Encouraging Feeding Skills

Eating is a complex process.  Children may have difficulty eating a well balanced meal due to difficulties coordinating their oral motor skills and/or difficulties with sensory processing issues.

Oral-motor skills include moving the tongue and lips in coordinated movements to bite and chew food.  If your child coughs, chokes or gags while eating or drinking, please consult with your child’s speech-language pathologist and pediatrician.  These signs may indicate the need for a “swallow study” to fully evaluate your child’s swallowing safety.

Others may have sensory issues surrounding feeding. They may be sensitive to food textures and reject all foods that are mushy or crunchy.  Some are sensitive to temperatures or even strong smells. Many toddlers may reject foods on sight, or are resistant to trying anything unfamiliar.

The reasons behind eating difficulties can be as varied as the children themselves, but the treatment is the same – positive, guided interactions with a variety of food in a safe, supportive environment. Children also need to be taught and encouraged to appropriately refuse foods they are not ready to try.  Force feeding should never be an option.

Dr. Kay Toomey, a psychologist and creator of the SOS (Sequential Oral Sensory) Approach to Feeding, has developed the following strategies for parents to use at home (Toomey, 2004):

Structure:  We provide safety and routine to children by offering meals at the same time, in the same place, with the same people.  These routines and scheduled meals and snacks provide awareness of the sensations of fullness and hunger.

Social Modeling:  Children learn by watching others.  Having regular family meals where everyone eats the same foods offers children a chance to interact with family members and a variety of foods in a supportive environment.

Positive Reinforcement:   Children who have issues with eating have often had unpleasant or even frightening experiences while eating.  We want to create a positive, supportive environment for all children.  Praise any and all interactions with foods by clapping, cheering and/or offering verbal praise.  Positive reinforcement avoids the negative effects caused by punishment (such as the loss of appetite) and decreases attention seeking through negative behaviors.

Make Foods Manageable:   Provide food in small pieces or thin strips that can be easily held and chewed by toddlers.  Toddlers can be visually overwhelmed fairly easily.  Provide foods that the child likes and eats all the time, along with at least 1 challenging food at each meal and snack.  Present the food repeatedly – it takes 10 to 15 different interactions, on separate occasions, with the same food, for that food to become familiar to the child.

Cognitive Skills:   Use lots of language and descriptive words to describe the food – crunchy, chewy, cold, etc.  This provides information about the food before the child touches it or tastes it.  This increases familiarity with the food (and provides language stimulation, too!).

Key Phrases:   Provide clear instructions to the child – this avoids the battle of wills at the table.  Avoid the words “no,” “stop” and “don’t” at the table and provide acceptable, alternative behavior.  If the child throws food on the floor, you could say, “food stays on the table” or “you can push your plate away.”

If you are concerned about your child’s feeding skills, please talk with your child’s pediatrician, occupational therapist or speech-language pathologist as soon as possible.  Some children and families may benefit from a consultation with a pediatric nutritionist to assess the child’s caloric intake and needs.

For more information about the S.O.S. Approach to Feeding and other feeding and nutrition resources, please review the following links:

S.O.S. Approach to Feeding
Picky Eaters vs. Problem Feeders
Top 10 Myths of Mealtime in America
Feeding Strategies for Older Infants and Toddlers
P.O.P.S.I.C.L.E.

References:

Toomey, K. (2004).  The SOS (Sequential Oral Sensory) Approach to Feeding.  Presented in Nashville, Tennessee.

 

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