What does feeding therapy look like?

A pediatric feeding disorder (PFD) is characterized by an impaired oral intake that is not age-appropriate and is associated with medical, nutritional, feeding skill, and/or psychosocial dysfunction. An impaired oral intake refers to the inability to consume sufficient food and liquids to meet nutritional and hydration requirements.

Pediatric feeding disorder impacts 1 in 37 children under the age of 5 in the United States. A pediatric feeding disorder is individualized to every child, therefore, therapy should reflect on your family's goals and focus on your child’s strengths and weaknesses.

Examples of strategies you may use in feeding therapy and implement into your mealtimes:

Hierarchy of sensory exposure

Novel foods (or previously accepted foods) may be slowly introduced to your child by using a hierarchy such as tolerating in the same room, tolerating sight on their plate, smell, picking up, kissing, biting, chewing & spitting out, and chewing & swallowing.

Food chaining

Food chaining helps children accept new foods by slightly changing their preferred foods regarding taste, temperature, and texture.

Exposure to new foods

Offering a preferred (safe) food with new food at mealtimes with no expectation of interacting (e.g., touching, biting, swallowing) with the new food. The child may need to see the food on their plate several times before their body feels safe to interact with it.

Manage the power struggle

Toddlers control their environment with the word “no” and it can make mealtimes challenging for everyone involved! Offering your child their preferred food with a novel food with no expectations of eating is a strategy we can implement to make them feel in control. Exposure to food without the pressure of eating can increase your child's willingness to interact with the food.

Family-preferred foods/meals

You and your child should target food and meals that are important to you and your family. Think of foods you serve your family frequently that your picky eater refuses. What foods/meals will make mealtimes less stressful for the whole family? These foods should be addressed first in feeding therapy.

Strategies to increase time at the table

Sometimes sensory preferences negatively impact your child’s ability to stay seated at the table for mealtime. Talk with your treating therapist (SLP or OT) regarding sensory needs that can be addressed to increase time at the table during mealtime.

Address underlying medical concerns

Sometimes picky eaters are picky because there is something else going on – like allergies, reflux, or GI issues. Medical problems can make eating a painful and negative experience. Your child may not be able to express this pain verbally but may be telling you by refusing their meals. Talk with a healthcare provider if you have concerns about underlying issues impacting your child’s feeding skills.

A feeding questionnaire from Feeding Matters can be found here: https://questionnaire.feedingmatters.org/questionnaire to help identify if your child needs intervention. Talk to your pediatrician about your concern with your child’s feeding skills. Call Sidekick Therapy Partners to schedule an evaluation with our feeding therapist.

-Samantha Shaffer M.S., CCC-SLP