What Does Pediatric Feeding Treatment Look Like?

young asian girl covering her mouth being a picky eater

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

  1. Tooomey, Kay. SOS Approach To Feeding.
  2. Tarbox, J and Tarbax, C. Training Manual for Behavior Technician Working with Individuals with Autism Spectrum Disorder. Retrieved from Sciencedirect.com.
  3. 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.

Continue Reading

November 4, 2019

MetroEHS Pediatric Therapy & Challenge Detroit

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.”

July 18, 2024

Why Do Some Children With Autism Toe Walk—and What Can Parents Do?

Are you concerned about your child’s toe walking habits? Toe walking, a common concern for parents, can sometimes be associated with autism spectrum disorder (ASD). Understanding the connection between toe walking and autism is crucial for early intervention and support.

What is Toe Walking?

Toe walking refers to a walking pattern where a person walks on their toes or the balls of their feet without their heels touching the ground. While occasional toe walking in toddlers is common, persistent toe walking beyond the age of two may indicate an underlying issue.

The Connection with Autism

Toe walking is often observed in children with autism spectrum disorder (ASD). While not all toe walkers have autism, studies suggest that many children with ASD exhibit toe walking behavior. Children with Autism often have higher sensory seeking behaviors, and being up on their toes gives them deep sensory input through their feet and in their contracted calf muscles. This connection can lead to more targeted interventions and support from therapists and parents.

How Can a MetroEHS Physical Therapist Help?

Physical therapy plays a crucial role in addressing toe walking in children, especially those with autism. A skilled physical therapist can:

  • Assess the Underlying Causes: A physical therapist will conduct a comprehensive evaluation to identify any underlying factors contributing to toe walking, such as muscle tightness, sensory issues, muscle weakness, or lack of range of motion.
  • Develop Individualized Treatment Plans: Based on the assessment, the physical therapist will create a personalized treatment plan tailored to your child’s needs. This plan may include stretching exercises, strengthening activities, balance training, or different sensory inputs.
  • Educate and Empower Families: MetroEHS Physical Therapists work closely with families to educate them about toe walking and provide strategies for home exercises and activities to support their child’s progress.

Toe-walking can impact your child long-term if left untreated:

Toe walking will impact your child’s overall body positioning, posture, and muscles. With toe walking, because of these impacts, it will also change the load of the body’s joints and likely cause chronic pain as the individual ages. It is common for toe walkers to lose range of motion in their ankles, preventing them from being able to reach their heels to the ground and causing their Achilles tendon to shorten. In more severe cases, if the Achilles tendon shortens too much, the only way to regain that length is with a surgical lengthening.

Take the First Step Towards Support

If you’re concerned about your child’s toe walking or suspect they may have autism, early intervention is key. Schedule an evaluation with a qualified physical therapist who specializes in pediatric care. Together, we can help your child take confident steps towards improved mobility and independence.

April 5, 2023

MetroEHS Joins WDIV for Autism Awareness Month

We are proud to sponsor Live in the D, and excited to have joined them this month to bring Autism Awareness.

Tati Amare:
As we watch children grow, we see them develop in many different ways, from infant to toddler to child. As they grow, we celebrate milestones like first steps or first words, but what if the child in your life hasn’t reached a milestone by a certain age or at all? That’s where our sponsor, MetroEHS can help families and children thrive when developmental challenges present themselves. Joining us now here from MetroEHS is our sponsor for Autism Awareness Month is Dawn Sterling, a board certified behavioral analyst with MetroEHS Pediatric Therapy. Good morning and thank you for being with us.

Dawn Sterling:
Good morning. Thank you for having me.

Tati Amare:
This is a lot to think about, but MetroEHS prides itself as a neighborhood therapy company that is accessible to everyone because you have 14 locations and 3 more on the way. Explain the work that you do with families and what makes MetroEHS unique.

Dawn Sterling:
Yes, so we are a pediatric therapy service provider and what really makes us unique is the different variety of services that we offer all in one location. So each neighborhood therapy center has a speech and language pathologist, occupational therapy, physical therapy, applied behavior analysis. We also have dieticians and mental health professionals working with us, and what really sets us apart is our feeding therapy program. So what we do, and its uniqueness, is this wrap around the whole child. So we focus on the whole child developmentally. So whatever a family may be concerned with or struggling with, we’ve got services and support for those families.

Tati Amare:
For every need. I like that. Now if I’m a parent at home and for family members of children, what are some signs that we should look for that may indicate that there may be developmental concerns with our children?

Dawn Sterling:
That’s a great question. So we look for what is called developmental milestones. So your pediatrician is a great person to get that resource from. So if you are at all concerned about your child meeting milestones, maybe they’re not meeting them in the timeframe that you expected, or maybe they had some of these milestones and they’re dropping off, you’re going to start with your pediatrician. They may recommend evaluations. Always pursue those. It’s better to rule out any concerns than to perhaps miss it.
Sometimes what’s recommended is behavior therapy. Applied behavior analysis is one type of therapy that can really help with children with developmental disabilities, and not just autism. These therapies, speech therapy, feeding therapy, occupational therapy, they are for a variety of diagnoses, global childhood developmental delay, any sort of developmental delay that your evaluators may see, there is a related service that can support these families.

Tati Amare:
All right. Now you’ve brought in some example of the items that you use to work with children. So walk us through these tools. I’m going to hold these up.

Dawn Sterling:
Thank you, Tati.

Tati Amare:
Of course.

Dawn Sterling:
MetroEHS is a collaborative pediatric center, so we collaborate with all of our service providers such as SLPs, or Speech Language Pathologists, that may help us design core boards for learners that are not communicating fully with their words yet. We also will collaborate with our occupational therapists on staff for things that may meet a young child’s sensory needs. We are movers and shakers, so sometimes we need to have things that we can play with in our hands, it might be scented to wake up some of those senses. We also have sensory oral chews. We work with a lot of very young kids and we know developmentally young children like to mouth on things.

Tati Amare:
Yeah, this is perfect.

Dawn Sterling:
So this is food grade silicone, it’s safe, it’s safer than the wooden puzzle piece that your toddler might be putting in their mouth. And then we do work on daily living skills, and this is from our OT department, as well. When children are learning to utilize a straw, this cup can be very helpful because we can squeeze it to give them a little bit of that liquid and really show them this is something you might want as we build up their ability to have independence with eating, drinking.

Tati Amare:
And all of that stuff.

Dawn Sterling:
Again, the whole child.

Tati Amare:
Yeah, definitely. Definitely. Okay, so I have to ask you before, because we’re just about running out of time, how rewarding is it for you to be in this position and have the impact with these kids?

Dawn Sterling:
It is the most incredible experience. We get to partner with families. The parents are a viable and valuable member of our treatment team, so we get to work with them and really see what their children and their families are achieving as a result of our therapies. So that is the biggest impact, is seeing progress with our kids.

Tati Amare:
That’s awesome. Dawn, thank you so much for being with us.

Dawn Sterling:
Thank you. Thank you for having me.

Tati Amare:
This is going to be helpful for a lot of families out there. Remember, MetroEHS has 14 locations and 3 more on the way across Metro Detroit. To find a location near you and to see how they can help your family, go to metroehs.com.