Nutritional Disorders Telehealth Network Project

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Referral Worksheet

Background Education for Providers
To understand the nature of feeding problems, one should first be familiar with the stages of feeding development. Although these stages are typically observed in children living in the United States, there may be variations in these stages across cultures due to differences in parenting practices and beliefs. During infancy, children typically are fed breast milk or formula for the first 4-6 months of life. Smooth foods and pureed textures are usually introduced at about 6 months of age, and easily dissolvable foods between 6 and 9 months. Most children are introduced to table foods by 12 months, and by 24 months most children are eating a diet consisting primarily of solid foods similar to those eaten by the entire family. Interest in self-feeding emerges as fine motor skills develop, typically between 9 and 24 months, with skills advancing from fisted feeding and holding a bottle independently to the use of utensils and an open cup. As children progress in their feeding skills, they are given and/or allowed more control over the foods selected and the volumes of food consumed. Feeding problems often are first identified in the first 2-3 years of life when the child does not progress from one feeding stage to the next or when feeding transitions are difficult.

Instructions for Provider
If a child does not advance their diet within these expected norms or appears to have excessive coughing, gagging or vomiting then a speech and language evaluation may be necessary.
Supplemental Materials
© 2015 Medical College of Wisconsin
Page Updated 04/15/2014