2. +
Prevalence
20% of children struggle with some type of feeding issue during
the first 5 years of life
5-10% of children with severe feeding disorders require
medical intervention
1/3 of children with developmental disabilities have associated
problems with feeding (Babbitt et al., 1994)
3. +
Prevalence
Myth: Is it a behavioral or organic problem?
Burklow et al. (1998) – 85% mixed
Budd et al. (1992) – 64% mixed
Rose PFC (2001) – 93% mixed
When normal early feeding experiences and interactions have
been disrupted, children are at risk of chronic eating difficulties
during early childhood.
Poor appetite
Food refusal and selectivity
Delayed skill acquisition
Disruptive mealtime behaviors (Babbitt et al., 1994)
4. +
Effect on Parents
68% of mothers felt stressed out during
feeding time (Lewinsohn, 2005).
78% of parents identified the quality of the foods to be the most
important issue (Cerro, 2002)
“The more worried a mother was about her child’s weight, the
more her interactions with her child at mealtimes were
impacted” (Gueron-Sela et al., 2011).
Caring for these children increases the physical and
psychological demands on parents because of balancing the
tasks involved in managing the child’s medical care and
nutrition, with other aspects of parenting and family life (Wolf &
Glass, 1992; Mori, 1997).
Guilt, worry, and stress
5. +
Family Meal Goals
1. Volume of preferred foods
2. Exposure to non-preferred foods
3. Creating a mealtime structure and routine
7. +
Parent-based Interventions
Have a schedule for meals & snacks
Have a consistent seated location for mealtimes
Avoid distractions at mealtimes
Preparatory activities
Use transitional activities
Incorporate mealtime-related activities
Positive reinforcement
* Reducing anxiety at mealtimes is critical for success
8. +
Social Role Modeling
At least one adult sits and eats with child
Model good feeding behaviors
Talk about the food
Over-exaggerate how to eat the food
Allow child to help with meal prep
Do not punish child
9. +
Steps to Successful Eating
1. Tolerate
2. Interacts with the food
3. Smells
4. Touches
5. Tastes
6. Eats
10. +
Hindrances to OT
Feeding progress is often slow
OTs might move to next level before it is appropriate
Too many people working on feeding with the child
Parents may be too busy/worried on basic needs that they
cannot add in new interventions
11. +
OT Considerations
Safety *
Work on spitting
Work on more challenging foods in OT before having the family
work on them
Postural stability and proper positioning
Sensory techniques prior to feeding
Key phrases
Parent education and training
12. + OT Considerations
Auditory
Volume of voices
Complexity of modeling
Visual
Colors of food
Clutter
Tactile
Tools to interact with
Use baggies or gloves
Food textures
Taste and Smell
Intensity
14. +
References
Clawson, E., & Elliott, C. (2014). Integrating Evidence-Based Treatment of
Pediatric Feeding Disorders Into Clinical Practice: Challenges to Implementation.
Clinical Practice in Pediatric Psychology, 2(3), 312-321.
Franklin, L., & Rodger, S. (2003). Parents’ perspectives on feeding medically
compromised children: Implications for occupational therapy. Australian
Occupational Therapy Journal, 50, 137-147.
Howe, T.-H., & Wang, T.-N. (2013). Systematic review of interventions used in or
relevant to occupational therapy for children with feeding difficulties ages birth–5
years. American Journal of Occupational Therapy, 67, 405–412.
http://dx.doi.org/10.5014/ajot.2013.004564
Maune, N. (2007, March). Pediatric Feeding Issues: Reexamining Assessment
and Intervention Using the Sensory Integrative Frame of Reference. American
Journal of Occupational Therapy, 30(1), 1-4.
Suarez, M. A., Atchison, B. J., & Lagerwey, M. (2014). Brief Report—
Phenomenological examination of the mealtime experience for mothers of
children with autism and food selectivity. American Journal of Occupational
Therapy, 68, 102–107. http://dx.doi.org/10.5014/ajot.2014.008748
Toomey & Ross (2015). Picky Eaters vs. Problem Feeders – The SOS Approach
to Feeding.
Editor's Notes
Stressed about:
Managing the child’s feeding and medical care
Disruption to family routines
The family relationships
Perceptions of parenting responsibilities
Guilt and worry for their child’s future as a result of not being successful at creating and enjoying quality family meals
1. Schedule - Helps to regulate hunger, the child can anticipate eating; beginning (wash hands..), middle (eat), end (clean up)
2. Distractions - Helps the child focus, set the expectation that mealtimes are for eating, they can understand the cues better
3. Prep – Blowing games that don’t touch the mouth (blowing bubbles)
4.Transitional - singing a certain song & washing hands before mealtime
5. Mealtime-related – to engage the mind & intention – reading books or watching videos about food & eating, singing songs about it, playing pretend with kitchen and foods
6. Positive reinforcement – staying at the table, looking at new foods, serving oneself, & touching food with one finger
1. Talk about the food – color, shape, size, texture
2. Over-exaggerate – big chews or bites, move food from tongue to back molars
3. Food prep – younger kids can be playing near food, older kids can help with meal prep
4. Punishing – Unpleasant association with food
Interacts with – child pours food from one container to another, smashes it with napkin…
Touch – hands (poke with one fingertip), body (drive food up arm), face to lips (drive down nose, kisses), lips (tap on teeth with whole piece)
Taste – lick off the plate like a puppy
Slow – discouraging
Moving too fast – because it is so slow you might run out of ideas to engage the child; the child might get too bored and start having avoiding behaviors
Too many people – you need to decipher who is in charge of what part of feeding; if they saw someone that week, what did they do with the child and what did they say about it?; and sometimes parents are too overwhelmed with all the therapy, appointments, etc. that their ability to comply with recommendations is more limited
New interventions – make the interventions go along with what the family already does
Spitting – so that they don’t choke
Postural stability is important because: stability will allow them to breathe easier, allows for better hand-to-mouth coordination and fine motor control; Positioning – 90-90-90
Sensory techniques – children need to be in an organized state to start with in order to engage in a difficult task
Joint compressions/brushing (Wilbarger)
Pushing/pulling
Weights/vests
Swinging
“you can” – you believe in them, different word than “eat”
“we stay in our chairs until clean up time” - We tell them what to do versus NOT to do
“food stays on the table” - Make a scraps plate; if you leave it on the floor it’s reinforcing – got away from the food or table, learning plate
“good job…!” - Encourage the EXACT action being taught/reinforced
Complexity of modeling
Use picture schedules
Use songs with known actions
Be patient and wait! (delays in auditory processing)
Be aware of office noises, doors shutting, etc.
Colors of food – bright colors are more exciting
Clutter – cut food into fun shapes
Always make sure the immediate space is clear
Place food in a cup or bowl
Tools – goes back to hierarchy
Present mixed texture foods separate first, and then combine (preferred with non preferred)
Intensity – may have to water it down initially
Present it on a washcloth first
A lot of these combine fine motor skills with oral motor.
Pinwheel
Fire breathing dragon – toilet paper roll
Blow paint – put paint on paper first
Whistle lips
Bubble volcano
Airplane?
Recycled bubble blower
Cotton ball soccer
Sucking/blowing – snack
