Everything You Need to Know About Feeding Therapy
What is feeding therapy? Do you think your child needs it, and if so, where and how do you get it for them? Get answers from feeding therapists!
Where have you done feeding therapy and for how long?
Marlee and Alexi have both provided feeding therapy for the last 4 years as occupational therapists in a variety of settings, including outpatient, in-home, autism centers, and school-based! They have worked and supported clients of all ages from 6-8 months old all the way up to 18 and 26 years old. Both of them were exposed to feeding therapy while in occupational therapy school, and Alexi had prior experience as a behavior therapist at a previous job.
What is feeding therapy/what to expect?
Feeding therapy is the modulation and integration of a variety of foods using a child’s senses into their diet. In simplest terms, feeding therapy helps children learn how to eat or how to eat better. Feeding therapists that provide therapy can be registered and licensed occupational therapists like Marlee and Alexi, or speech-language pathologists (SLP). SLPs often target it from an oral motor/structural approach whereas OTs take a sensory and strength/endurance perspective. Nutritionists/dieticians can also provide feeding therapy direct services but are more often sought out to help children manage their weight or growth concerns if applicable.
Feeding therapy can be viewed as a specialty within a specialty. Not all OTs and SLPs are trained in pediatric practice and not all pediatric therapists have additional feeding therapy education and practice either. As the picture demonstrates below, feeding is just the tip of the iceberg, and there are a lot of different contributing factors as to why your child may have difficulties with eating.
An initial evaluation is always conducted incorporating an assessment of engagement with a variety of foods from each category, an assessment of reflexes, and postural stability (including core strength). A food inventory, observation, and the child's sensory profile - 2 are usually utilized. These are not invasive at all.
After the eval and intake are over, the professionals or therapist that completed the eval will make recommendations for how often feeding therapy will take place. At this time, goals will be written that guide the direction of therapy. These are specific and include the parent’s concerns. Feeding therapy can occur on a weekly basis, but can also be every other week or once a month, usually lasting between 30-60 minutes long. This time will be spent teaching your child how to eat new foods (if they have a limited diet/specific preferences) or how to eat (if they don’t know how to chew correctly or manage food in their mouth). But depending on your child and their personal challenges, they may participate in sensory integration activities or complete exercises to strengthen the muscles they need for eating. This could include an assessment of reflexes, and postural stability (including core strength and tone). Your therapist may utilize a food inventory, observation, and the child's sensory profile - 2 to assess these. Then moving onto oral-motor exercises that could include; blowing bubbles and making silly faces with their tongues which are actually intentional to assess the range-of-motion (ROM) of the tongue. Check out the Beck Oral Motor website to learn more! Your therapist may also incorporate oral-motor strengthening tools into their session, such as Ark products, intense vibrating stimuli such as sensivibe/z-vibe, and diaphragmatic breathing.
Who is feeding therapy for?
Generally speaking, feeding therapy can be very helpful and highly recommended if your child is having difficulty actually eating (limited diet, picky eating, difficulty eating out of the house/at restaurants, poor oral motor control influencing independence, sensory difference influencing engagement, tongue/lip tie, etc). Those specifically with sensory processing differences related to the oral motor system. This is most common for children that have special needs or medical differences that may make it physically difficult. Your pediatrician will usually suggest feeding therapy early on in these cases, but there are two more common situations that may be overlooked as well.
Is feeding therapy for picky eaters?
Often these children are labeled as picky eaters due to the lack of understanding of the foundational deficits the child is experiencing. Not all picky eaters are created the same! It tends to be a blanket term used to describe any child with their own food preferences, but it can also include children who gag or even throw up at the sight of new food and only have the 5 foods they eat. This is a huge range! It should also be known that feeding therapy is not always necessary for all of them. It is more recommended for the extremely picky eaters that have a very limited diet and stress around trying new foods.
Is feeding therapy for toddlers?
Yes! Feeding therapy is for all ages. Feeding starts from the moment a child is born progressing from breast or bottle feeding and on. Age does not particularly matter! For toddlers specifically, it may be because they are behind on feeding milestones and a parent may be wondering how long they should wait to see if it improves.
In this case, reaching out for an eval is a good thing! Your child may or may not qualify for therapy, but at least you will have some supportive resources to help your child through food exploration and mealtime engagement. It is also important to consider if insurance will cover the cost of specific therapy settings or if you will have to pay privately. “Picky eating” often starts for children when they are toddlers and that is a completely normal phase (Taylor & Emmet, 2018)! If you feel like it is getting out of control or is beyond any limits of what you would typically expect, then this would be another instance that a person may need feeding therapy.
How to get feeding therapy/where is it offered?
It is always a good idea to talk to your pediatrician prior to starting feeding therapy. They may be able to point you in the right direction for local resources that can help your family. Feeding therapy is offered at most outpatient pediatric clinics, some hospitals, PICU & NICU. But, and this can be huge, if you explain your concerns and an receive answer that does not sit well with you, seek out a second or third opinion. It is important to ensure your pediatrician is hearing your concerns to support your child.
What to expect with feeding approaches?
There are two categories that feeding therapy approaches can be split into; Behavioral and Child Directed (Grogan, 2021).
Behavioral is a more traditional method of feeding therapy that uses rewards to gain new foods eaten. An example is giving your child a sticker for every successful bite of new food. To gain another sticker they need to take another bite. The reward should be phased out over time but this is not always the case.
Child-directed is a more modern approach and is positive in nature. Parents are more involved with this type of treatment and there is a focus on addressing the underlying cause of the problem (sensory, medical, etc). This approach may take longer to see results initially, there is research that supports the effects are longer lasting. The most common approach is the SOS Approach to feeding. The SOS feeding approach focuses on systematic desensitization which breaks down each part of the eating process into steps; tolerates, interacts with, smells, touches, tastes, and then finally eats. It might be surprising to hear that there are 32 steps to eating! The child receives positive reinforcement for every level of food interaction they progress through.
What are some tips for picky eaters that you have?
Start slow! Gain extensive rapport prior to even incorporating food. Feeding is the most complex sensory experience we experience throughout our days. The CDC offers a tip sheet for picky eaters as well!
References
Taylor, C. M., & Emmett, P. M. (2018). Picky eating in children: Causes and consequences. Proceedings of the Nutrition Society, 78(02), 161–169. https://doi.org/10.1017/s0029665118002586
Grogan, A. (2021, May 24). The ultimate guide to feeding milestones for babies and toddlers. Your Kid’s Table. https://yourkidstable.com/eatingfeeding-milestones-for-babies-and/