Stage 2 to Stage 3 Foods

As on occupational therapist in the early intervention field, parents often ask me, "Why won't my child eat Stage 3 foods?"

This is a very common concern for parents, since transitioning to new foods is a huge change for kids from both a motor and sensory (texture) standpoint.

There are many differences between being fed Stage 2 and Stage 3 foods. From a sensory perspective, visually the food looks different when presented on the spoon. Stage 3 may have multiple colors and different shapes so each spoonful looks slightly different from the last. Instead of having one smooth texture, your child is now faced with multiple textures. Stage 3 can consist of combinations of squishy, soft, chewy, rough, smooth, thin, thick, and any texture in between (versus the one smooth texture of Stage 2). There can also be different smells associated with Stage 3 as opposed to Stage 2. Since the child is now required to chew, he will also feel different types of movements in his mouth, jaw and tongue. The pressure between the teeth is also different and taste begins to vary more as the food is chewed.

Transitioning from Stage 2 to Stage 3 can also present new motor challenges for a child. Whereas Stage 2 only requires a child to move foods backward with the tongue for swallowing, Stage 3 requires the ability to manage several different textures within the mouth at one time. Some of these textures can be easily swallowed, some require minimal movement such as being moved to the side of the mouth with the tongue so the food can be mashed between the teeth. Other textures may require more sophisticated movements of the tongue and jaw. A child will need to move food from one side of the mouth to the other and use his jaw in a rotary movement to tear the food into smaller pieces for swallowing. In a nutshell, a child is required to be able to do a combination of several different movements to manage multiple textures of food when he eats Stage 3 food.

As you can see, although moving from Stage 2 to Stage 3 may seem like a small step to those of us who have been managing cheeseburgers and pizza for years, the management of Stage 3 's after experiencing only Stage 2's is actually a quite complicated process. If your child is doing well with Stage 2, but is having difficulty progressing to Stage 3, and is at least 8 months of age and developing at a typical rate, here are some suggestions to try at home:

• Try having your child experiment with "hard munchables" under direct supervision. Hard munchables are foods such as celery sticks, bell pepper strips, beef jerky and stale licorice. The goal of this exploration is not to have the child bite off pieces of the food to swallow, but to munch up and down on it, feeling different textures and helping the tongue move in different directions along with the food. A food net can be used to minimize choking risks with younger children.
• Then progress to meltable solids such as graham crackers, mum-mums, veggie sticks, or town crackers. These are foods that will dissolve easily without chewing.
• Next, progress to soft cubes of food cut about pinky nail size such as kiwi, bits of cooked potato, cooked carrots, or bananas.
• After that try "soft mechanical" foods such as muffins, pastas or lunch meats that are single textures.
• Once a child has mastered the above steps, it would be an appropriate next step to try mixed textures such as those seen in Stage 3 foods. Many children will just progress to more types of table foods from here onward.

If your child is still having problems progressing past eating Stage 2, he may have a delay in the development of the oral motor skills necessary to manage these foods. He may have a problem tolerating the sensory challenges these foods present, or have a combination of these two problems. It is also possible that your child may have other feeding related challenges not addressed in this article. If this is the case, talk to your pediatrician about getting a feeding evaluation and/or call your local early intervention provider to request a feeding evaluation. If you are in Allegheny County in PA, call the Alliance for Infants & Toddlers at 412-885-6000 to request an evaluation and then request TEIS as your child's service provider.

By Mary Ann Allen, MOTR/L
Occupational Therapist

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