What Is Pediatric DMI Therapy and How Does It Support Motor Development?

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.

When your child needs therapy, it is common to hear about several different types of support. You may be told your child could benefit from speech therapy, occupational therapy, physical therapy, or behavioral therapy. Each of these services can play an important role in your child’s development.

But for many children, progress can happen more smoothly when those therapies work together instead of separately.

That is the idea behind integrated therapy.

Integrated therapy means your child’s providers work as a team. Rather than having each therapist focus only on their own area, they collaborate, communicate, and build one coordinated plan centered on your child’s everyday growth and success.

Kids Do Not Develop One Skill at a Time

Children do not learn in neat, separate categories. A child who is working on communication may also need help with sensory challenges, motor skills, social interaction, attention, or behavior. These areas often overlap in daily life.

For example, a child may struggle to express their needs clearly, but that same child may also have trouble staying regulated, joining play, or managing transitions. One challenge can affect another.

When therapy is integrated, children can receive support in multiple areas at the same time. This often helps them make progress faster because the people helping them are all working toward the same bigger picture.

One Team, One Plan

One of the biggest benefits of integrated therapy is that your child is not working with separate providers who all have different goals. Instead, the therapists share strategies and work together.

A speech therapist may introduce a new way for your child to communicate. An occupational therapist may help your child practice that skill during play. A behavioral therapist may reinforce it during social routines or structured activities.

Because the same skills are being supported in more than one setting, children often have more chances to learn, remember, and use them.

This team approach can make therapy feel more connected and more purposeful.

Skills Are Practiced in Everyday Ways

Children learn best when they can use their new skills in real-life situations.

If a skill is only practiced during one therapy session each week, it may take longer for that skill to become natural. But when a child practices the same skill in different activities and across different therapies, it can start to stick more quickly.

This kind of repeated practice can help children build confidence, use their skills outside of therapy, and become more independent in daily life.

That might look like using communication skills during play, practicing motor skills during a routine activity, or learning how to handle transitions with support from multiple therapists who are using the same approach.

Parents Get Clearer Support Too

Integrated therapy is not only helpful for children. It can also make a big difference for families.

When providers work together, parents are more likely to receive one clear plan instead of separate instructions that may feel overwhelming or hard to connect. This can make it easier to understand what your child is working on and how to support that progress at home.

Many families find that a coordinated approach helps reduce confusion, makes home practice more manageable, and keeps everyone focused on the same goals.

When therapy feels more connected, it is often easier for parents to feel confident in the process.

Why Coordination Can Lead to Better Progress

Research has shown that children in coordinated, multidisciplinary therapy programs often experience strong benefits across many areas of development. These may include improved communication, better motor skills, more independence in daily routines, and stronger participation at home and at school.

When care is coordinated, children may have an easier time carrying new skills from one activity into another. Instead of learning something in isolation, they begin to use it more naturally in everyday life.

That is often where meaningful progress happens.

The Goal Is Real-Life Success

Therapy is not only about checking off goals in a session. It is about helping children communicate, move, play, participate, and grow with more confidence in their daily lives.

An integrated therapy model supports that by bringing people together around your child’s needs. It helps ensure that therapy is not fragmented, but connected in a way that makes sense for how children actually develop.

The Bottom Line

Children grow in many ways at once, and their therapy can work the same way.

When therapists collaborate as one team, children get more consistent support across different areas of development. That can help them build skills faster, use them more confidently, and make progress that carries into everyday life.

Because every child deserves support that helps them thrive.

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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.