Swallowing/Feeding

These children often demonstrate one or more of the following:

• Limited food selection (total of 15 foods or less)
• Limited food groups (refusal of one or multiple food groups)
• Anxiety and/or tantrums when presented with new foods.
• Experience food jags (one or more food must be present at every meal prepared in the exact same manner)
• Almost always eats different meal from the rest of the family
• Diagnosed with a developmental delay of some form.
• May at some point (or currently) require alternative forms of nutrition (i.e., feeding tube)

There are many different options available for feeding therapy. At LLA Therapy, our therapists follow the ideology of the SOS (Sequential-Oral-Sensory) program developed by Dr. Kay Toomey. This program incorporates motor, oral, behavioral/learning, medical, sensory and nutritional factors when approaching therapy. This approach is firmly grounded in the stages and skills of feeding found in typically developing children. Typical developmental steps are used to guide a child’s progress to eating various textures, and growing at an appropriate rate for them. The SOS program follows four basic tenets which include:

• Myths about eating interfere with understanding and treating feeding problems.
• Systematic desensitization is the best first approach to feeding treatment.
• “Normal development” of feeding gives us the best blueprint for creating a feeding treatment plan
• Food Hierarchies/choices play an important role in feeding treatment

Families will be asked to bring foods the child does and does not prefer to the evaluation. Bring anything that the child may use at home to help them feel more comfortable in the clinic setting. A multi-disciplinary team (when possible) will then observe the child eating preferred foods followed by non-preferred foods to gain a better insight into how the child reacts to each stimuli. Parent input is greatly valued during the evaluation and the family will receive a written report of all observations.

Based on the needs of the child they may be recommended for individual or group feeding therapy. Placement is determined by several factors including age of the child, number of other peers in feeding therapy who may be group candidates, and feeding concerns noted. Despite which treatment model is recommended best results always include at least one parent/caregiver present during all sessions.

In general, each treatment session begins with a set routine (perceptual preparation, sitting stability exercises, breathing and oral-motor exercises, handwashing, description/teaching about the food). Oral-motor and perceptual deficits are targeted through the food choices made and how they are presented (taste, size, textures, etc.). Children proceed through the developmental hierarchy with assistance from the therapist, positive social reinforcement is always used throughout this program. The range of foods not the volume of food consumed is what drives individual therapy sessions.

When will my child be done with feeding therapy?

The discharge criteria for therapy includes:

• Child will readily initiate tasting a new food when presented, 80-90% of the time.
• The child will have 30 different foods in his/her food repertoire. 10 will be proteins, 10 starches and 10 fruits/vegetables. (This number is recommended to go through 2 full days without repeating a food as to prevent food jagging.)
• Child will achieve a weight/height growth curve appropriate for their age and medical condition.
• The child will be able to eat age appropriate foods without gagging, vomiting or battling with parents/caregivers.
• Child will be able to take in adequate amounts of fluids via an age appropriate container.