What is the 90 90 90 rule for high chairs?

The Speech Therapy team has put together helpful reasons as to why the 90-90-90 method of eating is best.

When you are eating on the couch, in the car, or even in bed, have you ever noticed that you spill, cough, or even find eating more effortful? A big reason this happens is because we are not in an optimal position for eating during these moments. The same can be said for children while they are eating.

When a child is a picky eater, has sensory aversions to eating, and/or has oral motor difficulties with chewing and swallowing- adding in the additional effort of trying not spill or choke on the foods they are eating because of the way they are sitting makes it a very negative experience for the child.

Postural stability in summary is a child’s ability to keep their body in a controlled position against gravity. It requires the child to have strength in their back, tummy, and neck areas. If these areas are weak, more effort is needed to hold their body upright. Imagining having to do crunches while eating a snack? It would make most people not very hungry. Good postural stability in children while eating helps with breathing (the body’s most important job), support and security while sitting, and allows for better coordination between their hand to mouth.

This is where the 90-90-90 comes into play. An ideal position for sitting and eating is a 90-degree angle at the hips, a 90-degree angle at the knees, and a 90-degree angle at the ankles.

What this will look like:

1. Feet are resting flat on the floor or on a footrest which will create a 90-degree angle in their ankles.
   • Ways to support without an adjustable chair: using a stool, stacked heavy books, filled cardboard boxes.
2. Knees are resting at a comfortable level but over the edge of the chair to create a 90-degree angle.
   • If the chair is too big and you notice that their knees are not creating the 90-degree angle, try placing a pillow or cushion behind their back to eliminate the space from the chair being too big.
3. Hips need to be touching the back of the chair or the cushion placed behind them to create a 90-degree angle.
   • A wedge cushion can support a child that slouches in order to sit more upright.
   • A rubber mat or shelf line can be placed on the chair to aid in wiggly sitters.
     • This may be difficult for children that have high sensory needs.
4. When pushed to the table, the table height should be in between their chest and belly button. Another way to gauge the height is if their elbows are the same height as the table.
   1. • If the table is too small this might be a cause for slouching and a taller table is needed.

A great recommendation for a highchair is the Stokke Tripp Trapp chairs. 

One of our first recommendations for feeding therapy is to assess your child’s seating and see if they are at a 90-90-90. If not, that is a great place to start!

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As a pediatric therapist, I’ve really gotten into feeding. I love taking courses on it and expanding my expertise in this area. Feeding and eating is a slow process that sometimes is literally a daily battle. I have plenty of feeding resources and posts, so please check them out in hopes of finding something that will help you along your journey.

The first piece of feeding, regardless of the age or stage is positioning. Without stable sitting and support, oral exploration, chewing, and swallowing won’t come easily. I’m here to provide you with recommendations on how to determine the right high chair for the child in your life.

What to Look For in Position

When you introduce a child to solids, whether in the form of purées or table foods, you want to assure that their position is as stable and upright as possible. If a child is working hard on keeping their head or trunk upright, they may have more difficulty swallowing or managing food in their mouth. This makes the feeding experience too challenging and potentially unsafe. 

To achieve the right position, you want to shoot for a 90-90-90 rule. This means a 90 degree angle at hips, knees, and ankles. Yes ankles. That means having a foot rest is important. This assures that there is stable support at the entire trunk. I will say that MOST chairs on the market do not have a foot rest. If your child’s feet are dangling, you’re not doing anything wrong, they’re just missing out on one extra point of contact and opportunity for more stability.

 It’s also important to have a tray or surface in between the nipple line and belly button. I like when a tray goes all the way to the sides and under the arms to allow for a large surface area for support. A large tray also allows for a space for exploration of foods, textures, and for self feeding. 

Lastly, some kids need some support at the chest with a harness or strap. Many babies come forward when they want to get to the food. Lots of high chairs give a semi reclined position to prevent forward flexion. This might be ok if your child has variable muscle tone and you and your team have decided it is best to use this position and provide LOTS of back support. Otherwise, being upright is best for the swallowing mechanism.

My Favorite High Chair

I attended a continuing education course on feeding and it was there that I first heard of the Beyond Junior Y High Chair by Abiie. I had to check it out. It checks all the boxes above, which is an OT’s dream. Not to mention, It’s got a sleek design and grows with your child. This is a parent’s dream.

Who it’s Best For

This chair fits babies 6 months and up (yes, all the way to adults). It probably fits large babies that are younger, but the fit wasn’t quite right for my string-bean 6 month old. (For small babies and babies under 6 months, I like the Upseat for introducing solid foods and a supportive seat.) Keep reading about the features that allow this high chair to fit all bodies!

Features

This chair has structural features that support the activity of feeding. But also, it has features that are so practical for parents. 

Adjustable for Growth

The slats up and down the legs allow the seat and footrest to be adjusted regardless of your child’s dimensions. For example, some children with certain diagnoses have shorter extremities requiring a footrest closer to the seat. 

As your baby grows into a toddler and into a child, this chair can be pushed right up to the table for participation and mealtimes. No need for an additional booster seat. The step-like design makes it easy for children to climb up and down independently! This is such a win!

Comfort and Easy to Clean

The padding on the back and seat is both comfy and wipable. The material also allows for it to be non-slip. Now kiddos won’t slip when they inevitably squirm around. 

Sturdy for the Movers and Groovers

The wide base of support on the bottom makes it anti-tip. Many kids rock in their high chair. This could be to get sensory input or it could be a behavior to avoid mealtime or indicate that are all done. The wide legs make it a safe space still. Also, there is not a high back and this could then eliminate some of the head banging or back rocking that some kids engage in during mealtimes. 

Harness

This chair has a 3 point or 5 point harness that assures safety and an upright position. It is helpful to avoid a forward flexed posture to assure safety with swallowing. 

Tray

The tray has a removable top for easy cleaning. I don’t care what high chair you get. But get one with a removable tray and a removable top…if it’s dishwasher safe, even better! Once your child is old enough, it also serves as a chair at the table, so you can remove the tray and incorporate them into family mealtimes. 

Other chairs that I love include the following:

• Stokke Tripp Trapp Chair
• Keekaroo Height Right

It is so hard to decide on everything when it comes to baby stuff. There’s so much freaking stuff. Choosing a high chair can be so overwhelming. Take the guesswork out of it and follow this guide. Believe me. The ones mentioned here give you all the things you need in one chair. I recommend these for the patients I work with and I recommend it to you too. Ask me questions about it!