 21, and speech and language development.
References
- Alghadir, A. H., Zafar, H., Al-Eisa, E. S., & Iqbal, Z. A. (2017). Effect of posture on swallowing. African Health Sciences, 17(1), 133-137. https://doi.org/10.4314/ahs.v17i1.17
- American Speech-Language-Hearing Association. (n.d.). Feeding and swallowing milestones. Retrieved from https://www.asha.org/public/developmental-milestones/feeding-andswallowing-milestones/
- Arvedson, J. C. (2008). Assessment of pediatric dysphagia and feeding disorders: Clinical and instrumental approaches. Developmental Disabilities Research Reviews, 14(2), 118–127. https://doi.org/10.1002/ddrr.17
- Brackett, K., Arvedson, J. C., & Manno, C. J. (2006). Pediatric feeding and swallowing disorders: General assessment and intervention. SIG 13 Perspectives on Swallowing and Swallowing Disorders (Dysphagia), 15(3), 10–15. https://doi.org/10.1044/sasd15.3.10
- Infant and Toddler Forum. (n.d.). Developmental stages in infant and toddler feeding. Retrieved from https://infantandtoddlerforum.org/media/upload/pdfdownloads/3.5_Developmental_Stages_in_Infant_and_Toddler_Feeding_NEW.pdf
- Medlen, R. D., Joan E. (1999, January/February). From milk to table foods: A parent’s guide to introducing food textures. Disability Solutions, 3(3), 1, 3-9.