13: Feeding/Eating

Eating

The ability to keep and manipulate food or fluid in the mouth and swallow it.

Feeding

Setting up, arranging, and bringing food or fluids from the plate/cup to the mouth.

OTs can work on feeding and eating (oral preparatory and oral phases) ___ advanced certification.

Without

Pharyngeal Phase OT Scope (California)

Requires an Advanced Practice Certification or active pursuit of it.

Liquid Milestone: 6-9 months

Infant holds their own bottle.

Liquid Milestone: 6-8 months

Introduction to a sippy cup

Liquid Milestone: 9-12 months

Infant is able to use a sippy cup independently.

First Solid Foods Introduction Age

4-6 months (smooth purees of a single texture).

Teething begins (bottom & top front)

6 months

Finger Feeding & Dissolvable Foods Age

7-8 months (e.g., puffs, small pasta pieces).

Spoon Use Introduction Age

10-12 months using baby-sized, curved utensils.

Increased Control of Chewing

12-18 months

Increased Overall Motor Control with Utensils & Feeding

18-24 months

New Food Introduction Rule

Introduce only one new food every 7-10 days to monitor for allergic reactions.

Munching

Up-and-down jaw motion in young infants before transitioning to rotary chewing at 9-12 months.

Chewing

Breaking down food using lateral jaw movements, rotary chewing, and lateral tongue movements.

Controlled Mature Bite

The ability to grade biting force according to food resistance.

Jaw Stabilization

Holding the jaw steady (e.g., resting a cup on the lower lip while drinking at 15-18 months).

Phasic Bite-Release

Rhythmical jaw movement present until 5-6 months.

Tongue Lateralization

Side-to-side tongue movement inside the mouth used to form a food bolus.

Rooting Reflex

Present until 4 months (longer during sleep).

Suckling

Highly organized, reflexive suck-swallow-breathe pattern seen in newborns and infants under 3 months.

Sucking

Emerges around 4+ months; voluntary lip and tongue control to pull fluid/food into the mouth while coordinating sucking, swallowing, and breathing.

Typical Gag Reflex

Protective reflex triggered on the posterior third of the tongue.

Hyperactive Gag Reflex

Atypical reflex triggered on the anterior third of the tongue.

Absent Gag Reflex

Lack of gag reflex on the posterior third of the tongue; indicates potential cranial nerve damage and absent protective mechanisms (seen in TBI, Mobius syndrome).

Jaw Thrust

Forceful opening of the jaw associated with spasticity and Cerebral Palsy.

Tonic Bite Reflex

Uncontrolled, forceful bite pattern associated with spasticity and CP.

Lip Pursing

Tight puckering of the lips (associated with spasticity and CP).

Lip Retraction

Lips pulled back tight with limited closure.

Tongue Thrust

Tongue forcefully pushed forward out of the mouth, interfering with bolus transport.

Tongue Retraction

Tongue pulled back into the oral cavity, limiting bolus control.

Central Control

Cranial nerves involved in swallowing reside in the brainstem and receive corticobulbar inputs.

Upper Motor Neuron (UMN) Swallowing Lesions

Lead to poor motor organization.

Lower Motor Neuron (LMN) Swallowing Lesions

Lead to low muscle tone and poor muscular endurance.

CN V (Trigeminal) Feeding Role

Controls muscles of mastication (masseter, temporalis, pterygoids); tested via bite strength.

CN VII (Facial) Feeding Role

Sensory for anterior 2/3 taste; motor for facial expression and buccinator to prevent food pocketing.

CN IX (Glossopharyngeal) Feeding Role

Sensory for posterior 1/3 taste; motor triggers pharyngeal swallow and gag reflex.

CN X (Vagus) Swallowing Role

Controls palate, pharyngeal, and laryngeal muscles; assessed via vocal quality and swallow elevation.

CN XI (Accessory) Function

Works alongside CN X via pharyngeal plexus for palate/pharyngeal movements.

CN XII (Hypoglossal) Function

Intrinsic and extrinsic tongue muscles; lesion indicated by tongue deviates toward the side of the lesion during protrusion.

Extrinsic vs. Intrinsic Tongue Muscles

Extrinsic muscles position the tongue; intrinsic muscles change tongue shape.

Masseter & Temporalis

Elevate jaw / chewing.

Medial & Lateral Pterygoids

Jaw movement / grinding.

Buccinator & Risorius Function

Maintain cheek tension and lip control to prevent food spillage from the mouth.

Stage 1 of Swallow: Oral Preparatory Phase

Food is broken down, mixed with saliva, and formed into a bolus.

Stage 2 of Swallow: Oral Phase

Tongue propels the bolus backward through the oral cavity toward the pharynx.

Stage 3 of Swallow: Pharyngeal Phase

Involuntary reflexive swallow triggering laryngeal elevation, epiglottis closure, and soft palate elevation.

Stage 4 of Swallow: Esophageal Phase

Bolus is moved down the esophagus via peristalsis past the UES to the stomach.

Aspiration Definition

Entry of food, liquid, or saliva into the airway/lungs instead of the esophagus.

Cause of Aspiration BEFORE Swallow

Poor tongue control or impaired bolus management leading to premature spillage into the pharynx.

Cause of Aspiration DURING Swallow

Delayed trigger of the pharyngeal swallow or reduced laryngeal closure.

Cause of Aspiration AFTER Swallow

Remnants trapped in the valleculae or pyriform sinuses falling into the airway after swallowing.

Primary Feeding Intervention Positioning

90-90-90 upright posture (hips, knees, ankles at 90°) with a slight chin tuck.