Feeding Therapy Dos and Don'ts

I'll start with what feeding therapy isn't. It's not a quick solution. It's not easy. It's rarely a straight line to the goal. Now what it is. It is structure, it is play, it is progress, and sometimes regression, followed by more progress and more regression. It can be filled with moments of elation and disappointment. That is ok. It is a process.

Depending on the mode of delivery ( in person vs telehealth) and if its sensory vs skill based, feeding therapy can look different for every child. Evidence based approaches are used, but it is important to keep the personality of the child in mind to get the most out of each session. Here are some tips on what to do and what to avoid, so that your sessions are more likely to yield positive outcomes vs setbacks.

DO:

• Eat with your child. They get exposed to sights and more importantly the smells of foods you want them to consume. Eating with your child gives you the opportunity to ask them to help you interact with foods they are averse to, without the pressure of eating it themselves. Eventually they may sneak a taste. The goal here is to work on tolerating the sights, smells and textures they otherwise want absolutely nothing to do with. Even during my telehealth sessions, I eat with the child. Sometimes I have no choice but to use real food, but most often I pretend with playdoh, with cardboard cutouts of food with bite prints on them. I've torn out a rectangular piece of copy to look like a gogurt tube on the fly (helps that I've been doing this for so long that I've learned how to adapt during sessions; you'll get there too, just give it time). The point is I model the expectation and if there are phrases and expressions they get a giggle out of I will incorporate those to keep them engaged and frankly, entertained. You don't have to act like a clown, but you do want them to look forward to sessions and activities, and you want them to build positive associations with food/ mealtime to the degree they are capable of doing so.

• Incorporate other concepts and activities you know they love. For example, if they love letters but hate touching food. Use whip cream, spread it over a tray and show them how to write their name, the abc's, their favorite characters name. Draw their favorite characters, whatever gets them engaged and entices them to interact more. Use cookie cutters and cut out their favorite shapes, then spread something they already tolerate on the bread. They may lick it off initially, but at least they will be tasting the bread and slowly getting more and more used to texture. Before they eat a novel food, they first need feel comfortable with it, and tolerate touching, or manipulating it.

• Use tools until they feel comfortable using their hands. Developing comfort with food sometimes means maintaining a safe distance. This doesn't mean you'll never get to the point where you'll see them touch, hold, tear bread, naan, tortillas, or a muffin. It means you're going to start with child safe kitchen utensils to cut, tear, and hold food while slowly desensitizing them to the foods they are averse to. While making a jelly sandwich, you may use tongs and a butter knife, but if one slice needs adjusting, you can help them fix it quickly without drawing attention to jelly or the bread and instead focusing on making it straight. You can redirect their attention to what it is you want them to focus on. Is this ALWAYS going to work? No. You'll have days where they are more willing vs other days, but you keep trying. I'll admit sometimes I "misplace" tools and if I see they are more resistant to the challenge I'll have them help me look for the "missing" utensil. Funny enough these challenging situations have created scenarios where some of my non-verbal clients, spontaneously verbalize or approximate 1-3+ words because they really don't want to hold the food item. I've heard " need spoon", even " no, thank you" from kids who never uttered a single word before. Guess what , I honor it and positively reinforce their comments, because as much as I want them to progress with sensory feeding, I also want them to learn that using their words has power.

Now what not to do....

DON'T:

• Force them to eat a food item they are averse to. It will work short term, but you'll soon find yourself dealing with head turning, a mouth that is clamped shut so tightly, you need the jaws of life. You could very well end up with a child who screams and throws things of the table that are within reach. Force feeding does not work.

• I want to preface this by saying I am not judging you if you do the following. It's difficult to deal with sensory feeding issues. It's not the fact that you are using these items, but rather how you utilize them that can make a world of difference. So....

  Don't depend on tablets and the tv to distract them for feeding. It is one thing to use it as a motivator, and a completely different thing to use it as a distraction. When they are are distracted they aren't noticing the sensory information you need them to. They aren't learning to listen to their hunger cues. The aren't experiencing the textures in the way you need them to, in order to truly help them get past their aversions. They are also more likely to choke on their food if they inhale ( while laughing, or if surprised) just when you've put a spoonful of food in their mouth. Don't get me wrong, if you're using a tablet you're not automatically wrong here. It's how you use it . To use it as a motivator you need to set the expectation that x number of bites will be taken ( something manageable). Then you'll give them 2 minutes with tablet. Pause the show at 2 minutes and remind them it's time to take a bite and "chew chew chew", bring their attention to the flavors and the ingredients, model phrases like "Tasty", "Yummy" even "mmm". Work on pacing, taking appropriate sized bites, or sips, wiping, holding the spoon, scooping, spearing with a fork, and self feeding. Sneaking a spoonful of food into their mouth is not sustainable and isn't getting you any closer to achieving self-feeding goals. If I am working with a child who is already used to having the tablet during mealtime, one of the first things I'm going to be working towards is shifting them away from the tablet towards a different motivator, whether it's a book, music, or simply praise, and eventually getting them to a point where a motivator is not necessary.

• Don't get discouraged. It's difficult. As much as we want to be able to use a structured protocol, generalizing it into a typical mealtime is not easy. You're dealing with a tiny human who has moods, who has good days and bad days just like we do. You're not failing when you experience setbacks. You're not failing if reaching a specific goal is taking longer than expected. As long as you're trying, you're moving in the right direction.