WHAT IS FEEDING THERAPY?

Feeding therapy (FT) was completely unknown to me before my son needed it. I didn’t know what it was, how it worked, or what a FT session looked like. And I have found this to be a similar experience with other parents, as well. It can be intimidating to seek help for our child when we don’t know what the therapy looks like, or what the expectations will be.

None of the content below is intended as medical or therapeutic advice or recommendations. I am only sharing what I personally have learned from my son’s feeding therapy journey, and how beneficial it was for us both. If you think your child is delayed in his or her feeding abilities, be sure to address your concerns with their pediatrician, and seek an evaluation from your county or school district’s Early Intervention program.

Please watch these videos to hear experts explain what feeding therapy is, and how a feeding therapist can be a support for you in your child’s developmental journey.

“We all have an innate ability to eat. There is something preventing that from happening. The philosophy of feeding therapy is to determine what is causing the aversion to eating and address those issues so the child can have a proper diet to sustain both

physical growth and brain development.”

“Having a child who cannot eat is a very high stress level for parents. My job is to help them feel more confident around their child in providing for their daily needs, understand their child’s limitations and what they have gone through, and celebrate their successes.”

My son’s two feeding therapists were amazing – I learned so much from them, and how our body’s physical development is connected to our ability to learn to eat. The developmental stages and skills needed are very intertwined, so when one skill gets delayed, it can affect your child’s feeding abilities.

Some key takeaways:

• Everything correlates: oral motor skills, fine motor skills, gross motor skills. They follow the same continuum.

• Feeding therapy incorporates early childhood development, speech pathology, and neurology.

• Identifying feeding delays EARLY is key – by 18 months old.

• A feeding therapist can help identify a “picky eater” versus a “problem feeder.”

• Have a separate chair for feeding therapy practice, and one for eating with the family.

• Sensory, swallowing, structural, and/or emotional distress can contribute to feeding aversion.

• Match the food to what the mouth can do.

• Feeding goes from being reflexive to learned.

• Feeding therapy goals are different for each child.

• SOS: Sequential-Oral-Sensory approach to feeding by psychologist Dr. Kay Toomey.

• Parents need to be “okay” with the limitations of their child, and celebrate any success.

Sensory Play

One of my biggest “mind blown” discoveries from feeding therapy is that a child’s ability to tolerate textures with his/her hands ties directly to them being able to tolerate textures in their mouths. What??? Yes! I’ll say it again:

A child’s ability to tolerate textures with his hands correlates with him being able to

tolerate textures in his mouth.

One activity a feeding therapist does with a child is texture play. The therapist will put whipped cream, pudding, jello, crushed crackers, candy sprinkles, etc, on the highchair tray and encourage the child to get her hands messy, to play with it, to help get the child accustomed to textures, before the therapist does texture play in the child’s mouth.

In other words, there is a physiological and biological reason why infants first explore foods with, and learn to eat with their hands. It creates a mind-body sensory connection between what an infant feels in her hands, and what she feels in her mouth. Amazing!!

As parents, we are often yelling at our kids, “Don’t play with your food! Eat it!” And while this is appropriate correction for an older child or youth, this is NOT what to tell a toddler. Infants and toddlers need to play with their foods and explore foods with their hands to help them develop into healthy eaters who will tolerate a variety of textures and flavors in their mouths.

Besides my son’s developmental delays, he also has sensory processing integration delays, and he did not like to get his hands messy. He never really sucked on his fingers, he didn’t try to put random things into his mouth, and he had no interest in picking up any food on his tray. In fact, at his First Birthday party, I put a little cupcake in front of him to smash and eat. He stared at it for the longest time, not knowing what to do with it!! Everyone the room was laughing – they’d never seen a one-year-old who did not want to smash his cake and mash it all over his face. Finally, Kieran delicately touched the frosting with his finger, tasted it, and made the “yucky” face. Clearly, this was not my child! Haha. But after about 15 minutes, he figured out that he could smash the cupcake and wipe it all over his highchair tray, and he thought that was fun. However, it took him a long time to want to touch the cupcake or have anything to do with it. This was pre-feeding therapy, so I knew we had some work to do to help him eat better.

Motor Planning

I also learned a new concept and how it relates to eating: Motor Planning.

Motor planning is what our brains do subconsciously to carry out a fine or gross motor function with our body, such as picking up a pencil (fine motor) or walking up steps (gross motor.) We never stop and consciously think, “Now I am going to extend my arm, move my hand down to the table, open up my thumb and index finger, place them on either side of the pencil, close my thumb and index finger onto the pencil, then lift up my hand and arm.” That is a subconscious motor plan that your brain goes through automatically to know what to do in order for you to successfully pick up the pencil. Your brain knows the motor processes and sequential steps needed to pick up the pencil and just does it.

Likewise, eating requires motor planning, too. When you put food into your mouth, your brain goes through the motor planning sequence to help you effectively chew and swallow the food. When you have poor motor planning skills, however, tasks like picking up a pencil, or chewing and swallowing food, become challenging. You don’t know what to do with the food once it is inside your mouth. You don’t know how to move it side to side, how to chew with the back teeth, or how to safely swallow it. And when a task is challenging and difficult – and unpleasant – to a child, he or she won’t do it.

This is one cause of the food aversion that the therapists mention in the videos – at least it was for my son. Something is causing your child to have an aversion to food: they not only don’t want to eat it, they have an unpleasant association with food and a negative reaction when you try to get them to eat. Poor motor planning may be a cause. If your child has poor motor planning skills with the mouth and jaw, eating is just too difficult, unpleasant, and the child would rather not eat and be hungry, instead.

And speaking of hunger, after my son started eating pureed foods at age six months, he would gag and get upset if there was any texture at all. When he was about a year old, he had a nanny who tended him on Fridays. She said to me one day, “I gave him some lunch at 12:30 PM. He never really lets me know when he is hungry, so I just figured that he would be hungry and I fed him at 12:30.”

That became typical for Kieran. He preferred purees and the baby puffs that could easily be dissolved in the mouth by sucking on it. He never screamed with hunger ― he was just happy playing with his toys, so we had to set a mealtime schedule to keep him from starving himself.

When I asked the feeding therapist about this, she said that this is common in children with poor feeding skills. When eating becomes too difficult and unpleasant for an infant, they learn to suppress their appetite, which is what Kieran did. Even at age three, four, five, he could play for hours without eating a meal. He does like crackers and other “easy to chew” foods that don’t require a lot of work, but he is not motivated by food or mealtime (well, maybe with a cookie or chocolate!) He chews slowly and deliberately, and can take an hour or more to finish eating what’s on his plate. The therapist told me that a typical child finishes their meal in about 20 minutes, so I’ve used that as a guide when I encourage Kieran to finish his meal. He is easily distracted and comes up with all sorts of excuses to not eat his meal. I have to give the kid credit for his creative reasons why he cannot eat!

There is just so much to say about feeding therapy, but as someone who loves to eat, I found it to be fascinating and revelatory in learning how our physiological development is correlated with our ability to eat, and the many different tools and activities a therapist uses to understand what is causing the aversion to eating, and help infants and toddlers improve their motor planning skills.

Keep checking the Feeding Therapy page for more tools, tips, and resources that can help guide you to find the best and appropriate interventions for your kiddo!

** This post is not intended to provide medical or therapeutic information. I am only sharing what I have learned from my son’s therapies for his developmental delays. Please consult with your child’s pediatrician or therapist to learn what is best for your own child’s developmental and medical needs. **