Why Is Early Intervention Feeding Therapy So Important for Children?

Once a child has been diagnosed with a Pediatric Feeding Disorder due to oral dysphagia or sensory processing disorder or, if diagnosed by a psychologist, ARFID (Avoidant/Restrictive Food Intake Disorder), they will likely be referred for treatment. Eating is a learned behavior. It is only instinctive for the first 6 months of life. Older children must either teach themselves, or be taught (Toomey). Treatment for a feeding disorder can be completed by a Speech-Language Pathologist (SLP), Occupational Therapist (OT), Board-Certified Behavior Analyst (BCBA), Dietician, or Psychologist. All of these disciplines have overlapping and unique approaches to treatment, so a Pediatric Feeding team that involves more than one specialist may be best for your child. As an SLP who is part of a feeding team that involves an OT and BCBA, some approaches to treatment that I utilize alongside the team include the Food Chaining Approach, The Sequential Oral Sensory approach (SOS), and the Escape Extinction approach.

Food Chaining has become recently popular due to a book written by Fraker and Cox called Food Chaining: The Proven 6 Step Plan To Stop Picky Eating, Solve Feeding Problems, and Expand Your Child’s Diet. To summarize this approach, clinicians and parents would “chain” from food that children currently enjoy by changing 1 aspect of the food at a time: either color, texture, flavor, or shape. For example, if a child enjoys cheetos, you might “chain” to orange veggie sticks (changing flavor), then to green veggie sticks (change in color), then to green veggie chips (change in shape), then to zucchini cut in a circle and placed on the chip (change of texture), then remove the chip. The child is now eating zucchini, and it was introduced slowly in a non-threatening manner! In this procedure, food is not forced on children- they are able to touch and explore it themselves, the clinician models eating it, and children are encouraged to take a bite, but they decide if they would like to try it or not. Using food chaining, children will slowly and positively increase their repertoire of acceptable food.

The Sequential Oral Sensory (SOS) approach was developed by Dr. Kay Toomey, a psychologist who specializes in Pediatric Feeding Disorders. This procedure includes another slow process of children having repeat exposures to foods prior to being forced to take a bite. For example, a child would tolerate a new food, let’s say apple slices, on their plate without expectation of eating it. Once that is tolerated, the apple will slowly and systematically move closer to their mouth, again without expectation of eating. They will touch it first with a fork or toy, then their hand, then put it on their arm, then their cheek, then kiss it, then lick it, then take a bite and spit it out, then chew, and finally swallow the apple slice. This could take a couple of days or even weeks. The idea is to allow children to have positive interactions with the food so that eating is enjoyable and they control what is placed in their mouth according to their comfort level. Eventually the child will be able to more quickly and independently follow the above steps with a new food to independently increase their diet. Children will gain confidence and learn that new foods aren’t as scary as they once thought.

The Escape Extinction approach is an effective, evidence based approach used to aid with feeding problems across all ages and is often utilized in ABA therapy by a BCBA or Behavior Technicians under the guidance of a BCBA. Eating novel food items and non-preferred food items is broken down into easier steps to aid your child with succeeding in their feeding journey. Keeping the presentation of bites and the bite sizes predictable decreases anxiety and allows the child to feel more in control during meal times. We never move up in bite size until we are certain your child is able to handle the bite at that size and has the skills needed to properly lateralize the food item, masticate the bite, and take consecutive bites. Furthermore, this approach reinforces appropriate feeding behavior while extinguishing inappropriate or disruptive feeding behaviors by not allowing the child to escape from taking bites by using a non-removal of the spoon. Often times, children will spit out food, swallow food without chewing, pack bites, turn head away from the bite, or engage in aggression. When these behaviors occur, we do not remove the bite from their lips until the bite has been taken, and provide prompts and reinforcement for taking bites and chewing appropriately.

Children enrolled in the feeding program Metro EHS Pediatric Therapy are evaluated and treated as unique individuals, so these approaches, along with others, are often combined to best help your child experience success with eating.

Sources

2019. Tooomey, Kay. SOS Approach To Feeding.
2020. Tarbox, J and Tarbax, C. Training Manual for Behavior Technician Working with Individuals with Autism Spectrum Disorder. Retrieved from Sciencedirect.com.
2021. Fraker, Fishbein, Cox, Walbert. Food Chaining: The Proven 6 Step Plan To Stop Picky Eating, Solve Feeding Problems, and Expand Your Child’s Diet. Da Capo Lifelong Books.

As the days grow longer and the temperatures rise, parents everywhere are gearing up for summer break. For parents of special needs children, however, summer planning can come with its own set of challenges. From scheduling doctor appointments to finding engaging activities, it’s essential to plan to ensure a smooth and enjoyable summer for the whole family. If you’re in our beautiful state of Michigan, chances are you are planning on a trip up north or to the beach. There are plenty of options available to make this summer one to remember. Let’s dive into some tips and resources to help you efficiently prepare and plan for the upcoming season.

• Start Early: The key to successful summer planning is to start early. Begin by making a list of all the activities and appointments you want to schedule for your child. This might include medical check-ups, therapy sessions, and recreational activities. By getting organized ahead of time, you’ll avoid last-minute stress and ensure that you secure the dates and times that work best for your family and your vacation plans.
• Schedule Doctor Appointments Now: Take the time to schedule any necessary doctor appointments for your child before the summer rush hits. This might include routine check-ups, consultations with specialists, or adjusting therapy sessions if you plan to be out of town. Many healthcare providers experience increased demand during the summer months, so booking appointments in advance is essential. Be sure to communicate any specific needs or concerns with your healthcare provider to ensure that they can accommodate your child effectively.
• Explore Kid-Friendly Activities: Southeastern Michigan offers a wealth of kid-friendly activities that cater to children of all abilities. From sensory-friendly museums to inclusive parks, there’s something for everyone to enjoy. Take the time to research local attractions and events that are accessible and accommodating to children with special needs. Consider reaching out to community organizations or support groups for recommendations and tips on inclusive activities in your area. Maybe you can even suggest that more venues offer sensory-friendly options!
• Consider Summer Camps and Programs and register soon: Summer camps and programs can provide valuable opportunities for children to socialize, learn new skills, and have fun but spots fill up fast this time of year. Look for camps that offer specialized programming for children with special needs, especially those that include sensory-friendly activities and trained staff. Many camps in Southeastern Michigan offer scholarships or financial assistance for families in need, so don’t hesitate to inquire about available resources. Be aware that some of the scholarship programs for camps and summer programs are first come first serve.
• Create a Visual Schedule for your Kids: Visual schedules can be incredibly helpful for children with special needs, providing them with a clear understanding of their daily activities and routines. Take the time to create a visual schedule for your child’s summer break, incorporating doctor appointments, outings, and leisure time. Use pictures, symbols, or written words to represent each activity, and involve your child in the planning process to foster independence and self-awareness.
• Get a jump on Fall: An IEP is a personalized education plan designed to support a child with a disability. It can be a lengthy process to get an IEP in place for your child. To start the process, request an evaluation from your child’s school or school district, then work with the IEP team to develop a plan tailored to your child’s unique needs. If you need additional guidance, consider reaching out to local parent advocacy groups or special education organizations for support and resources.

Early summer planning may require some extra time and effort, but the rewards are well worth it. By starting early, scheduling doctor appointments, exploring kid-friendly activities, considering summer camps, and creating visual schedules, you can ensure that your child has a memorable and enjoyable summer break and save yourself some panic later. Remember to prioritize self-care and relaxation for yourself as well, and don’t hesitate to reach out to local resources and support networks for assistance along the way. Here’s to a summer filled with fun, adventure, and plenty of cherished memories!

Q: What is the RBT certification?

A: RBT certification is a paraprofessional certificate that is in the behavioral analyst field, and you work under the BCBA or BCABA treating and providing services to our kids.

Q: What are the requirements?

A: What it takes to become an RBT here at MetroEHS is you must be 18 years old, a high school diploma, you need the 40 hours of training, and then take a competency test with the supervisor, and then you apply at the BACB website, and take a test, and become an RBT.

Q: What does the training consist of?

A: The RBT training consists of like an interactive and comprehensive 40-hour training that you work in a small group or one on one with other technicians or your BCBA. You’re out in the clinic, hanging out with the kids, learning and watching how they run programs. That could be at the table time or out in natural environment and once you understand the new words in the ABA field, you take your competency test and take the test at the website.

Q: What is the competency test?

A: The competency test is when the supervisor comes out the clinic with you and they watch how you run programs, they interview you, ask questions about the terminology and it’s pretty much just one on one time or you and the supervisor and your client to make sure you understand the terminology and what you’re actually doing and it’s highly encouraged to actually take your RBT test within 90 days of your 40 hour training. It is free of charge. You take the test at the BACB website.

Apply now!

Q: How do I maintain my credentials?

A: To maintain my credentials as an RBT here at MetroEHS, I track all my supervision hours, and I retake my competency test at the year mark or year anniversary of my RBT testing date.

Q: What are the benefits if earning an RBT certification?

A: MetroEHS offers two benefits for becoming an RBT. One is a raise and two, once you become an RBT, you have more opportunities to move up the ladder and become admin or fun stuff.