How do I know if my child has a feeding problem worthy of therapy?

See the descriptions listed under feeding problems.  If you are still uncertain, reach out and we can discuss your child’s specific case.

My child has had feeding therapy services before and has made little progress. How is Pediatric Feeding Services therapy different?

Progress in feeding therapy is dependent upon several different factors including medical stability, skill development, cooperation, using the most effective treatment methods for the condition and carry-over at home.  Pediatric Feeding Services will provide you with a comprehensive evaluation and treatment plan utilizing the TR-eat® Model. Working together on this plan will hopefully bring you the outcome you are looking for. 

My child has had SOS therapy. How is treatment under the TR-eat® Model different?

SOS (Sensory Oral Sensory) and other sensory based therapies focus on moving children through a sequence of steps in hopes that they will eventually learn to eat the foods. Children are asked to look at, smell, touch, taste and potentially eat the food. Tasting and spitting out the food is common and often times this is where the child gets stuck.  Treatment is also discontinued when the child demonstrates poor tolerance.  Food selection for treatment is often random and not closely related to what the child currently eats.  Children I have treated who have undergone this method report feeling highly anxious as they never know what food was going to show up on the plate. In the TR-eat® model, treatment for selective eaters and children with autism is based upon providing structure to the meal and starting with new foods that are very close to the foods the child is currently eating. We want to practice the skill of eating not spitting or playing. Using positive reinforcement and slow steps the child is able to gain the confidence to try new foods successfully and work to expanding their diet.

How long does therapy take?  

The length of time for therapy varies greatly from case to case. Feeding therapy is complex and there are not a lot of quick fixes. For young children, it is not uncommon for progress to be delayed by teething and illness as well. Typical feeding skills develop over a three year period from a newborn who is only drinking to a 3 year old who is feeding themselves a wide variety of food. Interruption anywhere along this continuum can cause further delays. The sooner the problem is addressed, the faster the child can catch up.  

My child is older and has significant anxiety around eating new foods.  Is it too late?

While best case scenario is to get your child into therapy at a younger age sometimes when the child is older, they have a better understanding and are receptive to coaching. These children can be motivated to make changes to their diet but just don’t have the courage to do it. Other children that are older can be more stuck in their routines and have significant anxiety and may have additional behavioral problems that can make addressing eating issues more difficult. Reach out and we can discuss your child’s specific case.

What is the difference between child directed and child guided therapy?

In child directed therapy, the environment is set up for the child and he/she explores on their own terms.  In Child guided therapy, the therapist carefully reads the cues of the child to set up an environment where new skills can be learned with support, encouragement and adult/professional input and guidance. The child is guided to take small steps outside of their natural comfort zone. When you first teach your child to ride a bike, do you just set the bike up there for them and say “Here it is, good luck!” or do you help them on the bike, have training wheels and hold on to them until they are steady enough for you to let go? I consider a child guided approach putting “training wheels” on to help with feeding.  

My child is having trouble learning how to eat table foods and/or is a picky eater. Can that be a tongue tie?

Tongue and lip ties (tethered oral tissues) are often discovered because there is a problem with nursing or bottle feeding.   Less commonly noted are tongue ties that impact a child’s ability to transition onto table foods, mixed textured foods and can even cause selective eating in the older child.  The tongue plays a crucial role in moving food to the right areas in the mouth for chewing and gathering the chewed food and setting up for swallowing. Advance training and knowledge is necessary to properly evaluate tongue and lip ties.  Management of tethered oral tissue is complex and requires a functional assessment, referral to a knowledgeable provider (to assess and perform the release procedure if needed) and appropriate therapy interventions following. If you are wondering if a tongue or lip tie may be impacting your child’s feeding  Reach out today for further information and to schedule an evaluation. 

How does the TR-eat® model work when you don’t have a treatment team?  

You may wonder how this model can work as a sole practitioner. Having cross trained with other specialists for years, I am able draw on my experience and knowledge base within my scope as an occupational therapist.  I will help to create a virtual team for your child through referrals and coordination with other healthcare professionals who may be needed.

Will using behavioral techniques make my child more afraid to eat?

The TR-eat® Model is an integrated treatment approach that utilizes behavioral interventions in combination with other techniques to make learning a new task faster and easier. It is not a strict behavioral approach. The therapist/child interaction is structured with clear expectations but is provided in a supportive, loving and fun way.

Will using toys, video or other positive reinforcement make my child not want to eat without them?

There are many reasons why a child may be having difficulty with eating.  Regardless of the reason, the natural “enjoyment” of food is not a driving force for them. For some of the younger children, even the natural “drive” to eat is overridden by pain, discomfort or lack of skill needed to eat.  So, our way to help kids learn to enjoy eating starts with adding some additional “incentives” such as social interaction, toys, bubbles or video which are used in a therapeutic way. Once the child learns to eat and is successful, these tangible items are no longer needed. Now, they too can experience the “joy” in eating and the food itself is the reinforcement!

How much time does feeding homework take?

Homework and carry over of the treatment plan does take time and a consistent commitment to get the most out of therapy.  Some plans will be worked into each meal - typically for the younger children and others, for the “picky eaters,” I recommend one practice meal per day during a snack time.  Life does go on beyond mealtime and feeding therapy. I will work with you and your child’s schedule to come up with an individualized workable plan. If you are ready to make that next step, reach out now.

What supplies will I need?

Following the evaluation, we will go over what food and supplies you may need for therapy. I will let you know what you need and where to buy it. Some of the typical items are: digital timer, blender that is compatible with a mason jar, select spoons, resistive chewing tools, and FOOD!

Can my child continue to eat with the family? 

I like to designate feeding practice/home program time as “timer time” where there will be a specific routine and expectations. When “practice foods” become easy, they are moved to “normal” meal times including family meals, daycare settings, school lunches and social events. Family meals and other social events that bring a positive eating experience are always encouraged. The ultimate goal for all feeding therapy is to have your child join family and friends eating the same food as everyone else!

What if my child attends daycare or school?  

Reality is, we all have busy schedules. Work, daycare and school are just a few of the things we need to do on a daily basis. Figuring out what your child will eat when they are not at home can be extremely stressful and worrisome. As part of your feeding therapy process, I will help develop a good eating plan to maximize your child’s nutrition and food consumed in a variety of settings. This may include collaborating and/or providing training to the day care or school personnel. 

I am told my child’s feeding problem is behavioral. Does that mean he/she is not eating to misbehave? 

When a child is not a good eater, particularly when they are a picky eater, parents are commonly told it is a “behavioral issue.” This often makes parents feel it is a “parenting issue” and they are to blame for their child’s feeding problems. Unfortunately, there is quite a bit of judging that goes on in the world of parenting and eating. Let’s face it, it does not take parenting rocket science to feed the average kiddo.  As long as you provide them food, they should just eat it. This disruption of this natural process needs investigation and someone to help figure out where things went wrong and how to get them turned around. As a professional “Feeding Detective” my job is to figure out what the child’s behavior is trying to tell us and how to address the underlying problem.