What Does Pediatric Feeding Treatment Look Like?

MetroPrep Academy is a Therapeutic Preschool designed specifically to help children with delays succeed!

Allie is a speech pathologist that works at MetroPrep Academy. We are so excited about this preschool for children that need a little bit of help before they go to general education or community school. Our preschool offers kids, ages two to seven, with autism, down syndrome, speech and language delays, or sensory delays, the extra support that they need. Because we have professionals in the classroom with them, to help them in a smaller size, so they can get the individual attention that they need. We have a BCBA that’s able to help with behaviors. A speech pathologist that’s going to be developing those speech and language skills to get them ready to communicate with their teachers and peers in classrooms. An occupational therapist that’s going to integrate sensory systems and big activities, big movement activities, with the gym here. And a preschool teacher who’s, of course, going to teach things like the alphabet and colors and build the foundation that they need for school. So we would love to have you come check out MetroPrep Academy.

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.

Teletherapy, also called tele-practice or tele-speech, has become more popular during the uncertain circumstances and stay at home orders of COVID-19. Teletherapy can bring a sense of familiarity in uncertain times, as your child can have a weekly live speech therapy visit with a consistent speech language pathologist (SLP). A relationship is built, and the therapist and child share smiles and laughter in between working on their goals. With teletherapy, children can continue to receive continuity of care even as they stay safe at home! But does this foreign method of attending speech therapy really work?

Research is largely in agreement: Teletherapy is a very effective way of teaching kids speech and language!

With teletherapy, speech therapy is provided via a video chat platform that is secure. MetroEHS’s online platform includes fun games, a box for clients to watch applicable videos and talk through worksheets or read stories, screen share, practice cards, and, of course,  a live-streaming video SLP guiding them through all of it. All of these features engage most children, including those on the Autism Spectrum. This 1:1 teletherapy has been proven effective: according to a review of 7 studies of school-aged children, “telehealth is a promising method for treating children” (1). Another study looking specifically at children with ASD stated, “All [14] studies reported high levels of programme acceptability and parent satisfaction with the telehealth component of the intervention” (2). And another states, “Emerging research in telepractice treatment for ASD clients already shows success in both direct and indirect interactions” (3).

If a child is too young or difficult to engage, the SLP may opt for a parent training approach. The parent will receive a list of supplies to gather from around the house, and the SLP will teach the parent how to target the child’s goals. The parent is encouraged to ask questions, and the SLP coaches as the parent engages their child and completes their goals. This has also been proven effective for children learning language! Evidence suggests, “that parent-mediated intervention training delivered remotely can improve parents’ knowledge in [autism spectrum disorder] ASD, parent intervention fidelity, and subsequently improve the social behavior and communication skills of their children with ASD (4).

Feeding Therapy can be provided with a similar model. The SLP guides the caregiver during the session, and talks through strategies and techniques for children accepting the food, chewing, and swallowing. Providing feeding therapy online can be beneficial because the SLP can see where the child typically sits, the types of eating utensils that are used, and overall family dynamic- all of which play a major role in carryover of skills to the home environment. What better way to support generalization to home, than having therapy in the home! Feeding Teletherapy, too, is an excellent and effective substitute to in-person therapy, according to research (5)!

As you can see, teletherapy is a powerful alternative to in-person therapy, especially during situations when receiving in-person therapy is difficult or impossible for families. If you would like more information about teletherapy, to enroll your child, or a free “Teletherapy Tour” to see our platform, please contact MetroEHS today!

Resources

1. 2017. Wales, D., Skinner, L., et al. The Efficacy of Telehealth-Delivered Speech and Language Intervention for Primary School-Age Children: A Systematic Review. International Journal of Telerehabilitation, 9(1), 55-70.
2. 2018. Sutherland, R., Trembath, D., et al. Telehealth and Autism: A Systematic Search and Review of the Literature. International Journal of Speech-Language Pathology, 20(3), 324-336.
3. 2015, April 28. Cornish, Nate. Social Mediating: Using Telepractice for Clients With Autism. ASHAwire.
4. 2017. Parsons, D., Cordier, R., et al. Parent-Mediated Intervention Training Delivered Remotely for Children With Autism Spectrum Disorder Living Outside of Urban Areas: Systematic Review. Journal of Medical Internet Research, 19(8), e198.
5. 2008. Clawson, Seldon, Lacks, Deaton, Hall, Bach. Complex pediatric feeding disorders: using teleconferencing technology to improve access to a treatment program. Pediatric Nursing, 34(3): 213-6.