Category Archives: Feeding Therapy

Understand feeding therapy tools and approaches that support oral motor skill development, promote safe swallowing, and build positive mealtime experiences for all ages.

From Farm to Table: A Comprehensive Group Model of Nutrition and Feeding

nutritionist, Maria Napoleone, MS, RD, LDN and Occupational Therapist, Danielle Goldstein, M.Ed, OTR/L,The February 17, 2018 Saturday Seminar at Therapro was an innovative presentation from nutritionist, Maria Napoleone, MS, RD, LDN and Occupational Therapist, Danielle Goldstein, M.Ed, OTR/L, entitled: Farm to Table: A Comprehensive Group Model of Nutrition and Feeding. The women have developed a feeding group collaboratively at BAMSI Early Intervention Program, in Brockton, MA. Maria has notable pediatric experience as a nutritionist working in varied settings including the Boston Medical Center Growth and Nutrition Clinic, Pediatric Feeding Clinic and Pediatric Surgery Department at UMass Medical Center, WIC, early intervention, and as a Peace Corps volunteer. Danielle’s broad pediatric experience includes practice in acute care, outpatient services, feeding team, school-based therapy, early intervention, and private practice.

Danielle and Maria described Farm to Table as a comprehensive model to improve feeding outcomes with nutrition at its foundation. Their toddler feeding group at BAMSI involves using a multi-sensory approach in a structured group setting in which peer role models play a critical role in the development of eating skills. The seminar covered many topics including tips on how to structure a feeding group in various settings, how to implement key strategies, how to empower parents carryover and use the strategies learned through the group, how to improve the quality of foods consumed, how to improve mealtime behavior, and much more!

Farm to Table developed over a number of years as the model for the BAMSI feeding group that provided the toddlers with hands-on food exploration and multisensory experiences in a nurturing, supportive setting. The Sequential Oral Sensory (S.O.S) Approach, a trans-disciplinary program for assessing and treating children with feeding challenges and weight/growth problems, serves as the approach the BAMSI team uses in their feeding group. S.O.S. integrates posture, sensory, motor, behavioral/learning, medical, and nutritional factors to evaluate and manage children with feeding and growth difficulties. Creating a garden as part of the group experience gives the children other sensory and food-related experiences that helps them understand how food grows and what it looks like when it is cooked and on your plate. The garden has produced a wide variety of vegetables and herbs that the group has used to prepare snacks and meals including spaghetti sauce, zucchini muffins, and pesto. Growing food adds a critical component to the group in light of the fact that Maria noted that “70-90% of children who receive EI services have one or more nutritional risk indicators.”

Several of the many helpful resources recommended by Danielle and Maria include: www.choosemyplate.govwww.feedingmatters.orgwww.ellynsatterinstitute.org, and www.farmtopreschool.org.

Maria and Danielle presented an exciting model that addresses jointly the importance of developing a solid nutritional foundation for children as well as the need to support children with feeding challenges through a multi-sensory approach to feeding. They have documented great success with their Farm to Table feeding group. The rich experiences the children gain take them from learning about how plants are grown, cared for, and harvested, to how the plants are prepared, cooked, and eaten, in a structured group with peers and adult role models. This team approach takes children who experience feeding challenges on a nurturing, supportive, fun journey toward improved nutrition and enjoyment of food!

Take a look at a few of the many positive comments from attendees about Danielle and Maria’s seminar:

“Very informational on ways to improve feeding with children not just by using food but also through movement, circle time, structured activities. Really like the idea of group and using peer modeling.” – Julia N., Occupational Therapist

“It was interesting and well presented. I will use many of these strategies for my class. (I am in First Grade and work with Special Needs).” – Annmarie M., Teacher

“Great process from beginning to end of creating this group program.” – Micaela C., Physical Therapist

“The emphasis on the process was important in understanding that every student works at their own pace and that any type of food trial – whether it be touch, smell, or taste is success!” – Beth M., Occupational Therapist

Thank you, Maria and Danielle!

Filomena Connor, MS, OTR/L
February 17, 2018

Teaching Utensil Use Beyond Mealtime

It seems as natural as can be; use a child’s meals and snack times as opportunities for teaching utensil use. 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 utensils beyond mealtime, 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 toy to build hands skills for Utensil Use
Shape, Model, and Mold
Pizza Party, a great option for Teaching Utensil Use Beyond Mealtime
Pizza Party
Cutting Food Box, a great option for Teaching Utensil Use Beyond Mealtime
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.

Interventions for Toddlers and School-Age Children with Feeding Difficulties

Kerry Pearl, MS, CCC-SLPKerry 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 difficulties in toddlers and 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