Opening up New Opportunities with Pediatric Therapy in Spanish!

In today’s hectic world of parenting, where every child seems to come with their unique set of challenges, one common struggle that many families face is dealing with picky eaters. It’s a scenario familiar to almost every parent or guardian out there. But fear not, because MetroEHS Pediatric Therapy is stepping in to offer a solution that not only addresses the needs of the child but also brings relief to the entire family.

During a recent segment on Live in the D, Tati Amare dove into the topic of feeding therapy with two experts from MetroEHS: Dawn Sterling, a Board Certified Behavioral Analyst, and Sam Fitzsimmons, the Director of Occupational Therapy. Their insights shed light on the signs indicating a child could benefit from feeding therapy, how MetroEHS approaches this issue, and invaluable advice for parents navigating feeding challenges.

According to Sam Fitzsimmons, pediatric feeding disorders are more common than we might think, with one in 23 children under the age of five affected. These disorders often accompany developmental disabilities like ADHD and autism, making them even more prevalent. Signs to watch out for include mealtime behaviors that disrupt daily routines, extreme food selectivity, and a reduction in the variety of foods consumed.

MetroEHS takes a holistic approach to feeding therapy, utilizing an interdisciplinary model that incorporates occupational therapy, speech therapy, applied behavior analysis (ABA), and physical therapy. Their goal is to make feeding a positive and enjoyable experience for children, starting with non-food items and gradually progressing to food-based activities through play and sensory exploration.

One of the most significant takeaways from the discussion is that it’s never too early to seek help. Whether it’s addressing difficulties with latching during breastfeeding in newborns or tackling food aversions in older children, MetroEHS is there to support families every step of the way.

When it comes to feeding strategies, Dawn Sterling emphasizes the importance of keeping things light and pressure-free. Rather than engaging in power struggles over food, she advocates for creating a nurturing environment where children feel comfortable exploring new foods at their own pace. The key is to focus on engagement and enjoyment, both for the child and the family.

In their own words, both Dawn and Sam emphasize MetroEHS’s commitment to holistic care, not just for the child but for the entire family. By adopting a whole-child approach and empowering families, MetroEHS aims to foster growth and success in every aspect of a child’s development.

As the conversation drew to a close, Tati Amare reiterated the accessibility of MetroEHS’s services, with 14 locations already established in Metro Detroit and three more on the horizon. Whether it’s ABA, speech, occupational, feeding, or physical therapies, MetroEHS stands ready to lend a helping hand to families in need.

In conclusion, dealing with picky eaters can be a daunting challenge, but with the right support and guidance from experts like those at MetroEHS Pediatric Therapy, families can overcome these obstacles and ensure that every child thrives. If you’re facing feeding difficulties with your child, don’t hesitate to reach out and discover the transformative power of pediatric feeding therapy.

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.

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