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.

Challenge Detroit was founded in 2008, with a mission that reads; “We develop, support and connect emerging and existing community-minded leaders, amplifying the positive impact on our diverse, cultural vibrant city.” Challenge Detroit is making a difference.

MetroEHS Pediatric Therapy is proud to be a host company with Challenge Detroit.

MetroEHS is excited to introduce Dezha Willoughby, one of two Challenge Detroit Fellows MetroEHS proudly hosts! Dezha was born and raised in Detroit and places like Belle Isle were the norm on the weekends (when the weather was nice). She attended and graduate from MLK High School (#GoCrusaders) and she went on to attend college at Michigan State University where she honed in her skills to work with and serve people. Dezha studied Human Development and graduated with her Bachelor of Science Degree in Human Development and Family Studies. Dezha enjoys being outside and enjoying nature. Dezha is very determined and ambitious about being an agent of positive change.

According to the company, “Challenge Detroit cultivates diverse, innovative, community-minded leaders from the city and across the country, fostering their talents to support local initiatives that move Detroit forward. While they spend four days a week accelerating their professional careers with our Host Companies, each Friday Fellows take a day out of the office to bring social impact challenge projects to life in collaboration with our local nonprofit partners. They work in multi-disciplinary teams, bringing their vision, creative muscles, and entrepreneurial spirits to address some of Detroit’s greatest challenges and opportunities. We believe that to move our city forward, positive change starts with an individual and is ignited by a community of leaders who bring innovative perspectives to their work, and most importantly, the nonprofits already making an impact within our Detroit communities.”

Brittany: Hello! My name is Brittany, I am the bilingual Speech Pathologist at Metro EHS in Sterling Heights and Detroit.

Mallory: Hi! My name is Mallory, and I work in the Human Resources Department at the administrative office in Plymouth.

B: And we are so excited to announce that MetroEHS now offers speech therapy in Spanish and English!

M: That’s great! We can service Metro Detroit kids in their native language! But Brittany, can you tell me how to know if my child needs speech therapy?

B: Sure! If you have concerns about the language or articulation development of your child, it is possible that he/she might benefit from speech therapy. For example, if your child cannot pronounce certain sounds, does not say a lot of words or combine words to form sentences, or if you cannot understand him/her, we can do an evaluation to see if he/she qualifies for speech therapy.

M: That sounds great! What happens next?

B: After the evaluation, if therapy is necessary, we are able to initiate therapy in English, Spanish, or both languages to help your child communicate with family, friends and all of the people in the child’s life using their preferred language.

M: So cool! Are any other therapies offered?

B: Of course! We also offer therapy for feeding difficulties, stuttering, problems with social language secondary to autism, and the use of augmentative and alternative communication for children who are not able to talk using verbalizations. Here at MetroEHS we also offer occupational and behavior therapy at all of our centers. We have a phenomenal team of therapists that provide individualized services for your child. And Mallory, you can assist Spanish-speaking families get started, right?

M: Of course! We accept most insurances. I would be happy to answer any questions that families might have. Call our office to see if your child might benefit from speech therapy or other therapies in Spanish, English, or both languages. Our telephone number is 313-278-4601. We would love to talk to you!

Brittany: Hola! Me llamo Brittany y soy la terapeuta bilingue de habla en MetroEHS en Sterling Heights y Detroit.

Mallory: Hola! Me llamo Mallory y trabajo en el departamentro de recursos humanos en la oficina administrativa en Plymouth.

Brittany: Estamos emocionados de anunciar que MetroEHS ofrece la terapia de habla en ingles y espanol.

Mallory: Que excelente! Podemos proporcionar la terapia de habla a ninos en MetroDetroit en su idioma nativo. Brittany, me puedes explicar como saber si mi hijo necesita la terapia de habla.

Brittany: Por supuesto! Si tiene preocupaciones del desarrollo del lenguaje o de la articulacion de su hijo es posible que se beneficie de la terapia de habla. Por ejemplo,  si su hijo no puede pronunciar ciertos sonidos, no dice muchas palabras ni combina palabras para hacer oraciones, o si no le puede entender a su hijo, podemos hacer una evaluacion para ver si califica para la terapia de habla.

Mallory: Suena muy bien! Que pasara despues?

Brittany: Despues de la evaluacion, si las terapias son necesarias, podemos iniciar las terapias en ingles, espanol o ambos idimos para ayudar a hijo a comunicarse con la familia, los amigos y todas las personas en su vida usando su idioma preferido.

Mallory: Guau(wow)! Ofrecen otras terapias?

Brittany: Tambien ofrecemos terapias para dificultades con la alimentacion, el tartamudeo, problemas con el lenguje social secundario al autismo, y el uso de comunicacion aumentativa y alternativa para ninos que no puede hablar con verbalizaciones. En MetroEHS, ofrecemos la terapia ocupacional y la terapia de comportamiento (ABA). Tenemos un equipo fenomenal de terapeutas que proporcionan servicios individualizados para su hijo. Mallory, tu puedes ayudar a las familiar que hablar espanol en la oficina, verdad?

Mallory: Por supuesto! Aceptamos muchos seguros medicos. Yo estaria encantada de responder a cualquier pregunta que tenga. Llame nuesta oficina para ver si su hijo se podria beneficiar de la terapia de habla en espanol, ingles, o ambos idiomas. El numero de telefono de la oficina es 313-278-4601. Nos encantaria hablar con usted.