Feeding Fridays – The Real Stages of Eating

Cindy Hooks Morrison, M.S., CCC-SLP, CLC

When you walk down the baby food aisle in the food store you will find three stages of baby food: Stage 1, Stage 2 and Stage 3.   If you look a little closer, you will see that Beechnut also makes a stage 2 1/2.

But are these really the stages of eating?

Not even a little bit.  A lot more is happening prior to this and during this than most people realize.

Speech Language Pathologist’s that continue on to specialized in pediatric feeding are looking at different types of stages all together.  You see, the children that find their way into our treatment rooms have had a breakdown occur at a particular stage – and it was definitely not at Stage 1, 2, 2 1/2 or 3.

Before we are able to help children with feeding disorders, we need to be experts on how feeding progresses for children without disorders.  This knowledge, paired with clinical education and experience, enables us to get our patients to their ultimate goal of happy, healthy eating.

Two of my favorite clinicians that i’ve learned from are Dr. Kay Toomey, Ph.D and Erin Ross, Ph.D., CCC-SLP.  You can read Kay’s bio here and Erin’s bio here.  For me, meeting Kay was like meeting a celebrity, because the skills that I learned from her approach, and then applied clinically, have enabled me to help countless children eat successfully.  This ranges from behavioral feeders to children who were eating through tubes in their noses or bellies when I met them.

Kay Toomey’s Sequential Oral Sensory (SOS) approach “is designed for assessing and treating children with feeding difficulty and/or demonstrating weight and growth difficulty. The SOS Approach uses a transdisciplinary team approach to assess the “whole child”: organ systems, muscles, development sensory, oral-motor, learning/behavior, cognition, nutrition and environment.” (Toomey, 1998/2013)

This approach is able to do all of this while remaining focused on “increasing a child’s comfort level by exploring and learning about the different properties of food and allows a child to interact with food in a non-stressful way, beginning with the ability to tolerate the food in the room and in front of him/her; then moving on to touching, kissing, and eventually tasting and eating foods.” (Toomey, 1998/2013)

Clinically, i’ve had amazing firsthand experience using this approach and watching it work OVER and OVER again for families.  And this is able to happen, because by design the approach looks at each child individually from the perspective of what is happening inside their bodies and also what is happening in the environment around them.  This is not a “cookie cutter” approach.

So what does all of this have to do with the Real Stages of Eating?

It’s pretty simple.  The number one thing that parents have told me in my hospital treatment room is, “I have been using some of the skills that you’ve taught me here with all of our other kids at home and now ALL of them are eating better”. 

That is always such a profound statement to me.  It’s taught me that unless you are deep into the world of pediatric feeding or unless one of the steps have broken down for your own child, its hard to see and appreciate every small success that takes place.

So tonight I am sharing some basic information for you to only think about.  I know that sharing it can help ALL parents in understanding that not all meal time refusals are cut and dry.  Behavior is not always to blame.  Take a look at how meal times stages really break down.

THE STAGES OF EATING
Toomey & Ross, 2010

1) TOLERATING FOOD

• being in the same room
• being at the table with food on the other side of table
• being at the table with the food 1/2 way across the table
• being at the table with the food approximately in front of child
• looks at food when directly in front of child

2) INTERACTS WITH FOOD

• watches the preparation of food
• assists in preparation/set up with food
• uses utensils or a container to stir or pour food/drink
• uses utensils or container to serve self

3) SMELLS

• odor in room
• odor at table
• odor directly in front of child
• leans down or picks up to smell

4) TOUCH

• fingertips
• fingerpads
• whole hand chest, shoulder top of head
• chin, cheek
• nose, underneath nose
• lips
• teeth
• tip of tongue
• full tongue

5) TASTE

• licks lips
• tongue licks food bites off piece and spits out bites pieces
• holds in mouth for “x” seconds and spits out bites
• chews “x” times and spits out chews
• partially swallows chews
• swallows with drink
• chews and swallows independently

And then finally, ACTUAL EATING.

So when people ask me directly when I start to introduce food to my babies…its kind of a tricky question for me to answer.  It’s individualized, so its different for each of my baby boys.  As you can see above, in my world there are almost 4 full stages of introducing foods before I even expect my babies to have food touch the inside of their mouths.

What does that mean, Chew Chew Mama?

At the time that I am writing this article, my sweet little Cub, Henry, is five months old.  At his current age, I am not very concerned with him putting any solid foods in his mouth.  He is a happy baby boy in the 95 percentile for weight, so I am enjoying showing him different foods and letting him smell them (while simultaneously keeping them out of reach) during our meal times throughout the day.  Henry likes time with me in the kitchen while i’m cooking which provides me with a perfect opportunity to teach the language of food (i.e. names, colors, shapes) and to model how I interact with food and eat it.  So while many people would say that I haven’t introduced solid foods yet, I would have to disagree with them. I have introduced food, but we have not reached the stage for food to enter his mouth yet.

The day we reach the stage of food entering his mouth will be exciting.  On that day, I will not have a spoon out at all. 

Kind of eye-opening to learn about the real stages, right?

Believe me when I tell you that these stages are not even the tip of the iceberg. If you have a child that is struggling with feedings and to gain weight or grow, it is important that you get them to a pediatrician immediately and discuss options that are best for your individual child.  Every child is different. Every child needs individualized care by a licensed professional.The information on this web site is not intended to be a substitute for informed medical advice or care. You should not use this information to diagnose or treat any health problems or illnesses without consulting your pediatrician or family doctor. Please consult a doctor with any questions or concerns you might have regarding your or your child’s feeding, speech language development or food allergies to receive appropriate care.

For more information on Kay Toomey’s S.O.S .APPROACH TO FEEDING PROGRAM, please visit her website here.