Feeding Therapy

WHY WON'T MY CHILD EAT?

Acknowledgement: Information from this post has been compiled from the work of Dr Kay Toomey from the STAR Center in Colorado, USA- home of SOS Feeding Solutions.

Picky Eating is a common struggle for parents with 50% of parents describing their child as a picky eater at some stage. Most of these children will grow out the picky eating stage all by themselves. However, 3-5% of children can be classified as "Problem Feeders", who will have restricted eating habits on an ongoing basis. There are many myths about eating that are unhelpful and a common one is that children will eat if they are hungry enough. While this holds true for children who are developing typically in their feeding, it is not the case for children with feeding problems. Children can experience ongoing poor growth, health and failure to thrive. When children are not eating a wide range of age appropriate foods, they are telling us that something is not working for them. They do not have the skills to manage the food that you are offering them. The majority of children with feeding difficulties have a physical cause, whether that is due to their ability to manage food in their mouths (oral motor difficulties), their ability to manage the sensory properties of the food (the look of food, texture, smell and taste) or whether they have learned that eating makes them feel worse (premature babies who have had invasive procedures such as tube feeding, children who have had reflux, allergies and food intolerances, or children who have found it difficult to swallow food due to their poor oral motor skills- gagging, choking and vomiting). Feeding difficulties are often part of a variety of other medical conditions and syndromes, such as Autism Spectrum Disorder, Down Syndrome and Sensory Processing Disorder.

So how can you tell whether your child is a picky eater or a problem feeder?

Picky eaters

Eat a decreased range or variety of foods
Will eat at least 30 different foods
Foods lost to "burn out" from eating the same food over and over (food jagging) are usually regained after a 2 week break
Are able to tolerate new foods on a plate
Usually can taste or touch a new food (even reluctantly)
Eats at least one food from most food texture or nutrition groups (e.g. purees, meltables, proteins, fruits)
Frequently eats a different set of foods at a meal than the rest of the family (but typically eats with the family)
Is sometimes reported by parents to be a picky eater at child check ups

Problem Feeders

Eat a restricted range or variety of foods
Will usually eat less than 20 different foods
Foods lost due to food jags are NOT reacquired after taking a break, often resulting in a decreasing number of foods in a child's repertoire
Cries and "falls apart" when presented with new foods
Completely refuses non-preferred foods
Refuses entire categories of food texture or nutrition groups (e.g. hard mechanical foods, meats, vegetables, soft cubes)
Almost always eats different foods at a meal than the rest of the family (often doesn't eat with the family)
Is persistently reported by parents to be a picky eater across multiple check ups

Parents have often tried everything to help their child to eat. Out of desperation they may have yelled or forced their child to stay at the table until their dinner is completed. This causes a stress response that turns off the child's hunger and increased their learning that mealtimes are distressing. Parents may become permissive and only give their child preferred foods. These are often foods that are easy to manage orally- most "junk foods" are easy to eat as they melt in your mouth with little need for chewing. This limits the child's exposure to new foods and if they haven't seen new foods, they don't have opportunity to try them. Parents may have sought dietary advice- but are still not able to get their child to try the foods they need for health. Parents may have had therapies to work on oral motor skills or sensory processing, but these haven't addressed the child's learned avoidance of food. Similarly, parents may have tried hypnosis or other psychological interventions, but these haven't addressed underlying oral motor or sensory skills that the child needed to be able to manage different types of foods.

Feeding therapy using the SOS Approach to Feeding targets oral motor skills, sensory skills and uses systematic desensitisation to help children to break the stress response link that keeps them from being able to tolerate non-preferred foods. Parents are provided with thorough education about why their child is struggling and are given practical strategies to use during home mealtimes, while therapy meals are also provided in clinic to work on building skills.

Kids Can! OT is certified to provide Feeding Therapy using The SOS Approach to Feeding. We have an Occupational Therapist and Dietician on staff.

The aim of feeding therapy is for children to eat a wide variety of age appropriate foods from each of the categories of protein (meat and dairy), starch (carbohydrates) and fruit or vegetables. A research study found that children participating in a 12 session group using SOS Feeding Therapy gained 450g and grew 2.5cm during that time (these children had not gained weight or height in the 3 months prior to the group). [Reference: Toomey & Ross, SOS Approach to Feeding (2011) ASHA Perspectives on Swallowing and Swallowing Disorders (Dysphagia), Volume 20 (3), pp 82-87]

If you are interested in learning more, please message, email or text Kids Can OT. An article by Dr Kay Toomey, "When Children Won't Eat: Understanding the "Why's" and How to Help" can be emailed to you on request- please provide your email address if you would like a copy. Follow Kids Can OT on Facebook to check for upcoming talks in Brisbane North. Debbie is very happy to talk on the phone about your child's needs and whether SOS Feeding Therapy is appropriate for you.

Wishing you a positive journey towards relaxed mealtimes for you and your child.