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Eating, drinking and swallowing

We support infants and children with eating, drinking and swallowing skills. This is sometimes known as dysphagia.

Eating and drinking difficulties can be associated with a number of conditions and health issues, including:

  • Prematurity
  • Motor disorders, for example cerebral palsy
  • Infectious diseases, for example meningitis
  • Neurological deficits, for example acquired brain injury
  • Neuromuscular difficulties, for example muscular dystrophy
  • Respiratory conditions, for example chronic lung disease
  • Oncology
  • Cardiovascular disorders, for example congenital heart disease
  • Gastrointestinal difficulties, for example gastro-oesophageal reflux
  • Craniofacial conditions, for example cleft palate
  • Congenital syndromes, for example Down’s syndrome
  • Learning disabilities

Dysphagia can present in many different ways. Symptoms can include:

  • Coughing
  • Choking
  • Chest infections
  • Spluttering during feeds or messy with bottle feeds
  • Poor nutrition, weight loss, failure to thrive
  • Dehydration
  • Poor chewing skills

Eating and drinking development

4 to 6 months

Drinking

Bottle/Breast:

  • Strong rhythmical suck
  • Recognises and moves to bottle

Cup:

  • A cup may be introduced.
  • Tongue protrudes under rim of cup.
  • Little lip activity.

Eating

  • Soft smooth foods are sucked from the spoon.
  • Tongue protrusion used to control the food and transfer it to the back of the tongue for swallowing.
  • Soft lumpy foods may be introduced around 6 months.

7 to 9 months

Drinking

Bottle:

  • Sucking well integrated.

Cup:

  • Longer drinking sequence.
  • Moderate liquid loss.

Eating

  • Munching and biting emerge.
  • Front of the mouth is used.
  • Finger feeding begins.
  • Tight lip closure can be achieved.
  • Opens mouth for a spoon.
  • Draws food in with the lower lip.
  • May clear food from spoon with upper lip.
  • Teeth begin to come in.

9 to 12 months

Drinking

  • Longer drinking sequence.
  • Spillage reduced.
  • Assists with holding cup.

Eating

  • Tongue collects and controls food.
  • Graded mouth opening.
  • Graded jaw closure.

12 to 18 months

Drinking

  • Can manage several swallows in a sequence.
  • Jaw stabilization achieved by biting on the rim of the cup.
  • Improved lip function and tongue maintained in mouth during drinking.
  • May use a straw.
  • Enjoys playing with food and drink.

Eating

  • Well controlled bite.
  • Uses tongue to clear food in mouth.
  • Full eruption of teeth increases the size of the oral cavity. The larger the oral cavity, the wider range of foods the child can have.

18 to 24 months

Drinking

  • Stabilises cup without biting the rim.
  • Competent at sucking through a straw.

Eating

  • Chewing pattern is mature.
  • Cleans upper lip with tongue tip.
  • Both lips actively control food.

2 years plus

Drinking

  • Refinement of skills.
  • Independent and neat drinker.

Eating

  • Independent and mature eater.
  • Food is transferred in mouth with closed lips.
  • Good protective cough clears the airways.

Weaning

Weaning is when solid foods are gradually introduced alongside breast milk or infant formula.

There is a lot of information to help support your baby when they are ready to wean, but sometimes it can be confusing.

Introducing solid food is an important time for you and your baby. Health experts now recommend that babies should start eating solid foods from around the age of six months.

For the first six months, all the nourishment your baby needs come from milk or formula, but after six months, they will need more nutrients than milk alone can provide. This is why we start to introduce solid foods.

For further information:

If your baby was born prematurely, ask your paediatrician, health visitor, paediatric dietitian, or speech and language therapist for advice about what is best for them.

Bliss Baby Charter is an excellent resource of support and advice. Bliss recommend weaning your baby when you see three or four feeding cues:

  • Your baby can sit up by themselves, needing only a little support.
  • They can hold their head up easily and keep it upright while sitting.
  • They explore objects with their fingers, hands, and mouth.
  • They reach and grasp for food and/or open their mouth when food is offered.
  • They are beginning to bite and chew toys.

By around five months (corrected age) is the youngest age a premature baby may show cues that they are ready to wean.

By around six months, many babies are ready to begin solids foods. It is important to always correct your babies age for prematurity. Visit Bliss Baby Charter for more information.

Help with introducing textures and finger foods

Once your baby is used to eating a few foods, it’s time to move on to:

  • More meals – for example, once to twice per day. By 12 months your baby will probably have three meals per day and two snacks
  • More foods – offer different foods (see Fun First Foods: An easy guide to introducing solid foods for more info)
  • More texture – move on from smooth foods to lumps and then onto finger foods
  • Introduce a cup (free-flow beaker)
  • Encourage your baby to feed themselves and get messy!

If your baby only likes smooth foods

Some babies find it more challenging to move onto textured foods.

It’s important to work through this and introduce textured foods (lumpy, mashed, minced) and finger foods. There is no specific age that this should happen, but it is important not to get stuck on smooth solids.

We often get asked for help when a baby becomes used to being on smooth foods for longer than they need to be. You may find that your baby gags and, if they are very sensitive to texture, they can also make themselves sick.

They may become upset, or refuse food by:

  • turning away
  • spitting food out
  • refusing a spoon
  • clamping their mouth closed

This can make mealtimes stressful for you and your baby. There are a few tips to try and make things a little easier for you:

  • Put some food out on your baby’s high chair and allow them to touch and explore the food.
  • Don’t feel pressured into making them accept the spoon, they find it more enjoyable to feed themselves with their hands.
  • They may accept it better if they know they can play, touch or explore the food.
  • Add in some toys such as blocks, stacking cups and make it a game.
  • Encourage finger foods. If you are worried about this, start with soft, melty finger foods that dissolve in your baby’s mouth. Some babies prefer to eat finger foods rather than accept a spoon. This is okay and should be encouraged.
  • If you are using ready meals or baby jars/pouches, some of these which are aimed at 7+ months can contain big lumps. Try mashing them down with a fork to make the lumps smaller. Or, use smooth foods and add your own texture such as crushed cereals or mashed fruit/vegetables.
  • If your baby gags, try not to panic. This is a normal reflex and usually reduces over time. See our advice below on what you can do if your baby gags.

Gagging

Some babies may gag when they start to eat solid foods or foods with more texture. It is important to understand and recognise the difference between gagging and choking.

Gagging is a normal reflex and is very common when babies start to wean.

A gag is a normal reaction, which usually becomes less sensitive as a child experiences new tastes and textures in their mouth.

With practice, your child should develop chewing skills which allows them to manage lumpy foods easier. Babies and children often gag when they are introduced to lumpy foods. They may look like they don’t like the food and try to spit it out.

What to do if your child gags

  • Don’t panic.
  • Avoid looking worried or reacting negatively. Your child will pick up on the negative cues and is more likely to gag again.
  • Instead, distract them, or smile and give positive feedback (such as “yummy yummy” or “nice carrots”)

To prevent gagging, try to introduce lumpier or textured foods soon after your baby is coping with smooth foods.

Mashing foods rather than blending allows for more texture. Mashed foods can be introduced from 6 months.

If appropriate, encourage your child to feed themselves – this might mean offering more finger foods.

If your child is having difficulties accepting lumps, gradually increase the size of lumps into smooth or pureed foods. For example, crush up some cereal into a fine sand consistency and add it to yoghurt or custard.

Choking

Choking is different from gagging; it happens when food gets stuck in the airway.

Choking is quiet, skin can look blue and your child can struggle to breath. Immediate action is required.

If you need more information on the differences between gagging and choking, please visit the NHS Start for Life section on Choking and gagging on food.

Ways to help your baby and child develop feeding skills

There are lots of things you can do to help your baby, infant or child develop their oral feeding skills.

First, make sure your baby is developmentally ready, and aim to introduce solid foods around six months.

Here are our top 10 weaning tips:

  1. Food is fun until they’re one!
  2. Buy messy floor mats
  3. Get a highchair with a tray
  4. Embrace the mess
  5. Offer a variety of foods
  6. Eat with your baby
  7. Introduce finger foods from 6 months
  8. If they gag on food, try to distract
  9. Expect waste
  10. Try giving them a loaded spoon

Children with eating, drinking and swallowing difficulties

For some children, eating and drinking can be challenging.

As a parent, you want the best start for your baby. Your baby may have breast or bottle fed without difficulty, or they may have required some help with feeding in the early stages.

Some babies, especially those who are born preterm, may require supplementary tube feeding until they are ready to feed orally.

There are a range of local resources to support you and your baby in the early stages, including:

  • information leaflets
  • support groups
  • Messy Muncher groups

These are found within the Infant Nutrition section of Ayrshire Bairns on the NHS Ayrshire and Arran app, which is available to download for your mobile device:

Swallowing is a highly complex skill which can affect babies, infants and children of all ages. This can have an impact on your child’s nutrition, growth and enjoyment during mealtimes. It can also be a stressful time for parents and carers.

Some children require modifications to their food and drinks.

The International Dysphagia Diet Standardisation Initiative (IDDSI) is a tool for describing food and fluid:

  • textures
  • consistencies
  • thickness

The tool helps to improve the safety for children with swallowing difficulties.

Reflux

Reflux can also impact on how your baby feeds. For support in managing reflux, contact your health visitor or GP. If your baby has had reflux, you may find that they gag more easily, especially when it comes to introducing solids. See our information on weaning below.

Get in touch

If you are concerned that your child is having difficulties with eating, drinking or swallowing, please get in touch with your:

  • GP
  • health visitor
  • paediatrician

Speech and Language Therapists are trained to support and assess children’s eating and drinking skills. They work with other health care colleagues to support feeding and nutrition.

Further resources