Q. My baby is the messiest spoon feeder. His tongue pushes out all of the food and he loses most of what I put in. What can I do?
A. Most babies are ready to spoon feed between 4-6 months of age. Make sure that your baby has good head support, is able to sit with minimal support and shows interest in watching you eat.
From what you are describing, it sounds like your son has a tongue protrusion pattern or tongue thrust reflex during swallowing. If your baby still has the tongue thrust reflex and is under 5 ½ months of age, simply wait a few days to weeks and try again. If your baby is 5 ½ months of age or older and still pushes out the spoon or the puree, you should discuss this with your pediatrician, as a referral for a feeding evaluation may be indicated.
The type of spoon that you use and the way the spoon is placed in your baby’s mouth can influence his feeding patterns. Look for a spoon that is about the width of your son’s tongue and one that is relatively flat. A deep-bowled spoon is harder to eat from and often, because the baby has a hard time, clearing the spoon, the feeder will scrape the spoon on the baby’s gums. Just imagine that there is food on the backside of your top teeth. What would your tongue do to get it? If you answered push your tongue forward, you have answered correctly. Food placement there reinforces the tongue thrust reflex pattern and the baby accidently pushes out the food instead of collecting it and swallowing.
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Spoon placement can also impact your baby’s feeding skills. Follow this spoon-feeding technique:
- Place the spoon so that your baby can see that it is coming and can anticipate the spoon by opening his mouth.
- Once he opens his mouth for the spoon, place the spoon on the middle of his tongue.
- Hold the spoon stable and let your baby “suckle” the puree off of the spoon.
This spoon technique will reduce the tongue thrust reflex so that your baby can feed and swallow without the mess created by the tongue pushing out the food. You may not even need a bib.
The following are red flags that most likely need evaluation:
- Refusals or poor spoon-feeding skills by 6 months of age.
- Gagging, vomiting, choking or congestion during or after spoon feeding (any age).
- Stressful feeding (any age).
- Feeding refusals, head turning, batting at the spoon, crying, fussing (any age).
- Refusal to allow the spoon to touch the tongue, the tongue retracts in response to spoon placement or the tongue moves the spoon off.
Remember, feeding your baby should be a time of pure enjoyment for you and your baby. If you are stressed or your baby is stressed, seek help to avoid further complications or feeding disorders.
If you have a question about your child's health or happiness, ask Joan or any of our experts by sending email to firstname.lastname@example.org.
Joan Dietrich Comrie of Carolina Pediatric Dysphagia (919-877-9800) has dedicated her entire career to studying, teaching and practicing in the area of dysphagia, specifically pediatric dysphagia. She received her bachelor of science degree and then her master of science degree in the area of speech pathology at the University of Wisconsin-Madison in 1986. Before starting Carolina Pediatric Dysphagia in 1996, she worked at several hospitals (Cardinal Hill Rehabilitation Hospital, Lexington, Ky., Vanderbilt Medical Center, Nashville, Tenn., and WakeMed, Raleigh) where she developed or reorganized the hospital's pediatric dysphagia program.
Joan has spoken on the topic of pediatric dysphagia nationally and internationally. She has published in a professional journal. She co-taught the first dysphagia course offered at UNC and continues to guest lecture to several university graduate level speech pathology programs and to the UNC Medical Students who complete their rotation at WakeMed. She has served as chairman and member of a subcommittee of the Special Interest Division 13 of the American Speech Language Hearing Association (ASHA). She has received her certificate of clinical competence (CCC) through ASHA and is licensed in the state of North Carolina.