Advantage Speech & Language Services

Table IV-5 Milestones Relevant to Normal Feeding

Table IV-6: Clinical Clues of a Possible Feeding Problem

• Prolonged feeding times (>30 minutes)
• Stress during or following feeding for child and/or parent
• Poor suck, difficulty latching on to nipple
• Loss of liquid or food around lips
• Excessive tongue retraction or protrusion
• Holding food in mouth or prolonged chewing before swallowing
• Excessive drooling
• Indication of respiratory distress during oral feeds (for example, arching back, turning away, eye widening, nasal flaring, difficulty catching breath)
• Gurgly voice quality
• Difficulty in making transition to a new texture at developmentally appropriate stages
• Coughing or gagging while eating
• Frequent vomiting or excessive spitting up during or after meals
• Poor weight gain
• Reduced interest in or negative response to oral presentation of food

Table IV-7: Components of an Initial Oral-Motor Assessment

• Physical examination and comprehensive history:
• Structure and function of oral, facial, pharyngeal, respiratory, and gastrointestinal systems
• Other conditions that could affect the child's tolerance and stamina (such as cardiac conditions)
• Observation of interaction patterns between the child and caregiver
• Effects of muscle tone, posture, movement, and positioning
• Oral-motor exam, to be performed prior to offering liquid or food, including:
• Presence/absence of oral reflexes
• Structure and coordination of movement of the lips, tongue, soft palate, and jaw
• Oral sensation
• Laryngeal function
• Control of oral secretions (drooling)
• Respiratory rate and effort
• Oral postural control and voice quality
• Feeding assessment including:
• Feeding environment
• Level of alertness and attention
• Affect, temperament, and responsiveness
• Ability to self-calm and self-regulate
• Non-nutritive sucking (such as on a pacifier)
• Observation of trial feeding
• Swallowing
• The effect of alternate positioning and modifications of the feeding process
• Evaluation of the diet for adequate nutritional intake