Feeding Development and Difficulties

Mealtime Environment

  • mealtime puzzle piece - green

    • Mealtimes are a time for sharing and social interaction and for the provision of foods to meet nutritional requirements. Food choices and how food is offered are strongly influenced by cultural norms and parent’s individual beliefs.
    • The interplay between Social and Emotional development, Physical, Sensory and Oral motor development and Cognitive and Communication development is influenced and shaped by the mealtime environment.
    • Mealtimes provide opportunity to practice motor skills, develop communication and cognitive skills and support social and emotional development.
    • At all stages of feeding development, mealtime tasks are shared between parent and child in a feeding relationship that is reciprocal in nature and relies on mutual trust. Child and parent are equal partners in the feeding relationship.

    Exclusive breast or formula feeding

    • Exclusive breast feeding is the best way of feeding healthy term infants.  If breast milk is not available infant formula should be used.
    • Breastfeeding provides benefits to both baby and mother. 
    • Breast milk or formula meets all nutritional requirements until around 6 months.  No other food is needed for nutrition.
    • Baby and parents both have responsibilities for feeding.
    Parent decides: Baby decides:
    • What and How to feed:
    •  Whether to breast or formula feed.
    • In response to baby's cues when and where to feed.
      • Position for feeding is comfortable for mother and baby. 
      • Interactions with baby at feed times are enjoyable but do not disrupt feeding.
    • When or How often  to feed:
      • Provides cues to indicate hunger and satiety.
      • Sets the pace of feeding
      • Decides how much to drink:
        • Intake varies between babies and over the day for individual babies.
        • For formula fed babies, volumes on the can are only a guide.

    First Foods

    • First foods are usually introduced at around 6 months to meet increasing nutritional requirements.
    • At this age most babies are developmentally ready for first foods and the feeding relationship takes on new dimensions.  
    • Breast milk or formula continues to be the main source of nutrition.
    • Children and parents share responsibilities for feeding.
    Parent decides: Baby decides:
    • When to begin first foods:
    • Where food is offered:
      • A supportive safe feeding position is used.
      • Feeding position allows for eye contact and interaction but not necessarily face to face.
    • What food is offered:
      • Foods can be introduced in any order providing iron-rich nutritious foods such as iron fortified rice cereal, puree meat and chicken, cooked plain tofu and legumes are included.
      • Repeat presentations are provided to increase familiarity with new foods.
    • How food is offered:
      • First foods may be puree, mashed or in soft pieces depending on baby’s stage of development and preference.
      • The size of the spoon, amount of food and how it is presented is appropriate to baby’s needs.
      • Foods are kept separate to help baby experience individual flavours and textures.
    • How much to eat or if they will eat at all:
      • Provides cues to indicate hunger and satiety.
      • Sets the pace of feeding.
      • May be inconsistent in deciding which foods are eaten.  
      • May eat less than a teaspoon to begin with.  The amount increases gradually as the variety of foods increase.

    Increasing variety

    • An increasing variety of foods is gradually introduced so that by around 12 months a wide range of family foods are included in the diet.  
    • Solid foods gradually provide an increasing proportion of nutrient requirements.
    • Breast milk or formula continues to be the main drink.
    • Cow’s milk is not given as the main drink until after 12 months.
    • Children and parents share responsibilities for feeding.
    Parent decides: Baby decides:
    • When to offer food: 
      • Mealtime routines are predictable and gradually fit in with family mealtimes.
    • Where to feed:
      • Mealtime environment enables a focus on enjoyment of food and social exchanges.
      • Feeding occurs in new and different environments.
      • A variety of role models are provided.
    • What food is offered:
      • A variety of foods are offered over the week – including iron rich foods, vegetables, fruits, grains and cereals and dairy.
      • Graded experiences are used to introduce new textures to match oral motor development.
      • Finger foods are offered.
      • Use of family foods increases.
      • Homemade vs. packaged foods.  Home prepared foods assist with providing graded experiences.
      • Repeat presentations increase acceptance.
    • How food is offered:
      • Use of utensils or fingers is encouraged. Motor skills enable baby to start to self feed.  Turn taking with two spoons may be used.
      • Natural curiosity is encouraged.
      • Mess at mealtimes is tolerated and managed.
      • A cup for drinking is introduced.  Water, expressed breast milk or infant formula is offered.  Juice or cow’s milk is not used.

    Independent feeder

    • In the second year of life children refine their feeding skills progressing at their own pace to become independent feeders. 
    • Children learn to enjoy a range of healthy family foods.
    • Children and parents continue to share responsibilities for feeding.
    Parent decides: Child decides:
    • When food is offered:
      • Regular meals and snacks are provided.
      • Sets limits with respect to:
      • Length of mealtimes.  Not more than 20-30 minutes.
      •  Acceptable mealtime behaviours.
    • Where food is eaten:
      • Mealtimes are enjoyable, relaxed and social.
      • Mealtime routines avoid coercion bribery and distractions.
      • Eating occurs in a range of environments. 
      • A variety of role models are provided including adults, siblings and peers.
    • What food is available and offered:
      • A variety of foods from all food groups are offered over the day.
      • Limited choices from a range of healthy foods are provided.
      • Excessive intake from any one food group is avoided. 
      • A balance of ‘everyday’ and ‘sometimes’ foods is maintained.
      • Individual likes and dislikes are accepted but the preparation of separate meals is avoided.  Link  
    • How food is offered:
      • Opportunity to develop skills in using a range of eating and serving utensils is provided.
      • Milk and other drinks are offered in a cup.  Bottles are not recommended after 12 months.
      • Feeding independence is encouraged reducing need for mealtime assistance. 
      • Opportunity to be involved in food preparation and mealtime routines is encouraged.
    • How much to eat or if they will eat at all:
      • Understands and responds to hunger and satiety.
      • Appetite varies and intake may vary over the day and from day to day.
      • Practices refusal to test routines and limits – not necessarily about the food.
      • Gets side tracked by own curiosity, contributing to variable appetite.
      • At times may be too tired to complete a meal or enjoy the social interactions of mealtimes.
      • May be reluctant to try new foods. 
      • Trusts that parent provides a range of appropriate foods.

    Further Reading:

    Australian Dietary Guidelines 2013

    Eat for health

    Infant Feeding Guidelines: information for health workers. NHMRC 2012

    Ellyn Satter Institute