The tot OT

In-home Pediatric Occupational therapy, Feeding therapy & Developmental Consults 

Fort Lauderdale • Broward County • Miami • Palm Beach



The Forgotten Milestones


With social media, it is hard to miss the baby milestones of your friends' cherubs. It is so cute to watch a baby's face as he realizes he successfully managed to mobilize independently even if clumsily toward a favorite toy or parent. Who does not want to cheer like their favorite athlete just won a gold medal after a Herculean effort? Even more exciting, is to watch the proud expression on his parents' faces. Crawling! Walking! Milestones indeed.

2 years old and trying salmon sushi and teppanyaki! 

2 years old and trying salmon sushi and teppanyaki! 

However, there are other milestones that are less obvious, less celebrated and nonetheless important. I might argue more important. Barring some motor-specific diagnoses, the large majority of toddlers will walk. They may make take first steps later than their age mates (which I know feels important at the time), but by 4 years or 6 years old, it is hard to distinguish the 1year old walker from the 15 month old walker. I taught first grade, and I had no idea which of my students were 'early' walkers and which were 'late' walkers. They were walkers. They were jumpers. They were players. But some were not eaters.

There are milestones in eating, but these are often uncelebrated, taken for granted or neglected. This is not to place blame on parents. We talk as a society about 'learning to walk' and 'learning to talk', but how often do we talk about 'learning to eat'?

 I went to a fantastic 4-day training on feeding assessment and therapy using the SOS method delivered by Kay Toomey, Ph.D. and Erin Ross, Ph.D. As a clinician, I found the information and strategies very useful and could immediately apply the techniques in the clinic. However, my biggest takeaway from the conference is that most parents have no idea of what they are doing or not doing when it comes to feeding! This is no fault of their own. How could they? We put food in our mouths, chew and swallow, don’t children do the same?

 Broadly, we as a society have very little information and/or reverence for the difficult process that is eating. We don’t understand that it is a learned not acquired or innate set of skills. People make comments about French children and how they eat everything and cookbooks have been written to “get your baby to eat like a bébé”, but it really comes down to this- French babies learn to eat and often American babies don’t. French people understand it is a process to know and to manipulate and to make sense of different foods and textures in their mouths and have a department in the government and national curriculum dedicated to teach these things! We don’t.

 Children come into the world with a sucking reflex and several other primitive reflexes that keep them on autopilot for the first couple of months while we [as adults] figure out what we are doing. By the time sucking starts to become voluntary (~3months) their sucking has changed; they actually have learned to do a more mature and efficient suck rather than a suckle to get milk. They learn and practice by doing and they improve!

 Children do not automatically move their tongues and their jaws in a coordinated fashion. They do not innately know to take bites off of larger foods. They do not know how to grade the pressure of each bite of food by looking at it (otherwise babies wouldn’t bite on the spoon!)… They watch, they mouth, they experiment, they play, they gag and they learn!


By 18- 24 months, children should have all the necessary motions and movements to manipulate any food that comes their way. They may not be perfectly efficient, and they will continue to refine their jaw motions and learn to chew with closed lips. They will gain speed. However, they should be able to bite, chew and hopefully swallow all the foods that are sitting on your lunch or dinner plate. They should ideally try (taste, bite, chew) at least 85% of the foods that are put in front of them.


However, many factors have conspired against us/them and taken away lots of primary learning and practice opportunities. We are busy. We are eating on the fly. We are scared of choking**. We are dieting. They are stubborn. They are picky. There are kid’s menus. There are pouches. There is little support for parents around feeding. There are 1000s of different kinds of spoons, plates, cups, etc. The list goes on…


Here’s the upshot. Given the same reward (let’s say a $100 bill), would you choose to run 100 yards or a mile? You are going to choose the path of least resistance and so is your child! Your toddler is picking goldfish crackers and frozen chicken nuggets not just because of the simple and delectable flavors, but because he is smart!  1.  It is easier to chew reprocessed meat and dissolvable crackers than real foods like chicken and carrots. 2. Chicken and carrots always change- the flavor, the consistency, the size, the dryness, etc. Given your choice of a $5 coffee, do you gamble or go with the grande skinny 2-pump hazelnut latte that will taste the way you are expecting? If your child hasn’t had much practice with new foods, he is going to steer clear and stick to what is safe. If he hasn’t practiced eating ready hard or chewy foods, he isn’t going to waste his time and energy on a bite of steak or piece of apple. And if he does, he will probably spit it out because he has not figured what to do with it in that black hole that is his mouth (can you see your own mouth while you eat?). 


In this first post, I haven’t done much in the way of addressing the problem but just outlining it. There are many small things that you can do from the time your child is very young (7-9 months!) to help avoid trouble down the road. There are things that you can do now with your 2- or 4- year old to start helping them catch up on practice and exploration they have missed. I will go over strategies in future posts. But for today, you can start by posting photos of your children exploring foods on your plate, spitting out new foods and making messes, and you can like and comment on the photos of your friend’s little tots doing the same! Celebrate these milestones!




** Choking is a real hazard, and certain foods are greater hazards than others.

American Academy of Pediatrics (AAP) has listed these foods as particular risks: Hot dogs hard candy, peanuts/nuts, seeds, whole grapes, raw carrots, apples, popcorn, chunks of peanut butter, marshmallows, chewing gum, and sausages

However, by cutting them appropriately, making sure your child is always sitting while eating/snacking and helping to model safely biting and chewing these and other foods, your child can learn to manage new foods safely.





Pediatric Occupational Therapy • Feeding Therapy • Child Development

Fort Lauderdale • Davie • Weston • Aventura • Miami

Cynthia Pepper, MS OTR/L • (754) 300-8687

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