One area of daily functional tasks that pediatric occupational therapy providers support family and caregivers, is by addressing infant feeding challenges. When we receive an occupational therapy referral for a newborn, we are definitely going to be addressing infant feeding therapy in both the evaluation and probably the OT interventions. This means we support new parents or caregivers with strategies to help a little one eat from a bottle or by breastfeeding. Or, we might support newborns that are not typically developing or have other physical needs to acquire the food intake that they need to grow and thrive. Ultimately, this is one step in self feeding. At this stage, the newborn is the client and so is the family unit, so we support, educate, and provide tips and tricks to help with newborn feeding needs. In this blog post, you’ll find information and resources to help with feeding a new baby.
Read through our article on feeding developmental milestones, because that is a good place to start to know what age a baby should be doing certain things when it comes to feeding skills. Also important to read and understand is infant oral motor skill development.
You’ll want to incorporate the feeding cycle in therapy sessions with baby play strategies that will help with digestion, visual motor skills, visual tracking skills, positioning, spatial awareness skills, and other skills that in turn actually help with feeding. This is all part of infant feeding in occupational therapy and when we support the family or caregiver, we do want to mention that feeding cycle which includes other things like sleep and play as part of feeding needs.
infant feeding therapy
The main thing to consider when it comes to infant feeding therapy is addressing the needs of the child, which might be different depending on the age, the stage, the family needs, and other input like diagnoses, birth complications, hospital or NICU stays, and other things that will be different for each baby. This is all going to be part of the intake in the occupational therapy eval.
The OT processionals on the therapy team may see a lot of caregiver burnout when there is a feeding need in babies. This happens because it’s such an exhausting period of time for new parents or parents of multiple kids. The caregiver has a lot on their plate and when the baby struggles with feeding and often times, infant sleep schedules as well, we have a big cause of that exhaustion.
Once you have that information, you’ll address the needs that impact food and liquid intake so that the little one can grow and thrive. Let’s break down tips for each stage, because that is one way to know how to support different age levels. Remember that you can adjust these recommendations depending on the developmental age and stage of the little one. They might be a one year old who is developmentally at a 6 month old stage, for example, and then you can pick and choose the strategies that work for that age range.
Feeding is one of the most crucial activities you will learn to do with your baby, and it can be an exciting milestone in your child’s development. Around 5-6 months old is typically when you can start introducing solid foods to your baby. However, it’s perfectly fine to start earlier, provided that your baby is ready. Here are some signs to look for to determine if your baby is prepared for solid foods:
- Can they sit up on their own or with support?
- Are they able to hold up their head and control its movements?
- Do they open their mouth when milk is offered?
- Can they swallow without spitting out milk?
- Do they bring toys to their mouth?
If your baby can do these things, it might be time to start trying thin purees. While breastmilk or formula will continue to be their primary source of nutrition, introducing new foods now can help your baby develop feeding skills, get accustomed to different textures, and build the muscles in their mouth. Your baby will still need to be fed 6 ounces of breastmilk or formula 4 to 6 times a day.
Creating a feeding routine is essential for your baby’s development. Start by offering solid foods 1 to 2 times a day, ideally during family mealtimes. Sitting at the table with the family helps your baby learn that mealtimes are an important and regular part of the day. As you establish this routine, ensure that distractions like phones and televisions are minimized so that your baby can focus on exploring and enjoying the new foods in front of them. Eventually, work towards offering solid foods at breakfast, lunch, and dinner, giving your baby multiple opportunities to practice eating.
However, if your baby is having difficulty with feeding—whether it’s challenges with transitioning to solids, a newborn refusing to eat, or struggles with oral motor skills—occupational therapy can provide vital support. Infant feeding therapy, provided by an occupational therapist or an infant feeding specialist, is designed to address these challenges. This specialized form of occupational therapy focuses on developing the necessary skills for successful feeding, from improving oral motor function to addressing sensory sensitivities.
Here are some resources that help with this area:
- Jaw Clenching Oral Motor Problems
- Jaw Thrust Oral Motor Problems
- Exaggerated Jaw Thrust Oral Motor Problems
Occupational therapy for feeding is not just about helping your baby learn to eat; it’s about creating a positive and effective feeding experience for both the baby and the family. An occupational therapist will work closely with you to develop a personalized plan that meets your baby’s specific needs. This might include hands-on guidance during feeding, strategies to enhance your baby’s comfort with new textures, and support for building the muscles necessary for eating solid foods.
If you notice that your newborn refuses to eat or struggles with feeding in any way, seeking out an occupational therapy service that specializes in infant feeding therapy can make a significant difference. By addressing these issues early on, you can help ensure that your baby receives the nutrition they need for healthy growth and development.
How to Feed your Baby: 0 to 6 Months Old
Note that we tried to create this blog post as a resource for parents, so the recommendations are things that you might tell a parent or a caregiver of the baby.
It might be hard to know what to do when you have your first child. Here are some tips that will help you learn how to parent your baby in a way that will help them grow up in a happy and healthy way.
Important tips for feeding your baby include:
- Look at your baby while you feed them. This is a very special bonding time with them, and eye contact can help them develop healthy attachment to you as they grow up.
- In a soft voice, talk to them and sing to them. This helps with their brain growth and early language skills. You can hum them a lullaby, tell them that they are cute and that you love them, or sing a song like “Twinkle, Twinkle, Little Star”.
- Never force anything into their mouth. This may make them afraid to start feeding.
- Instead, gentle introduce them to the nipple by gently brushing the cheek closest to the breast or the bottle, then lightly touch their lips to it.
- DO NOT give your baby cow milk, corn syrup, or honey within the first year.
- Everything in this article is based on typical child development. Consult your doctor if you have any questions or concerns about your baby’s progress. Use this child development checklist as a resource to find out more about your infant’s development!
How much and How Often to Feed Your Baby
Look for signs that your baby might be hungry such as: sucking on their fists, increased movements, opening their mouth, and turning towards breasts. Crying is a late hunger sign and they should be fed before they get to this point. You do not want to feed a baby while they are crying, so to prepare them for feeding you can put a clean finger against the roof of their mouth to stimulate the reflex.
Hold your baby in a position that is comfortable and where their head, neck, and body are in a straight line with their arms in the middle of their body. It may help to have them swaddled while they are feeding. Knowing the signs of when your baby is hungry, you will notice that they are typically feeding about as often as the chart below states and will drink approximately as much as is listed.
Two Weeks
- For the first couple of weeks of your baby’s life, it might seem like they are wanting to eat all of the time. That is normal! Even though every child is different, they will usually want to be fed about every 2 to 3 hours, day and night.
- They will only eat up to about two ounces at each feeding.
Four Weeks
- Your baby will still want to be fed about every 2 to 3 hours. They now may start eating 2 to 3 ounces per feeding to make up for the weight they lost during the first couple of weeks.
Two Months
- Your baby will now be eating every 3 to 4 hours throughout the day and night. They will take about 4 to 5 ounces of milk at each feeding.
Four Months
- Your baby will now start to eat 4 to 6 ounces every 3 to 4 hours. Remember to look at your baby and use feeding as a time to improve their vision skills. Find out more about that here!
Six Months
- Your baby will not want to eat as often, usually wanting to be fed every 4 to 5 hours. They will now eat up to 8 ounces at each feeding.
How to Breastfeed
Your doctor will help you learn how to encourage your baby to latch to your breast while in the hospital, and it is common to work with a lactation consultant. For basic instructions about breastfeeding, click here. For ideas about positioning while breastfeeding, click here.
Its important that you keep track of how your baby reacts to your milk in relation to your diet. Sometimes the baby may react to what you are eating (like become more gassy if mom eats a lot of dairy), so keep this in mind to adjust as needed.
How to Use Baby Formula
If you choose not to breastfeed, don’t get discouraged! Many women feed their baby formula, which is a completely acceptable alternative that provides baby with many nutrients that they need for healthy development. Formula can be found at most grocery and department stores, and is provided for free by your local WIC agency. They can also help teach you how to properly feed your infant if you have any questions.
It is important to know that different types of formula exist for different needs, so talk with your doctor if your baby has a specific need.
Add water first. Use the measurer that comes with the formula and make sure that the scoop is not packed and flattened evenly. Use the guide on the formula to see how much of a scoop to add per ounce of water.
How to Burp a Baby
Burp halfway through their feeding. If you are breastfeeding your baby, burp them before switching to the other breast. There are different ways you can hold your baby while burping them.
Some of the most popular are:
Sit upright and hold your baby against your chest. Your baby’s chin should rest on your shoulder as you support the baby with one hand. With the other hand, gently pat your baby’s back.
Sitting in a rocking chair and gently rocking with your baby while you do this
may also help. You can put a burp rag over your shoulder to catch any spit up that
may occur.
Hold your baby sitting up, in your lap or across your knee. Support your baby’s chest and head with one hand by cradling your baby’s chin in the between your palm and index finger. Rest the other side of your hand on your baby’s chest, but be careful to grip your baby’s chin, not the throat. Use the other hand to pat your baby’s back.
How to Introduce Solid Foods to Baby
Introducing new foods to your baby follows a gradual pattern. As your baby’s mouth learns how to handle and swallow solid foods, you can slowly begin offering thicker and more textured foods.
It’s important not to start with hard foods, as your baby won’t yet know how to manage them and may be at risk of choking. Instead, begin with a thin puree and gradually progress through different foods and textures. Move on to the next texture only once your baby has become comfortable and proficient with the current one, which may take a few weeks or more.
Start each meal by first offering your baby a bottle of breast milk or formula to ensure they have some nourishment in their stomach. After that, place a small amount of puree on a plate or directly on their highchair tray so they can see and explore it. Don’t worry if they don’t eat much at first—they might simply touch the food, decide they don’t like the texture, and become upset. This is a normal and positive part of the feeding process!
Initially, your baby might only smell the new food, and that’s perfectly okay. The next time you introduce the same food, they might touch it, play with it, and even cry to have their hands wiped off. Provide a baby spoon for them to use during this exploration, though they will likely spit out the food initially, which is completely expected.
These steps, while they may seem small or even messy, are crucial as your child learns about new foods. Expect a bit of a mess—that’s a good sign! It may take time before your baby is ready to actually taste the food, so celebrate the slow but steady progress they are making in this new learning experience.
Baby Crying after Feeding
Starting around the age of about 6 weeks old, you may notice that your baby is crying a lot more, especially after feeding. Many people call this “colic”, when a baby cries many times throughout the day without seeming to be able to calm down.
The most common reason for this is that the baby’s tummy muscles are not fully developed, so sometimes the strong acids in the stomach will come up into the throat, and even cause them to spit up often.
To help prevent the milk from coming back up, keep your baby upright after feeding for 10 to 15 minutes or longer if your baby spits up or has GERD. But don’t worry if your baby spits sometimes, this is very normal.
One thing to remember is that feeding cycle that we should be using. This means we might follow a general schedule:
- Baby wakes, crying
- Feed baby
- Change baby’s diaper
- Tummy time or baby play time
- Sleep
This schedule, with some adjustments…remember that at this stage of childhood, there is nothing regimented, can be used most of the time throughout the day.
Before bedtime, you may want to change the schedule slightly. This means that at the same time each evening, you start an evening schedule. It might looks something like:
- Play time, tummy time
- Bath
- Dress baby, snuggle, swaddle
- Read a book, quiet play like singing
- Feed baby
- Sleep
Resources on Infant Feeding Therapy
Jain, S. (2020, October 29). How often and how much should your baby eat? Healthy Children. https://www.healthychildren.org/English/ages-stages/baby/feeding-nutrition/Pages/How-Often- and-How-Much-Should-Your-Baby-Eat.aspx
Scott, J., & Land, S. (2016). The confident parent: A pediatrician’s guide to caring for you little one without losing your joy, your mind, or yourself. TarcherPerigee.
US Department of Agriculture. (n.d.). Special supplemental nutrition program for women, infants, and children (WIC). https://www.fns.usda.gov/wic
Colleen Beck, OTR/L has been an occupational therapist since 2000, working in school-based, hand therapy, outpatient peds, EI, and SNF. Colleen created The OT Toolbox to inspire therapists, teachers, and parents with easy and fun tools to help children thrive. Read her story about going from an OT making $3/hour (after paying for kids’ childcare) to a full-time OT resource creator for millions of readers. Want to collaborate? Send an email to contact@theottoolbox.com.
