There are a variety of reasons why a child may need feeding therapy. To many of us, it would seem like eating should be a basic instinct. However, eating is one of the most complex activities we do, especially for the developing, young child. Eating involves several processes in the body, including sensory, oral-motor, muscular, neurological, digestive, and behavioral systems. Feeding problems can arise involving any one of these systems, and often more than one of these is implicated.
The following are reasons why a child may have feeding difficulties:
- Sensory processing issues
- Picky eating
- Food allergies or severe reflux
- Developmental delays
- Complex post-op recovery course
- Transition from feeding tube to oral nutrition
Feeding therapy is usually done with one or more clinicians. Depending on the type of feeding problem, therapy may involve a speech-language pathologist, an occupational therapist, a registered dietitian, a social worker or behavior therapist, and/or a physician.
A speech-language pathologist will approach feeding in a comprehensive manner, looking at the actual physical swallow mechanism as well as the sensory aspect of feeding. Before beginning a more structured feeding treatment approach, it is key to rule out any medical reasons that a child is not safe to be taking food or drink orally. If there are concerns regarding vomiting, choking, gagging, etc. then the family should seek further guidance from their pediatrician who may recommend a modified barium swallow study. This test looks at the actual swallow mechanism in real time using x-ray to determine whether or not food or liquids are being aspirated (i.e., food items may slip into the lungs rather than where it is supposed to go). If a child is aspirating, physical symptoms may or may not include choking, wet/gurgly voice, and refusal to eat. Feeding therapy can move forward once it has been determined that a child is safe to take food by the mouth.
In addition to safety concerns, therapists will also look at the various chewing and swallowing stages to see if there is a breakdown in this complex process, once food is in the mouth. There is a developmental sequence of chewing for a child as well as development of independent feeding, first using hands and then moving to use of utensils. Each child will have different needs and a feeding therapy plan should be developed that is unique to your child. One approach to feeding therapy that has high success and is evidenced based is the Sequential Oral Sensory Approach to Feeding.
The Sequential Oral Sensory Approach to Feeding is a therapeutic intervention developed by Dr. Kay Toomey. Certification by Dr. Toomey and her associates through a training course is required for therapists to utilize this technique. Once certified, occupational therapists, speech language pathologists, dieticians, social workers and other health care professionals can intervene using the SOS approach. Under this approach, children are exposed to a variety of foods to increase their comfortability with a range of foods, focusing on exploration of the foods using all the senses: sight, sound, touch, smell, and taste.
Each week, the therapist will send the family a list of 8-14 foods based on sensory characteristics that will help the child experience foods that he/she might never have tried before. The family then brings these foods to the therapy session that week. During the session, the child and therapist (and often the caregiver) engage with the food in a playful manner to move up the “Steps to Eating” with each food, a 32-step process involved in eating developed by Dr. Toomey. The ultimate goal is for the child to explore a variety of foods and expand the range of foods that he/she tolerates. The goal initially is not for the child to eat the food, rather discover and interact with a variety of foods and develop the skills needed to do so. Parents receive feedback after each session and are given recommendations to continue practicing these techniques at home during the week for ultimate success and generalization across environments. Using this approach, children become more comfortable with and generalize the skills needed to eat a wide variety of foods.
NSPT offers services in Bucktown, Evanston, Highland Park, Lincolnwood, Glenview, Lake Bluff, Des Plaines, Hinsdale and Milwaukee. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates!
Julie Paskar is a speech-language pathologist, and the Branch Director at the Lincolnwood clinic. She joined North Shore Pediatric Therapy in August of 2012. Julie obtained both her Bachelor of Arts in speech and hearing sciences and her Master of Arts in speech-language pathology at Indiana University in Bloomington, Indiana. She has lived and worked in the Chicago area for the past eleven years. During that time, Julie worked for a pediatric clinic providing Early Intervention services as well as speech-language therapy services to children ages 3-12. She has her Early Intervention credential in speech pathology as both a provider and an evaluator. Julie’s areas of interest include: phonological disorders, motor speech disorders: specifically childhood apraxia of speech, feeding disorders, and expressive language disorders/delays. Julie is a Hanen certified therapist, has also attended both the Introduction to PROMPT and Bridging PROMPT trainings, has attended Picture Exchange Communication System (PECS) Level 1 and Level 2 trainings as well as the Kaufman Speech to Language training. She has been trained in the Orton-Gillingham program which is a treatment program for dyslexia. Julie is a member of the American Speech-Language Hearing Association and is licensed to practice in the state of Illinois. Julie is dedicated to working with children and their families to make communication both fun and functional.