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.

In the fast-paced world of grand parenting, it’s crucial to stay informed and equipped with the best solutions for raising grandchildren. With approximately 3 million grandparents across the United States taking on the responsibility of raising their grandkids, there is a growing need for expert guidance and support. That’s where the podcast “It’s a Grand Life” comes in, connecting listeners with subject matter experts who understand the unique challenges faced by grand families.

A Valuable Resource:

In a recent episode, host Craig Nash warmly welcomed new listeners from Texas, Nevada, Colorado, Florida, and Alabama. He emphasized the importance of being informed about the best solutions for raising grandkids, setting the objective of “It’s a Grand Life” to present subject matter experts who can provide valuable insights and information.

Expertise in Pediatric Therapies:

The guest of the episode was Kris Krajewski, a speech and language pathologist with MetroEHS Pediatric Therapy, a group dedicated to pediatric therapy in Michigan. Kris shared her background and expertise in speech and language pathology, highlighting her passion for working with children and her personal experience as a parent of a child with Down syndrome.

Comprehensive Approach to Care:

MetroEHS offers a wide range of therapies, including speech, physical, and occupational therapy, as well as applied behavior analysis (ABA) and mental health services. Their focus is on a holistic and coordinated approach, providing support not only to the children but also to their families and caregivers. By incorporating various services, MetroEHS aims to address the unique needs of each child and help them reach their full potential.

Addressing Feeding and Swallowing Issues:

Kris shed light on pediatric feeding disorders, a relatively new diagnosis, and emphasized the importance of understanding the sensory challenges that some children face when it comes to food. MetroEHS provides interventions to help children develop tolerance for different textures and improve their chewing and swallowing abilities.

Navigating the Path to Treatment:

To begin the journey of seeking therapy services, Kris advised starting with a discussion with the child’s pediatrician, who can refer them to appropriate specialists for evaluations and treatments. MetroEHS collaborates with pediatricians, school districts, and insurance providers to ensure comprehensive and accessible care for children.

Supporting Grand Families:

The podcast episode acknowledged that the journey of raising grandchildren can be overwhelming, but it highlighted the importance of seeking help and support. MetroEHS welcomes inquiries and assists families in finding the right resources for their specific needs. Additionally, the Autism Alliance of Michigan was recommended as an excellent resource for families dealing with autism-related concerns.

Raising grandchildren comes with unique challenges, but resources like “It’s a Grand Life” and organizations like MetroEHS provide valuable expertise and support for grand families. By accessing specialized therapies and collaborating with professionals, grandparents can help their grandchildren thrive. Remember, you are not alone in this journey, and there are pathways to assistance and resources available to support you and your grand family along the way.

AAC Devices in Pediatric Therapy

AAC is the term used to describe any form of communication that a person can use that is not speech. This may include pointing to pictures of what the person wants, using sign language, or using a device that will speak a message when a specific button is pushed.

MetroEHS can boast a 100% success rate in supplying clients with these crucial communication devices giving a voice to our superheroes.

When Should AAC be Considered for a Child?

An AAC device should be considered for any child whose speech output is not adequate to fully communicate their wants and needs.

Things to consider:

-Child’s frustration levels

-Adult frustration levels

-Access to school curriculum

-Participation in classroom activities

-Ability to demonstrate knowledge to teachers

-Access to home and community environment

-Ability to interact appropriately with family and peers

-Independence in developmentally-appropriate daily activities

MetroEHS partners with an AAC company and a medical equipment company. These companies serve as consultants for Metro EHS SLPs as we work toward supplying families with AAC devices. Some AAC tools are covered by insurance, but some are not. MetroEHS Pediatric Therapy will help you understand your options.

The Process:

Step One: Our SLPs identify kiddos who might benefit from using AAC!

Step Two: We begin trialing different devices and different communication systems determining which systems work best for each individual client. There are several devices and programs to choose from.

Step Three: Once the SLP determines which system works best, an AAC evaluation is submitted to the client's pediatrician for review. If the pediatrician approves, we obtain a prescription for the device, much like obtaining a prescription for a splint, or other form of medical equipment.

Step Four: When the prescription is received, the prescription and evaluation report are all submitted to the insurance company.  Once approved, the device is ordered!

Step Five: The device is delivered to the family and they family receives assistance with set up and demonstration.  The device fully belongs to the child.

After the device is in the hands of our client, MetroEHS SLPs work with the family and the client to integrate the device into their world in speech therapy.

With Locations all over South East Michigan and excellent Speech Therapy services, MetroEHS Pediatric Therapy is here to help. Browse through our Locations Page to find a Local Therapy Center near you!