Editorial: Cutting pediatric therapy in two to promote inclusion. Part 3: Teaching a child to drink from a cup and other functional skills

'involves the knowledge, understanding and skills of all the people around the child at home or in the nursery'

Drinking from a cup is an early skill and is used here as just one example of what babies and infants might learn in their pre-school years. Drinking is necessary for survival and drinking from a cup, glass or other vessel is a skill most children acquire from their parents and other family members in the family home. For the child there are elements of thirst quenching, pleasurable taste and social activity.

Like other baby and infant functional skills*, drinking from a cup is multifaceted and involves the whole child. If we clearly describe the skill we will see its many elements and then know what knowledge, understanding and skills adults must have to teach the child. Each of these elements must be considerd in more or less detail when teaching a child whose multifacted condition requires very careful support for physical, sensory and intellectual development. This applies to all baby and infant functional skills.

I am going to refer to paediatric ‘therapists’ because the term is still in common usage. However, there is certainly no drinking-from-a-cup therapy! When I use the term ‘specialist’ it refers to practitioners who have a professional qualifiaction in some aspect of early child and family support including therapists and teachers.

Success or partial success in drinking from a cup will include:

Sitting in a chair to a tray or table.
Understanding the idea of drinking from a cup and knowing it is a sequence of activities.
Being aware of the presence of the adult who is helping.
Understanding and responding to a question about wanting a drink.
Choosing a drink.
Knowing the cup is on the table, reaching for it and grasping one or two handles.
Lifting cup to lips. Taking some drink into mouth, closing lips and swallowing.
Replacing cup on table, releasing grasp.
Understanding and responding to a question about wanting more.
Feeling personal satisfaction, understanding and enjoying praise.

There should be four phases in this, the first three being preparatory:

Parent or nursery staff member (in discussion with family) wanting to embark on teaching a child this skill and then seeking support.
Pediatric ‘therapists’ having oversight and involvement in any potential health dangers for the child in, for instance, sitting to a table and swallowing effectively.
Making sure the child has any and all appropriate equipment for the task, for example, chair, cushions, tray/table, cup, non-slip table mat, thickener for drink.
The fourth phase is the educational one – teaching the child to drink from a cup. This will involve such considerations as the child’s moods and willingness at different times of day, where to start in the drinking-from-a-cup sequence, which words to use and how to communicate them, how to support and prompt movement – all taking into account the child’s physical, sensory and intellectual abilities.

The fourth phase involves the knowledge, understanding and skills of all the people around the child at home or in the nursery. Good practice in early child and family support in this fourth phase requires that specialist practitioners around the child teach the child’s parents how to teach their child to drink from a cup. If the child attends a nursery, then the specialists teach nursery staff members. So, to be clear, pediatric therapists have a health function in phases 2 and 3 and an educational one, shared with others, in phase 4. Specialists can have an advisory role rather then being with the child for each drinking-from-a-cup session. People who are with the child most regularly as family members at home or staff members in the nursery will have gained collective competence to help the child learn and practice the new skill on a daily basis.

Focusing again on the role of paediatric therapists: there is the health role which they might do on their own or with health colleagues in clinic or hospital and then the teaching role which is best done alongside other people around the child who are working on the same skills in home or nursery (where the necessary equipment must be available for daily use).

Perhaps there are two aspects to inclusion in this:

Visits to hospital and clinincs are kept to a minimum and are for health reasons. This gives the child more time at home or in the nursery or kindergarten. Drinking from a cup at the table and other functional skills will allow the child to be more included in routines at home and in the nursery.
Some parents feel they cannot take their child to cafes or restaurants or for meals with friends before their child has acquired some ‘eating out’ skills. Drinking from a cup and other functional skills the child develops can mean the family becomes gradually more included in social activity.

Peter Limbrick, August 2012

* There is an infographic of baby and infant functional skills here: https://ectacenter.org/~pdfs/eco/three-child-outcomes-breadth.pdf