Positioning of Infants and Young Children for Feeding

Feeding a child who has poor trunk control in an unsupported, upright position can make it difficult for the child to develop a refined chewing pattern (Evans Morris & Dunn Klein, 2000) and may place them at increased risk of aspiration. It is important that a child who has not yet achieved functional sitting and/or displays tonal issues (hypertonicity or hypotonicity) is well supported in their highchair or equivalent.

Midline positioning or alignment of head, trunk and limbs can enhance the safety and efficiency of feeding in conjunction with strategies addressing food consistency and swallowing skills (Redstone & West, 2004). Infants need to be positioned age appropriately but with consideration for developmental level.

Midline development can influence the development of hand, foot and oral control. Infants require a stable base from which to develop movement and functional skills. Without this stable base, it is difficult to carry out controlled and functional movements (Evans Morris & Dunn Klein, 2000).

Positioning intervention will need to be provided to those infants and children who:

• are disorganized
• require support to maintain a midline position
• have not yet achieved, or cannot achieve, functional sitting without additional support

Considerations in evaluating the child’s position for feeding should include information on the following:

• location of the assessment
• position of the child for feeding, for example, held by parent, seated in high chair or commercially available chair, or seated in specialized chair or equipment

Specific questions to be answered may include:

• is the child symmetrical?
• is head and trunk support required?
• is the head in a chin tuck position?
• are the pelvis, trunk, head and neck stable?
• are the feet and legs in stable supported position?
• is tilt or recline required?
• is the parent in a supportive position that allows eye contact with the child?
• what is the required action or follow up?