Adolescents gain independence by taking a greater role in food choices and amounts eaten. It is frustrating for parents who worked to establish standards to see the young person seek independence, even with foods consumed. This is a stage in life that demands high caloric intake, because growth needs are second only to those in infancy—more kilocalories per kilogram are needed than in any other life stage. This high caloric consumption is favorable to nutritional status because with high calories comes the increased likelihood of taking in more nutrients. Parents must remain hopeful that good health habits will guide the teenager. There may be concern over peer pressure leading to "strange" or different food habits, such as disordered eating, sports nutrition, and vegetarian diets, which many teens attempt. Such exploration is often a natural part of expressing independence. These food patterns can be healthy, such as improving food habits with vegetarianism or sports nutrition. The family physician needs to determine when the teen's exploration could become harmful. Nutrition assessment is appropriate in this life stage in regard to determining whether a nutritional problem is present.

Development stage

Physical skills

Eating skills

Baby's hunger and fullness

Appropriate foods and textures


Supported sitter


• Needs head support

• Baby establishes a suck-swallow-breathe pattern during breast or bottle feeding

• Cries or fusses to show hunger

• Gazes at caregiver, opens mouth during feeding indicating desire to continue

• Spits out nipple or falls asleep when full

• Stops sucking when full

• Breastmilk or infant formula oducts Company

• More skillful head control with support emerging

• Breastfeeds or bottle feeds

• Tongue moves forward and back to suck

• Cries or fusses to show hunger

• Smiles, gazes at caregiver, or coos during feeding to indicate desire to continue

• Spits out nipple or falls asleep when full

• Stops sucking when full

• Breastmilk or infant formula

• Sits with help or support

• On tummy, pushes up on arms with straight elbows

• May push food out of mouth with tongue, which gradually decreases with age

• Moves pureed food forward and backward in mouth with tongue to swallow

• Recognizes spoon and holds mouth open as spoon approaches

• Moves head forward to reach spoon when hungry

• May swipe the food toward the mouth when hungry

• Turns head away from spoon when full

• May be distracted or notice surroundings more when full

• Breastmilk or infant formula

• Infant cereals

• Thin pureed foods

Independent sitter

Independent toddler

• Sits independently

• Can pick up and hold small object in hand

• Leans toward food or spoon

• Learns to keep thick purees in mouth

• Pulls head downward and presses upper lip to draw food from spoon

• Tries to rake foods toward self into fist

• Can transfer food from one hand to the other

• Can drink from a cup held by feeder

• Reaches for spoon or food when hungry

• Points to food when hungry

• Slows down in eating when full

• Clenches mouth shut or pushes food away when full

• Breastmilk or infant formula

• Infant cereals

• Thin pureed baby foods

• Thicker pureed baby foods

• Soft mashed foods without lumps

• Learns to move tongue from side to side to transfer food around mouth and push food to the side of the mouth so food can be mashed

• Begins to use jaw and tongue to mash food

• Plays with spoon at mealtime, may bring it to mouth, but does not use it for self-feeding yet

• Can feed self finger foods

• Holds cup independently

• Holds small foods between thumb and first finger

• Reaches for food when hungry

• Points to food when hungry

• Shows excitement when food is presented when hungry

• Pushes food away when full

• Slows down in eating when full

• Breastmilk or infant formula

• Infant cereals

• Ground or soft mashed foods with tiny soft noticeable lumps

• Foods with soft texture

• Crunchy foods that dissolve (such as baby biscuits or crackers)

• Increase variety of flavors offered

• Takes early steps

• Feeds self easily with fingers

• Can hold cup with two hands and take swallows

• More skillful at chewing

• Dips spoon in food rather than scooping

• Demands to spoon-feed self

• Bites through a variety of textures

• Expresses desire for specific foods with words or sounds

• Shakes head to say "no more" when full

• Breastmilk, infant formula or whole milk

• Coarsely chopped foods, including foods with noticeable pieces

• Foods with soft to moderate texture

• Toddler foods

• Bite-sized pieces of foods

• Bites through a variety of textures

• Walks well alone

• Chews and swallows firmer foods skillfully

• Learns to use a fork for spearing

• Uses spoon with less spilling

• Can hold cup in one hand and set it down skillfully

• Combines phrases with gestures, such as "want that" and pointing

• Can lead parent to refrigerator and point to a desired food or drink

• Uses words like "all done" and "get down"

• Plays with food or throws food when full

• Coarsely chopped foods

• Toddler foods

• Bite-sized pieces of foods

• Becomes efficient at eating foods of varying textures and taking controlled bites of soft solids, hard solids or crunchy foods by 2 years

Figure 37-1 Summary of physical and eating skills, hunger and fullness cues, and appropriate food textures for infants and children. (From ButteN, CobbK, DwyerJ, et al. The Start Healthy feeding guidelines for infants and toddlers. J Am Diet Assoc 2004;104:455-467.)


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