Hi-
Sarah has significant feeding aversions. She was born at 36 1/2 weeks and was IUGR/SGA- she was 3 pounds 14 ounces at birth- we have no idea why she was so small. She is now 15 months. She has had feeding problems since birth- started with a poor suck then she developed reflux which I guess led to her feeding problems. We see an OT twice a week and a PT once a week. I feel like with OT we really haven't made much progress and I was wondering if there is anything else we can try. They basically observe her eat- we start with a hard munchable or something to stimulate her mouth like beef jerky to kind of waken up her mouth then we move to finger foods putting only a couple pieces in front of her at a time so as not to overwhelm her. She will put a couple pieces in her mouth but usually spits it out. She will sit in the chair for maybe 10 minutes. It doesn't seem like they are doing anthing else other than watching her. I feel like we haven't made much progress. I was reading one of your other posts about baby einstein. I use this to get her to drink her bottle. Do you think it would be worth while to try it with solids? The OT has now said to let her run around and feed her while she is running around the house- for maximum of a 1/2 hour. So I give her finger foods in the chair which she mostly spits out then I try and spoon feed her some stage two while she plays. I just don't know what to do at this point. What would be your next step?
Thanks- I hope this makes sense

Hi Karie:

Yes, your story absolutely makes sense. My first thought after reading your thread about Sarah’s OT was OY! I am going to give you advice based on my experience as a trained feeding therapist who works with infants and toddlers who have reflux/feeding aversion. I am not trying to step on your OT’s toes, but I was a little surprised to hear about the recommendations.

When addressing children with feeding difficulties, it is extremely important to establish a feeding routine in one environment with the rest of the family when possible. Children learn so much from their peers/role models. That is the second rule any feeding therapist learns! More importantly, establishing boundaries sets the foundation for all expectations; especially for a 15 month-old whose autonomy stage is kicking in.

In my feeding clinic, I do use favorite videos, books, and cause-effect toys as primary reinforcement only. I use a treatment protocol that is specific to each patient as I learn their history and current conditions. I want you to understand that I do not have the video running in the background the entire time. If a patient takes a bite of food on their own volition (no forcing or shoveling from the feeder) they get 6 seconds ONLY of their favorite video, toy, or book. Most kiddos are smart and realize if they take another bite, then they get their reward again (for 6 seconds only). This specific form of behavioral therapy is faded out quickly when the patients realize that eating is fun, and they do not need TV or a toy to eat. I quickly take away the reinforcements once we accomplish good intake during sessions. NONE of my patient’s leave the clinic having to watch TV to eat! This is a form of distraction that can help children get over texture transitions.

For a 15 month-old who is just beginning therapy, I would set a kitchen timer at the beginning of the session with the child and announce “It’s time to eat.” I would set the child in the high chair or toddler seat with a tray table. The timer is typically set for 10 minutes. After 10 minutes and regardless of how much or little is consumed, I tell the child “It’s time to play” and turn off the timer. At that time, I totally remove the child from the feeding environment for a 5 minute “break.” I then say, “It’s time to go eat” as we return back to the feeding environment and set the timer for another 10 minutes. Once you establish a routine, it does not have to be so formal. I bring out the bells and whistles each time the child takes a bite and I NEVER force feed (That is the first rule you learn as a therapist). You may try giving her a spoon to hold while you are feeding her. You can also buy special mesh bags made for feeding therapy and put foods in them to practice chewing. Juicy fruits are great in mesh bags. Hope this helps. Please write back with more questions.

Robynne