Occupational Therapists and Pediatric Feeding Therapy: What is our role? How can we help?
By: Anna Cole McTish OTD, OTR/L
Occupational Therapy encompasses many different areas of treatment. A relatively new treatment area for pediatric occupational therapists is Clinical Feeding Therapy.
Eating is one of the most important ADL’s for an individual and an occupation that sustains life. The eating process begins in the newborn and develops as the child grows and learns additional skills. At times, the eating/feeding process can be disrupted and requires additional intervention by a therapist and family.
Clinical Feeding therapy itself has many different facets and entails a wide range of treatment options. A few examples of why a child might receive feeding therapy include: oral or tactile sensitivities to different textures, enhanced olfactory sensitivities, decreased oral motor control, decreased oral motor strength and endurance, swallowing difficulties, aspiration risk with thin liquids, transitioning from a G-tube to oral eating, significant behavior/anxiety during mealtime, difficulty eating as a newborn, etc.
It is important to remember when helping a family with eating/feeding difficulties that mealtime is not only a sustaining practice but a social event as well. Some of the best learning, conversations, and social opportunities occur during mealtime. Children who are not eating meals due to any eating or feeding difficulty are missing out on these mealtime experiences. Feeding therapy should be individualized to fit into the family’s lifestyle in order to make feeding/eating an enjoyable experience for the whole family, especially the child you are treating. This is an opportunity for any OT to serve a family, even if you are not specifically trained in Clinical Feeding. Setting the eating routine for a patient and family as well as social engagement during eating is crucial for success.
Below you will find a list of resources for continuing education, feeding therapy techniques/tools, and ideas to help eating/feeding become an enjoyable event for your patient and their families:
1. For the children with sensory sensitivities:
- Exposure, exposure, exposure: Children learn and explore through all of their senses. Expose children to different food textures, tastes, and smells without pressure to eat these foods.
- Complete heavy work exercises prior to mealtime in order to regulate the sensory system for participation
- Participate in messy play with food and non-food items (sticky, dry, squishy, wet, etc.) in order to promote tactile desensitization.
- Have fun and play with different food items (build a snowman out of mashed potatoes, hear what a raw carrot sounds like when it is “dropped” on the plate, deliver grapes in a tow truck to different plates on the table, crunch dried blueberries and watch them melt in the mouth)
- Provide a side plate for the child that has difficulty tolerating non-preferred foods in front of them. As the child becomes more comfortable with the foods through play and exploration, have them move these foods to their main plate for additional exploration.
2. For children with G-tubes:
- Introduce play with and exploration of foods during tube feedings in order to help children associate food (smell, touch, taste) with feeling full and satisfied.
- Create routines for tube feedings where the child is at the table with family members during mealtime
3. For children with decreased oral motor control and decreased oral awareness:
- Provide sensory stimulation to the cheeks through vibration or electric toothbrush prior to starting mealtime in order to activate the muscles
- Participate in blowing/sucking games prior to mealtime
- Have the child put two different foods in their mouth and ask them to pick one of the foods and spit it out
4. Additional resources for Occupational Therapists treating feeding/eating difficulties:
- http://www.educationresourcesinc.com/pediatric-feeding-ceu-courses – Continuing Education courses for OTs
- http://www.aota.org/~/media/Corporate/Files/EducationCareers/BSC/initial/SCFES-OT-Part-1-Application.pdf – AOTA Specialty Certification in Feeding, Eating and Swallowing OT Candidate Application
- http://www.ellynsatterinstitute.org/ — Ellyn Satter Institute; Satter Feeding Dynamics Model
- http://www.mealtimenotions.com/ — Mealtime Notions; Marsha Dunn Klein Med, OTR/L
- http://www.arktherapeutic.com/blog/post/tag/feeding-therapy-techniques — Ideas, tools, techniques for feeding/eating