Development-based Milestone Symbols™
8 min read • By: Gerber Medical Hub
Quick summary
Gerber's nutrition journey features a symbol-based plan for milestones: newborns, supported sitters, sitters, crawlers, toddlers, and preschoolers. Each milestone covers gross motor development, fine motor development, oral motor development, eating skills, and hunger and fullness cues.
Table of contents
Newborn: Birth+
Gross motor development
Little truncal (vertical) stability
Fine motor development
Reflexive grasp only
Oral motor development
- Rooting and sucking
- Early gag reflex
Eating skills
- Suckling pattern from bottle or breast
- Secures nipple with greater ease
Hunger cues
- Cries or fusses to show hunger
- May bring fingers to mouth
- Roots for nipple or stops sucking
- May squirm or throw arms and legs about
- Moving, licking, or smacking lips
Fullness cues
- Slows down speed of sucking, may even fall asleep
- Starts and stops feeding often, latches and unlatches on nipple frequently with only a few sucks in between, eventually will not relatch
- Seals lips tightly when nipple is reinserted
- Ignores or spits out nipple
Supported Sitter: 4+ months
Gross motor development
- Controls the head
- Truncal stability to sit with support
Fine motor development
Sustained voluntary grasp
Oral motor development
- Moves puree food forward and backward with tongue to swallow
- Loss of extrusion reflex (tongue thrust)
- Gag reflex locus moves from the mid portion to the posterior of the tongue
Eating skills
- May push food out of mouth with the tongue, which gradually decreases with age and experience
- Moves pureed food forward and backward in mouth with tongue to swallow
- Recognizes spoon and holds mouth open as spoon approaches
Hunger cues
- Opens mouth and leans towards spoon when food is presented
- May swipe food toward mouth when hungry
- Cries or fusses to show hunger
- Smiles and looks at you while feeding to communicate they want to continue eating
Fullness cues
- Turns head away from spoon when full
- May be distracted or notice surroundings more when full
- Keeps mouth closed, will not open when spoon is presented
- Spits out familiar foods
- Blocks mouth with hands
Sitter: 6+ months
Gross motor development
- Sits independently
- Truncal stability
Fine motor development
- Primitive squeeze / palmar grasp
- Begins to rake (with fingers) food toward self
Oral motor development
- Develops tongue wave and lip close
- Begins chewing movements using up and down movement of jaw (“munching”)
- Uses upper lip to help clear food off of spoon
- Able to keep thicker purees in mouth
- Can drink from a cup held by feeder
- Eruption of first tooth
Eating skills
- Learns to keep thick purees in mouth
- Uses upper lip to help clear food off the spoon and move into the mouth
- Can drink from a cup held by feeder
Hunger cues
- Leans toward food or spoon
- Reaches for spoon or food when hungry
- Shows excitement when food is presented
Fullness cues
- Slows down in eating when full
- Clenches mouth shut or pushes food away when full
- Leans back and moves head away from offered food
- May try to knock spoon out of parent’s hand
Crawler: 8+ months
Gross motor development
- Crawls with stomach off the floor
- May pull self to stand
- Struggles to get objects out of reach
Fine motor development
- Begins to self-feed finger foods as pincer grasp is developing
- Begins to manipulate objects correctly (spoon) but does not use it for self feeding yet
- Explores objects with hands and mouth
- Can hold lidded cup independently
Oral motor development
- Developing tongue lateralization used to move food to jaw line for mashing and chewing
- Begins to use jaw to mash and chew food
- Begins to track and sort pieces of food in the mouth
Eating skills
- Plays with spoon at mealtime, may bring it to mouth, but does not use it for self- feeding yet
- Holds a cup with a lid independently
Hunger cues
- Shows excitement when food is presented
- Makes noise to get parent’s attention: cry, fuss, kick legs, bang toys on tray, etc.
- Puts things into mouth: fingers, cup, toys
- Focuses on feeding; watches parent prepare, bring, dish and spoon the food
Fullness cues
- Shakes head to say “no more” when full
- Bats, pushes, or drops the serving dish off feeding surface
- Clamps lips shut, stops opening mouth
- Leans back away from offered food and may close eyes
- May stick tongue out when food is offered
Toddler: 12+ months
Gross motor development
- Stands alone
- Walks with and without support
Fine motor development
- Feeds self easily with fingers
- Fine pincer grasp developed
- Begins to use spoon and fork
Oral motor development
- Able to drink from a cup or straw
- Skillful at chewing of complex foods
- Bites through a variety of textures
- Coordinated tongue movement
- First year molars begin erupting
Eating skills for 12-18 months
- Dips spoon in food rather than scooping
- Begins using fork by scooping
- Moves food precisely between the gums or teeth for chewing more complex food
- Sits in a high chair for safety and security at family dinner table
- Bites skillfully through soft foods but may have more difficult with firm, hard foods
- Grasp the cup with both hands and tilts it to mouth with wrist rotation
- Typically uses an up-down movement of the jaw when drinking
- Takes liquids primarily from a sippy cup with valve
- May lose some liquid when drinking from an open cup or straw
- Takes 2 or more swallows in succession and drinks up to 2 ounces or more without stopping
Eating skills for 19-24 months
- Emerging wariness of new foods; needs multiple presentations of a new food (as many as 10-20)
- Can be erratic in variety and volume of intake; monitor intake over the course of a week not a day
- When pressured to eat more, will likely eat less
- Enjoys having same pattern repeated at mealtime; same bib, spoon
- No longer needs the high chair safety and security
- May continue to lose some food and saliva when chewing
- May open the mouth wider than necessary to bite through the food. Chews easy meats easily and well. Offered more opportunities to drink from a regular open cup, but primary liquid is given with a sippy cup
Hunger cues for 12-18 months
- Expresses desire for specific foods with words and sounds
- Combines phrases with gestures such as “want that” and pointing
- May appear low in energy, patience, and good cheer or exhibit “crabby” behavior when hungry
Hunger cues for 19-24 months
- May approach kitchen or dinner table on their own
- Expresses desire for specific foods with words and sounds
- Can lead parent to refrigerator and point to a desired food or drink
Fullness cues for 12-18 months
- Shakes head to say “No more” when full
- Plays with food or throws food when full
- Uses words like “all done” and “get down”
- Chewing slows
- Crosses arms and refuses more food
- Spits out familiar liked foods
Fullness cues for 19-24 months
- Becomes easily distracted
- Hesitates before opening mouth to accept additional food (automatic response)
Preschooler: 24+ months
Gross motor development
- Runs well without falling
- Sits in a booster seat or at table
Fine motor development
- Manipulates small objects
- Practicing/mastering utensils
- Holds spoon level during transport to mouth
- Holds and drinks from a cup
Oral motor development
- Refined drinking skills
- Chews skillfully and efficiently
- Needs less time and fewer chews to finish a mouthful of food
- Molars present
- Uses tongue to clear food from lips
Eating skills for 24-36 months
- May express verbal refusal of food
- Toddlers and preschoolers do best with set menus which includes a variety of familiar foods along with some new foods
- May be very cautious about accepting new foods (neophobia)
- Prefers familiar foods and may require 10-15 taste experiences with a new food before accepting it
- Able to adjust the opening of the jaw when biting foods of different thicknesses
- Chews more difficult meats and some raw vegetables under supervision
- Chewing movements become more skillful and efficient. Needs less time and fewer chews to finish a mouthful of food
- Doesn’t lose liquid when drinking from a regular open cup
Eating skills for 36+ months
- Head extends to drain last drop from cup and also bends to spoon
- May help set the table for family meal
- Continues to refine chewing movements (i.e. reduced duration and number of chewing cycles)
- Continues to refine drinking skills from an open cup
Hunger cues for 24-36 months
- Expresses desire for specific foods with words and sounds
- May approach kitchen or dinner table on their own
- A child is influenced by how parents eat and the food they select
- Is interested in eating when it’s time to eat
Hunger cues for 36+ months
- Expresses desire for specific foods with words and sounds
- Seeks out specific foods
- May be listless and cross due to hunger
- May approach kitchen or dinner table on their own
Fullness cues
- Loses interest in food
- Expresses self with phrases or simple sentences
- Resists coming to the dinner table
- Walks away from dinner table
* All ages are approximate. Because all babies develop differently, it’s important that feeding choices are based on stages of development, not chronological age. References on file.
