As parents, and especially mothers, one of our primary jobs from the very early days of our children’s lives is to feed them. Inability to do so successfully can cause feelings of failure and inadequacy as parents. These feelings can lead to anxiety and frustration, causing mealtime to feel like a battlefield. When so called “picky eaters” refuse to eat certain foods, gag, cry and make excuses, it can make even the most even-tempered parents want to pull their hair out. Parents often feel guilty and blame themselves when their child doesn’t eat well — when this is rarely the case. It is also rarely the case that a child is not eating for behavioral reasons (stubbornness, control, being difficult etc.). Most of us can agree that eating is an enjoyable and pleasurable experience. When a child is refusing to eat, especially if they only eat 20 foods or less, there is usually more to the story that needs to be uncovered.
“Why won’t my child eat?” Sometimes the answer to this question requires a good bit of detective work. The S.O.S. (Sequential Oral Sensory) Approach to eating is a feeding intervention approach that is focused heavily on this question. It was developed by Kay Toomey, PhD, as a family-centered transdisciplinary approach to tackle tough feeding issues. This approach looks at the whole child and encourages children to explore new foods through a very specific playful and non-stressful way.
Those trained in S.O.S. will tell you it is important to get a thorough history and take a very good look at the child’s entire progression of feeding. The S.O.S. approach is transdisciplinary, meaning that multiple professionals are involved to provide different perspectives. This includes an occupational therapist, speech therapist, nutritionist, and behavioral health professional. These different professionals look at the whole child to determine what is contributing to the picky eating and help the family decide the best course of action for that child.
Some questions they might ask are:
Did the child have feeding issues early on in life?
Was there any trauma/negative experience around eating?
Are there any underlying medical issues?
Did or does your child suffer from acid reflux?
Does your child have any food allergies?
Does your child have sensory sensitivities, especially in the mouth?
Does your child seem to have delayed oral motor skills or speech issues?
The answers to these questions may need to be further explored before therapy can begin. The answers can often provide valuable information as to why a child has picky eating tendencies. For example, the child may not like to eat meat because they do not have the oral motor skills to manage it. However, they don’t know this and will instead say “I don’t like meat” or “I’m allergic” in order to get out of eating it. Or, they may have experienced painful reflux each time they ate when they were younger, causing a negative association with food. Once the team has assessed the child they will determine the best fit for treatment.
If the child is 18 months or older, a feeding group is often the best choice. One of the primary ways all children learn is through social modeling, or watching and imitating other children. Social modeling and play are important elements of an S.O.S. feeding group. Although the group is led by adults, the children set the pace for how foods are explored. The progression of play starts with tolerating a food in their area, then interacting, smelling, touching, tasting and finally eating the food. The S.O.S. trained adults keep a watchful eye on how the children are reacting to the foods and then playfully encourage further and further exploration over the course of many sessions, with the goal of eventually eating the foods. If the children become overwhelmed, the adults will take a step back with the play until they are comfortable again or move on to the next food. Often times, progress is made when the pressure to immediately eat a food is taken away, trust is built, and the children are presented with foods they can actually manage in a fun atmosphere.
Increasing the number of foods a child will eat is not a fast process and S.O.S. therapy is not a quick fix. There are sometimes years of negative feeding experiences a child has gone through that have to be overcome. The family and caregivers have their work cut out for them too, as they must overcome their own negative feelings and have a new and different positive food relationship with their child. With a team approach and a family that is committed to change, S.O.S. can be a very successful method for addressing this challenging and often perplexing problem.
Why Won’t My Child Eat?
Courtney Webb Carriveau MS, OTR/L
Courtney is an occupational therapist who is passionate about helping children overcome obstacles to succeed in their everyday lives. She works with children of all ages and has a special interest in working on feeding issues. She is trained in the S.O.S. feeding approach and Beckman Oral Motor protocol.
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