Feeding

Believe it or not, eating is one of the most complex physical tasks we engage in. Eating involves every organ system in the human body, and each system must work simultaneously with one another. Eating involves all 8 sensory systems. One swallow involves 26 muscles and 6 cranial nerves! It is no wonder that feeding can be such a challenging task for some children.

Because eating is “easy” for most individuals, many people assume feeding is automatic. Unfortunately, this is not the case. Eating is a learned behavior. After 6 months of life, eating is no longer instinct or reflex driven, but rather it is voluntary and becomes a learned skill.

Problems with feeding can be related to medical, neurological, behavioral, psychological, or sensory-based issues. The vast majority of cases involve a combination of these systems. Many children with GERD (Gastroesophageal Reflux Disease) end up experiencing feeding issues. Poor weight gain can be an additional indicator of feeding concerns. Some children cannot tolerate specific textures, and others have poor jaw and oral motor strength. Children may gag, vomit, or resist eating by arching, refusing to sit in their chair, or batting at the food/utensils. For problem eaters, mealtime becomes a highly stressful event for both the child and the family. 

Picky Eaters vs. Problem Feeders

Picky eaters refer to individuals who have a range of at least 30 foods they will consume. They will eat at least one food from most food texture groups, and they can tolerate new foods on their plate even if they are initially reluctant. Problem feeders refer to individuals who have a range of less than 20 foods they will eat. They “fall apart” when presented with new foods, and regularly have to eat a different meal than what their family is served. Many problem feeders have poor appetites stemming from a variety of causes. One primary reason is that when a child experiences stress while eating (due to lack of skills or pressure from an adult), adrenaline is released, which immediately suppresses the child’s appetite. Typically, developing children who are picky eaters will not starve themselves or make themselves ill; however, problem feeders might, and this becomes a serious issue.

What Takes the Blame: Environmental vs. Biological?

The prevailing belief is that feeding issues are primarily “caused” by the environment, but research does not support this idea. In fact, only 10% of feeding issues are purely the result of the environment. If the environment were solely to blame for problem eaters, then 100% of children from “picky” parents should be “picky eaters”. Another false belief is that many problem eaters are defiant and their poor eating is a result of an underlying behavioral problem, but again, research does not support this claim. Because eating is a learned experience, behaviors are learned and do influence feeding, but research has found that only 2-7% of feeding issues are strictly behavioral based. It is important to remember that the majority of “problem” behaviors observed during feeding are actually driven by the child’s sensory system. For children ages 1-3 years, 90% of the “bad behavior” during feeding is sensory-driven, and for 3-7 year olds that only decreases to 80%. Marsha Dunn Klein, a fellow OT, articulated it well when she explained that if we believe the child has a behavioral problem, we will try to control and “fix” the child, but “if we believe the child is having a stress response because they cannot manage the task, we will teach the skills in a manner that respects the child’s readiness for the task.”

Here at Great Kids Therapy, our focus is to support you and your child in creating a more positive experience around food and helping your child develop the skills needed for successful eating. More specifically, our goal is to:

  • Decrease your child’s anxiety towards new foods
  • Teach mealtime routines and cues for eating
  • Decrease your child’s aversion towards touching, tasting, and swallowing foods
  • Increase the number of foods your child will try and the volume of food they consume.

Lastly, we want to educate you, the caregiver, to help you better understand feeding issues and how to carryover the skills your child has learned in therapy into your home environment. As parents, you have the most opportunities to feed and teach your child about food, thus we want to help educate you on how to shape food interactions into a positive learning experience to encourage growth in your child.

Because of the complex nature of eating, learning to eat involves many steps. Some examples of the progression to eating involves tolerating the sight of food, allowing the food to be in placed in front of them, touching the food, and bringing the food to their mouth. Through feeding therapy, we assist and support your child as they work through these steps at their own pace. This can be a slow process with small successes along the way, but it leads to long-term gains as they learn about foods at a pace that is right for them.

Group vs. Individual Therapy

Small group feeding therapy is a great resource for problem eaters. Children typically make quicker gains when participating in a group feeding therapy as they are able to watch peers with similar issues make gains, as well as participate in a supportive environment that many children enjoy. Individual therapy is appropriate if the child needs more support to progress through the steps to feeding and if the feeding group schedule conflicts with your family’s schedule.

Check out our Food School page to be directed to our feeding therapy page! Please contact us with any questions or concerns you may have. We are here to help support you and your family.

*Information derived from the Star Center and SOS Approach to Feeding and the following resources:
Carruth, B. R., & Skinner, J. D. (2000). Revisiting the picky eater phenomenon: neophobic behaviors of young children. The Journal of the American College of Nutrition, 19(6), 771-780.
Carruth, B. R., & Skinner, J. D. (2002). Feeding behaviors and other motor development in healthy children (2-24 months). The Journal of the American College of Nutrition, 21(2), 88-96.
Dunn Klein, M., & Evans Morris, S. (2000). Pre-Feeding Skills (2 ed.). San Antonio, TX: The Psychological Corporation.
Field, D., Garland, M., & Williams, K. (2003). Correlates of specific childhood feeding problems. Journal of Paediatrics and Child Health, 39, (4), 299-304.
Toomey, K. A. & Sundseth Ross, E. (2011). SOS Approach to Feeding. American Speech-Language Association, 82-87.
Williams, K. E., Riegel, K., & Kerwin, M. L. (2009). Feeding disorder of infancy or early childhood: How often is it seen in feeding programs? Children’s Health Care, 38, 123-136.
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