Feeding Development and Difficulties

Communication and Cognitive Development

  • Communication yellow puzzle piece
    • Communication and cognitive (thinking) skills develop during exchanges that happen at mealtimes.
    • The conversation of mealtime changes and increases in complexity as communication skills develop.
    • Cognitive development is supported by the sensory experiences of feeding.
    • Mealtime behaviours change as cognitive skills develop and children’s understanding of their world increases.

    Exclusive breast or formula feeding

    Newborn

    • Uses crying to communicate all their needs.
    • Relies on parents to interpret needs. The mealtime conversation is somewhat one sided. 

    During the first few months of life

    • Sensory and motor skills work together to encourage exploration supporting cognitive development.
    • Skills to more effectively communicate needs develop.
    • Baby learns that feeding of breast milk or formula satisfies hunger.

    Conversations of feeding might include:

    ‘Are you hungry?’ – ‘ I think a feed is what I need’
    ‘Do you have a tummy pain?’
    ‘Do you need to burp?’
    ‘Why aren’t you sleeping?’

    Communication Cognition
    • Differentiates cry and uses other sounds to get attention and indicate hunger.
    • Begins to use gestures such as lip smacking or hand sucking purposefully to indicate hunger.
    • Gives cues to indicate satiety e.g. stops sucking, moves head away from breast or bottle.
    • Demonstrates enjoyment with feeding.
    • Turn-taking with vocalisation emerges
      • Begins to engage in voluntary and differentiated communications.
    • Distractibility increases. Feeding may be interrupted by attention to noise.
    Cognitive development is supported by the ability to coordinate eye movements to first fix and then follow.
    • Differentiates objects.  Understands sucking from breast or bottle is different from sucking on hands, dummy or toy.
    • Recognises external cues and routines associated with feeding to predict that feeding is about to occur. e.g. mother preparing to feed,  sounds associated with feeding.
    • Develops reciprocal enjoyment. Responds to facial expressions e.g. responsive smiling
    • Becomes curious showing interest in examining objects.

    First Foods

    • Mealtime conversations involve two-way communications. Vocalisations are purposeful, intonated and directed.
    • Understanding of associations with the process of feeding is supported by repeated experiences.
    • Understanding that solid foods can also satisfy hunger develops.

    Conversations of mealtimes might include:

     ‘Are you ready to begin solids?’- ‘What is this in my mouth?’
    ‘Are you enjoying new foods?’  
    ‘Do you want more?’ – ‘No! I’ve had enough?’‘I think I want to sleep now’

    Communication Cognition
    • Communicates using vocalisations, facial expressions and body movements.
      • Enjoys babbling and engaging in two-way ‘conversations’.
      • Responds to terms such as ‘yum yum‘ when food is presented.
    • Communications may be open to interpretation.
      • Facial expressions such as grimace provide responses to new feeding experiences.  Response could be interpreted as ‘I’ve never tried this before’ rather than ‘I don't like this’.
    Understanding of object permanence, consequences and causality, begins to develop
    • Anticipates and develops expectations about feeding.
      • Associates feeding with routines such as having bib put on, being placed in the high chair, hearing the microwave beep.
    • Understands:    
      • Opening mouth indicates readiness to feed.
      • Turning head or closing lips indicates desire to stop feeding.
    • Uses carers’ emotional responses to help interpret what the experience means  e.g. ‘mum is smiling so this food must be safe’
    • Searches for food and utensils after they fall from high chair.

    Increasing variety

    • Participation in social communications at mealtimes increases.
    • Cognitive and communication development allows and encourages increasing feeding independence.
    • Cognitive development influences mealtime behaviours.
    • Understanding that eating a variety of foods of varying textures satisfies hunger develops.

    Conversations of mealtimes might include:

    ‘Don’t throw your food on the floor!’ – ‘ If I drop this off the high chair what will happen’
    ‘Is that too much in your mouth?’ – ‘How much do you think I can fit in here’
    ‘Are you choking’ – ‘It’s Okay, I’m still learning about lumps’
    ‘Do you like this?’- ‘What will happen if I refuse to eat’

    Communication Cognition
    • Uses a few words or vocalises to communicate and seek attention.
    • Uses gestures to communicate needs e.g. pointing at cup to request a drink, shaking head to indicate ‘NO’.
    • Requests and refusals become clearer and enjoyed.
      • Indicates  clearly when  ‘finished’
      • Refuses for the fun of the interaction or for asserting control.
    •  Understands: 
      • Words with visual cues
      • Simple instructions and frequently used words e.g. dinner time, all gone, stop, no.
    • Understanding of object permanence, consequences and causality, increases.
    • Desire for independence and autonomy emerge.
      • Starts to self feed.
      • May refuse spoon or food.
    • Understanding of control at mealtimes develops.   However not all actions are ‘Deliberate’ or ‘Meaningful’.
      • May throw food or utensils off the high chair to indicate satiety or out of curiosity.
    • Understanding of sensory concepts to predict what food may taste like develops e.g. warm- cold, rough - smooth, soft-hard.
    • Physical development provides skills to further explore and learn about food e.g. squashes food between fingers, uses hands to explore food in the mouth.

    Independent feeder

    • Mealtimes are a time for enjoyment of social interactions.
    • Mealtime interactions provide opportunities for further developing language and cognitive skills.
    • Understands that eating a variety of foods in a range of settings satisfies hunger.

    Conversations of mealtimes might include:

    ‘Why won’t you eat your pumpkin? I thought you liked it yesterday’- ‘I don’t see you eating this’
    ‘Would you like apple or banana?’- ‘I really want the biscuit’
    ‘Why won’t you feed yourself? You've done it before’ -  ‘I’m really tired and would like some help’

    Communication Cognition
    • Uses words to:
      • Make simple requests for food and drink.
      • State preferences.
      • Protest about food offered.
    • Continues to use actions with or without words to communicate. 
    • Understands simple instructions.
    • Increasing ability to make choices from a limited range.
    • May use words out of context or with incorrect meaning to achieve desired response.
    • Independence increases but may be inconsistent.  Prefers to self feed but:
      • May give cues or make requests for assistance.
      • May not be tidy. Understands correct use of utensils but hands may be more efficient.
    • Enjoys learning through play.
      • Simple pretend play, initially alone e.g.  Feeding teddy, pretend tea party, home corner play.
    • Executive function i.e. memory & planning begins to develop.

    Over time develops the ability to:

      • Discriminate between foods. Can remember having had food before and if it was enjoyable.  Requests preferred foods.   ‘I only eat mashed potato with cheese on top. Like I have had before’
      • Understand consequences of choices.
      • Understand mealtime routines and expectations.
      • Understand time sequences such as ‘lunch, then play’
      • Generalise skills and apply them to different environments such as home, childcare, grandparents, restaurants but also learns to respond to different expectations e.g. will do at child care what they won’t do at home, including eating and drinking.

    Further reading:

    Suzanne Evans Morris Website