Category Archives: Feeding Therapy

Teaching Utensil Use Outside of the Mealtime Experience

It seems as natural as can be; use a child’s meals and snack times as opportunities to teach them how to hold and control their fork or spoon. In this atmosphere of “least restrictive environment” and push-in treatment, this sounds like a great plan for your therapy session.

Although it seems like a good idea, there are circumstances in which separating utensil use from food consumption, at least initially, can be more effective in treatment:

  • Children with tactile aversions and oral sensitivity may find combining manual and intra-oral exploration to be too overwhelming.
  • Children with both motor and sensory issues may find that they cannot work on practicing multiple skills at the same time.
  • Children with behavior issues can be faced with a difficult situation: they want to eat and they want to exert control over their body or an adult’s behavior.
  • Kids with minimal endurance or tolerance can lack the ability to complete a meal, leaving them dependent on adults or frustrated with their fatigue or a sense of failure.

Teaching utensil use without the expectation of food ingestion can solve these problems.  As skills and tolerance grow, the two experiences can be joined successfully.  Here are some suggestions to make practice effective and weave it back into functional experience as seamlessly as possible:

  • Have the child feed an adult using child-friendly utensils and foods.  A child may decide to take a bite instead of feeding the adult, so a food’s size and texture should be safe for the child’s developmental level.
Pediatric Utensil Holder
Pediatric Utensil Holder
EazyHold Universal Cuff
EazyHold Universal Cuff
Happy Bowl Silicone Feeding Mat
Happy Bowl Silicone Feeding Mat
  • Playfully scooping and piercing non-food objects such as non-edible dough with utensils and other “real” tableware may extend practice sessions while decreasing the stress of multi-sensory exposure with food.
Shape, Model, and Mold
Shape, Model, and Mold
Pizza Party
Pizza Party
Cutting Food Box
Cutting Food Box
  • Watching the therapist eat food that the child has prepared or served with utensils reinforces the social and nurturing aspects of meal preparation and eating.
  • Using strategies such as backward chaining or graded exposure, activities that begin by separating utensil use from eating can become more like a typical mealtime experience over time. When children are given a “just-right” level of challenge, they make faster progress with ease.

Cathy Collyer, OTR, LMT, PLLC

Cathy Collyer, OTR, LMT has treated children with neurological, orthopedic and sensory processing disorders for over 20 years. She is the author of The Practical Guide To Toilet Training Your Child With Low Muscle Tone. Learn more about her work at

Saturday Seminar: Interventions for Toddlers and School-Age Children with Feeding Difficulties

Kerry Pearl, MS, CCC-SLP, Therapro’s Saturday Seminar speaker on February 11th   drew attendees representing a variety of backgrounds who work with children having feeding problems. She spoke about Interventions for Toddlers and School-Age Children with Feeding Difficulties to a rapt audience.

Kerry, of Boston Children’s Hospital, specializes in evaluation and treatment of pediatric feeding and swallowing disorders as the Coordinator of the Food School feeding therapy program. Her goal for today’s seminar was to provide information about feeding principles applicable in various settings and how to promote successful oral feeding across disciplines. Kerry has generously made her PowerPoint slides available at this link.

Kerry’s talk covered a lot of ground beginning with the components of the Clinical Feeding Evaluation, which include obtaining the child’s medical history, feeding history, and goals of the caregiver.  She stressed that it is important to understand where the child is in terms of his/her skill level and use that as a point of where to begin with treatment for building feeding skills. An interesting thing to consider when evaluating a school-age child, is the importance of exploring what motivates the child…for example, does the child eat their lunch quickly so he/she doesn’t miss recess?  Another important factor in evaluation is knowing the child’s eating environment, because it is essential for feeding success.  This includes positioning in an appropriate supportive seat that supports the child’s hips, knees, and feet at 90° angles, like a Height Right Chair. When considering the mealtime environment, Kerry advocated establishing a routine so the child knows what to expect, providing clear instructions, and a visual schedule.

Evaluation may identify a number of target areas that need to be prioritized with input from caregivers.  Kerry recommended planning intervention in 10 week blocks, which provides time to target several goals and subsequently focus on the skill deficit areas when they become more apparent as treatment sessions progress. Working with the child’s team is important in a number of areas including when it comes to prioritizing what foods to introduce with the child’s dietitian. When initiating therapy, discharge criteria must be in place so that the child’s set, measurable goals can be reviewed to determine whether the therapy has been successful.

A distinctive feature of Kerry’s presentation was her discussion of two intervention models: 1) Operant Conditioning and 2) Sensory Desensitization.  She distinguished between the two approaches by discussing how operant conditioning targets behavior directly, is child focused as well as parent focused where the therapist consults with parents to help the parent change the structure of mealtime and nutrition. It involves expanding the foods a child eats, improving volume of intake, and targeting specific behavior or skills. A prompt and immediate reinforcer (like a Wind-Up Toy) is given in treatment so that the eating behavior becomes linked to the prompt and the reward. In this approach, the child builds skills but must overcome their fear associated with eating. Individual therapy is provided and “homework” is given.

In the Sensory Desensitization approach, the child develops skills while gradually adapting, with the focus being on changing mealtime behavior by using modeling and positive reinforcement. In this model, the child progresses through “steps to eating” that include: tolerating the presence of food, interacting with the food, smelling the food, touching the food, tasting the food, and finally eating the food. The end result is that the child experiences less stress around foods and is more willing to try foods. This approach can occur in either individual or group sessions.

When selecting the approach that will be most effective for a particular child, Kerry recommended bearing in mind the child’s current skills and sensory profile as well as family concerns/goals. Considerations should include the child’s nutritional status, oral motor skills, and sensory processing ability.

Kerry provided many specific examples of therapeutic activities throughout her talk. Some examples of strategies she discussed to develop chewing skills included lateral placement in the mouth of tools such as the Baby Safe Feeder filled with chewable foods, Chewy Tubes, Y-Chew, or Theratubing dipped in pureed food, progressing to placing small pieces of dissolvable food inside the hollow tubes.  Using a Chu Buddy can help the child keep track of the chewy so it is always available.

Kerry’s thoughtful, organized, chock-full presentation provided us with a practical way to approach feeding problems in young children. Her anecdotes, videos, and tidbits of interesting information gleaned from her extensive experience as a feeding specialist complemented her presentation and were greatly appreciated by all who attended her seminar.

As you can see from some the following comments, Kerry’s seminar left attendees with much information and useful treatment strategies:

“The seminar was well organized & relatable. Examples were provided. I enjoyed the contrast of therapy styles & when each were appropriate.” Lauren P., Speech/Language Pathologist

“I would recommend this seminar to a colleague! I loved the specific interventions discussed. I look forward to applying them in my practice.”  Marianna Q., Occupational Therapist

“This was a unique learning topic, and I was thrilled for this opportunity to gain more understanding and techniques.” Marisa G., Child Development Specialist

“It was very informative in many ways – I appreciated the intervention strategies given & how they should be implemented. Also, it was helpful to hear how to identify which intervention is best for individual children.”

Amy V., Occupational Therapist

“Very interesting from a teacher’s point of view. It broadened my understanding of the issue & encouraged me to reflect on how the issue can impact classroom learning.” Maura M., Teacher

Thank you, Kerry!

Filomena Connor, MS, OTR/L

Saturday Seminar: Sensory Differences and Mealtime Behavior in Children with Autism

Jeanne-Zobel-LachiusaEvidence based practice (EBP) involves the integration of:

  1. Clinical expertise,
  2. Scientific research, and
  3. Patient/caregiver perspective.

The goal of EBP is the improvement of patient outcomes. It holds us accountable for our treatment plans, strategies and outcomes among our peers and other health care professions. According to the AOTA, generating research in the field of occupational therapy is “critically important for advancing the field and ensuring the viability of the profession.”

Jeanne Zobel-Lachiusa, EdD, OTR/L was the featured December Saturday Seminar Series speaker, who shared her research on Sensory Differences and Mealtime Behavior in Children with Autism (AJOT September/October 2015, Vol. 69, No.5).  In summary, the study results helped to identify problem eating behaviors in children with ASD that may be associated with sensory differences. Children with ASD were compared with typically developing age-matched peers. The study concluded that children with ASD who receive occupational therapy that offers sensory strategies might result in less stressful mealtimes.  The findings supported the need for further research in this area of self-care with children who have been diagnosed with ASD.

The seminar attendees were from varied backgrounds, including occupational therapy, speech therapy, special education, social work, psychology, child care, medicine, and parents. They engaged in a lively brainstorming session on sensory strategies in the different sensory domains that might provide mealtimes with less stress for both the child and family. They shared innovative as well as tried and true ideas with the group.

Just a few examples of the many suggestions include ideas for tactile and oral sensitivity:

Hush BuddyFor auditory sensitivity Jeanne suggested:

For children with sensitivity to fluorescent lights that flicker and glare in the cafeteria or classroom, Fluorescent Light Filters, which are magnetic were recommended. Another suggestion was for the student to wear a visor to reduce vision sensitivity.

Jeanne suggested a number of resources for the group including the book, Autism Interventions, and recommended the AOTA website for its user-friendly handouts on mealtime and feeding.

Producing research is essential for validating assessment and treatment strategies. Jeanne shared that her research was motivated by the question of whether interventions are actually effective.  Her current research demonstrated that there was a statistically significant difference in sensory differences and in mealtime behaviors between children with ASD and the typically developing group she tested.  This groundbreaking research paves the way for further studies to investigate specific treatment strategies discussed today for their effectiveness in helping make mealtimes a pleasurable experience for children diagnosed with ASD and their families.

To view Jeanne’s PowerPoint slides, click here.

Following the seminar, attendees provided feedback about the seminar.  Please see a few remarks below:

“It provided an opportunity to review recent literature and share strategies with other therapists.” Kristyn S., Occupational Therapist

“Loved the topic and the format. Jeanne was great!!   Diane H., Occupational Therapist

“Informative, interactive, insightful. It was interesting listening to other OTs experiences and suggestions.”  Sylvia K., OT student

“Helpful to organize sensory treatment with a food tolerance/mealtime behavior perspective.”  Anonymous Occupational Therapist

Thank you, Jeanne!

Filomena Connor, MS, OTR/L