Feeding Therapy

We use the SOS Approach to Feeding, which is an interdisciplinary model for helping children without complicated medical status but who have current feeding challenges, including history of medical challenges, picky eating, oral motor challenges, eating disorders, and food aversions.

How to Know if Your Child Has a Feeding Problem

If you are reading this section of our website, you are likely struggling with a child who struggles with eating. Eating is one of the most stressful challenges that parents face, and it is one of the most complex tasks the body needs to accomplish. If you or your child are struggling daily with eating challenges, and you feel like you have tried everything to get them to eat, it is likely time to seek outside support.

Questions to consider when deciding whether or not to seek outside support

  1. Does your child eat foods from all four food groups i.e. protein, dairy, grains, fruits & veggies?
  2. Does your child eat foods from all textures groups i.e. liquid, puree, soft solid (bagels, bread, baked goods), hard solid/dry (pretzels, chips, crackers),  hard solid wet (apples, melon, oranges, grapes), mixed (casserole, spaghetti & meatballs, vegetable soup)?
  3. Is your child gaining weight and growing at a rate expected for their age?
  4. Does your child have a list of at least 30 foods he/she accepts on a consistent basis?
  5. Are you able to get through meals or snack times without emotional upset or behavioral outbursts?
  6. Is your child able to eat without having an iPad available or without watching some kind of screen?
  7. Is mealtime an enjoyable time for your family?

If you answered “No” to at least two of the above questions and/or your child has a history of feeding difficulties or some diagnosis that impacts feeding such as reflux, failure to thrive, difficulty latching, food allergies or has feeding challenges that are getting worse, we encourage you to schedule an in-take for our feeding program.

Treatment Options

Our feeding therapy is based on the SOS Approach to Feeding program, a nationally and internationally recognized approach for assessing and treating children with feeding difficulties, developed by Dr. Kay Toomey. The SOS Approach is a play-based program that meets a child wherever they are developmentally, and builds readiness for eating and greater capacity to progress through the 32 different steps involved in eating.

Our Feeding therapy, referred to as “Food School,” may take place in individual sessions or in small groups of 3-5 children per group. All group Food School sessions consist of an 8 week block of treatment that includes 8 weekly child sessions and 4 required parent education sessions over the course of the 8 weeks. All individual Food School sessions consist of a 12 week block of treatment that includes 12 weekly sessions and 4 required parent education sessions over the course of the 12 weeks. Each 8 or 12 week block of treatment targets a different phase of treatment, but children receiving individual sessions may progress through or remain in various phases for different lengths of time and so may complete the three phases sooner or over a longer duration than might be experienced in the group program. This is because group programs may be more or less effective for some children and the opportunity to individualize sessions for each child in the group is less than it might be during individual sessions.

  • Phase I targets reducing stress at mealtime and related to food.
  • Phase II targets food exploration.
  • Phase III targets actual eating and carryover of skills to multiple environments.

Completion of all phases is not expected or required and the decision about how many sessions of Food School a child needs is made according to the needs of each child and family. Parents and children learn together. Some children benefit from one round of food school while others return for the next scheduled session, in order to continue the momentum of progress or functional gains they have started to make.

A typical feeding session is comprised of gross motor and oral motor activities designed to prepare the body for eating, along with food activities designed to encourage interaction with whatever foods are being presented. Foods are pre-selected by the therapist each session, to target certain aspects of skill development needed by the participants and children are led through the various activities of the session with parents either participating or observing remotely. Food activities are assigned for “homework.” Homework for young children consists of a weekly “therapy meal” at home with parents and parents are taught how to conduct such a therapy meal using strategies they have observed in sessions. Older children complete “food challenges” and parents are coached in how to structure these challenges at home with their child.

All children, regardless of age, learn various ways to taste food. Children also learn multiple ways to cope with fight or flight nervous system responses related to food and food aversions while they are helped to decrease these responses through the successful interactions they have with food in therapy. All feeding therapy is accompanied by a strong required home program (the “homework”). Thus gradually, children and parents learn to shift how they approach eating and various eating behaviors that often accompany mealtime.

Group Food School sessions run approximately 2-3 times per year (spring, summer, fall) and are contingent on matching children of similar ages and developmental levels as well as having similar clinical needs. Children meet with 1-2 therapists, contingent on group size and both group and individual sessions last approximately 60 minutes per session. Group sessions and required parent education sessions are not billable to insurance. Individual feeding therapy sessions are billable to insurance and are billed as occupational therapy treatment.

SOS (Sequential-Oral-Sensory) Approach to Feeding

Feeding therapy services at OTC follow the “SOS Approach to Feeding” developed by Dr. Kay Toomey. It is a trans-disciplinary program for assessing and treating children with feeding and weight/growth difficulties. The program uses a play based approach to interacting with food, along with principles and practices from multiple disciplines including counseling, dietetics, speech-language pathology, and occupational therapy. The program begins with assessment of sensory, oral, motor, behavioral, learning, family and any medical factors that could be contributing to a child’s eating challenges. Treatment is based on typical developmental principles, stages, and skills and requires family involvement both in sessions and at home. Individual and group treatment options are available at various times throughout the year and children of all ages participate in programs designed to target their age-specific needs.

For young children (toddlers and preschool-aged) the SOS Approach uses social reinforcement of playful interactions with food, developmental strategies, and social engagement with parents, to build skills. For older children (school-aged through adolescence) cognitive behavioral strategies, goal setting, teaching methods, and experiential learning through “food experiments” are incorporated into each feeding session.

Feeding therapy at OTC is referred to as “coming to Food School.” It is our job as therapists to teach children how to eat and teach parents ways to support improved eating at home. Parents play an active role throughout the feeding therapy program in treatment sessions, in parent education sessions, and by carrying over and completing the “Food School” homework with their child(ren) in between sessions at home. Parent involvement and follow-through on a daily basis is what helps to make food school effective and fun. Children want to please their parents, even when they are acting in opposite ways and social engagement with parents paired with positive interactions with food are the cornerstone of changing a child’s eating behaviors.

Feeding therapy requires all parents to participate in at least 4 parent education sessions. The schedule of these sessions will vary based on the feeding therapy program in which your child is participating.

Individual Feeding Therapy

For children 12 months and older: You and your child will have a Therapy Meal with your Food School Teacher (therapist). You do not need to bring food with you because your child’s teacher/therapist will choose and prepare foods ahead of time and have plates, bottles, cups, utensils etc. available at the therapy meal. Each session will follow a predictable routine and begin with a warm-up of preparatory ad enjoyable oral motor activities, followed by playful activities or “food experiments” for older children, using various foods that have been pre-selected and that will be presented in a systematic way by the teacher/therapist. Each session ends once all foods have been presented and played with in some manner. The playful activities used in sessions are designed to encourage progression up the 32 steps to eating and your teacher/therapist will guide you on how to interact and what to do during each activity with your child. Parents should be prepared to fully participate and model positive eating behaviors for their child.

Group Feeding Therapy

For children 2 years old and older: Groups of 2-4 children have a Therapy Meal together in our treatment space, while the parents observe remotely or attend a parent education session in an adjacent room. Parents participate directly at the start of each session prior to moving into the adjoining space, by guiding their child through a sensory play routine with the Food School Teacher/therapist. By observing remotely, parents can see what their child does and how the teacher responds so as to ask questions and learn along the way.

All groups are filled with children of similar ages and struggles, as indicated in their initial feeding evaluation. Food School Group Sessions run three times per calendar year and some children participate in more than one round of group feeding therapy, depending on their goals and their rate of progress.

Schedule an in-take call to discuss feeding therapy!

What You Can Do Today

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