Elizabeth Mahaney, M.A

Elizabeth Mahaney, M.A.

South Tampa Therapy

www.SouthTampaTherapy.com

3522 W. Azeele St.

Tampa, FL 33609

813-240-3237

SEQUENTIAL ORAL SENSORY (SOS) APPROACH

Picky Eaters vs. Problem Feeders: The SOS Approach to Feeding, an advanced training that I attended, was presented by Kay Toomey, Ph.D. Clinical Psychologist and Erin Sundseth Ross, MS, CCC-SLP in Hartford, Connecticut. This approach has been based on experiences and has developed over the past thirteen years and has implemented a philosophical approach to normal developmental stages or steps of feeding and growth. There were four main training objectives for the Sequential- Oral- Sensory (SOS) Approach to Feeding, Weight, and Growth Difficulties. The first objective for the training was for the participants to be able to recognize the main reasons why children will not eat based on learning theory principles. Second, participants were taught the developmental skills and understand the order of attainment needed for feeding and eating. The third objective was for participants to understand the physical, behavioral, learning, medical, nutritional, motor, oral-motor, and sensory factors that must be comprehensively observed and examined when assessing the needs for each child. Fourth, the focus was on implementing the multidisciplinary SOS Approach to Feeding treatment plans and strategies with other health care professionals in group and individual practices. This workshop was very informative and enlightening. The in-depth lectures and discussions were held from 8am until 5pm each day for four consecutive days. Through out this advanced training program, I grasped the importance of the role of the mental health clinician in this multidisciplinary approach.

SOS Approach- 1 –

An example of a family who benefited from the SOS Approach to Feeding may be portrayed by a three year old little girl, her mother, and her father. The three year old gradually stopped eating over time and had literally been force fed by the father for the past year. The family had been to several different professionals including a speech therapist who told the family that there was probably nothing wrong with the child and that it was most likely a behavioral problem. The father would frankly have to physically hold his daughter down on the bed and pour Pedia-Sure down his daughter’s throat. The family finally decided to come to the clinic to find another option to deal with their disheartened experiences and to get answers to the questions of why their child would not eat. The Father also felt that he could not go on force feeding his child because of the fact that he could no longer endure the pain that he saw in his daughters eyes. The Father also did this alone so that the daughter would not hate or fear her mother. He explained how he felt that his daughter hated him and was afraid of him but that he felt that he was the only person who could thrive to keep his daughter alive. After bringing the child in to the feeding center, the professionals did a multidisciplinary assessment to not only meet the health and nutritional needs of the child but also to deal with the relationship dynamics involved with all the family members. After extensive analysis, the child was diagnosed with having several ulcers, which resulted from having reflux.

ü  The main populations that may benefit from the SOS Approach to feeding/eating

includes:

- Children who are transitioning from tube to oral feeding.

- Children who have a low volume of oral intake (or no oral intake).

- Children who have poor weight gain.

- Children who have a limited variety of tastes and textures in diet

- Children who have difficulties transitioning to advanced textures.

- Children who demonstrate food refusal.

- Children who have maladaptive behaviors around eating

- Families who have power struggles at meal times.

- Children who are simply “picky eaters”.

- Children with mild to moderate neurological impairments.

-  Children who have difficulties with swallowing and who may aspirate and experience sensations of suffocation.

-  Children with sensory integration dysfunctions which may include children who have been diagnosed with autism spectrum disorder.

-  Children with medical disorders.

-  Children who have food jags and only eat a select few different foods.

-  Children who model their parents who may have an eating disorder.

-  Children who have ongoing choking, gagging or coughing during meals.

-  Children who have problems with vomiting.

-  Children who have had more than one incident of nasal reflux.

-  Children with a history of a traumatic choking incident.

-  Inability to transition to baby food purees by 10 months of age.

-  Inability to accept any table food solids by 12 months of age.

-  Inability to transition from breast/bottle to a cup by 16 months of age.

-  Has not weaned off baby foods by 16 months of age.

-  An infant who cries and/or arches at most meals.

The SOS approach follows a hierarchy to feeding, from tolerating foods in the room, interacting with the food, smelling, touching, tasting and, eventually, eating the food. Parent psychoeducation and involvement is an essential part of this feeding approach. Parents watch each feeding session to identify and learn their child’s body language in order to learn this approach for home programming.

The role of the mental health counselor within the multidisciplinary team is to help the FAMILY deal with their emotions, anxiety, and other impacts the feeding difficulties have had on the relationships and dynamics of the family. The mother and father in this particular instance may feel low self esteem from receiving the diagnosis, from a previous physician as a , “Failure to Thrive”-ICD9:783.4. Because of the negativity associated with this label or diagnosis, the SOS Approach Team believes in the importance of using family friendly dialogue and notating more specific terminology as “failure to Gain Weight”-ICD9:41(this is more concrete which actually means failing to gain weight) and “Feeding Disturbance”-ICD9:783.3(which may mean that a child who only eats certain foods may not be getting proper nutrients needed for his or her development but is gaining weight, for example; a child who only eats Oreo cookies and drinks chocolate milk.). Parents may misconstrue the term “Failure to thrive” which may seem to basically say to the parents- “You are not doing your job as parents” or “you are not good parents”. Therefore, it is important for mental health professionals to use terminology that does not insinuate blame or judgment.

ü  It is also important for the Mental Health Professional to educate the parents. A myth about eating is that it is instinctual. Actually instincts just start this process because eating is instinctive for only the first month of life. From 1 to 6 months, eating or sucking is a reflex, after 6 months eating is completely a learned behavior.

ü  Another crucial aspect of helping a family is to deal with issues associated with child-parent interactions around eating and feeding. The inability for a parent to effectively feed an infant or child can result in feelings of frustration and feelings of inadequacy as a parent regardless of the cause of the feeding problem. As a result, the interactions between the parents and child may become negative. Therefore, behavioral problems may develop secondarily to the feeding or eating difficulties. The goal for this dilemma is to increase positive parent-child interaction through play therapy and psychoeducation.

ü  The psychoeducation piece of the SOS Approach is crucial. The parent must be educated and understand all of the aspects involved in why and how the professionals assess and implement the plans and strategies that facilitate the wellbeing of their child. Through this educational aspect of the process, the parent is then able to eventually implement feeding and eating procedures in their own home.

ü  Play therapy or “play with a purpose” may be a way that a family can implement positive reinforcement with mealtimes in the home.

The Sequential Oral Sensory feeding program is a developmental approach to feeding designed to assess and address all the factors involved in feeding difficulties. It focuses on teaching a child the basic rules of eating through exploring different properties of foods, including texture, smell, taste and consistency. The SOS approach allows a child to interact with food in a playful, non-stressful way.

Dear Parent:

Having a child who does not feed well is a worrisome, frustrating, confusing and at times, medically concerning problem. We understand how complex feeding difficulties can be. Because of these complexities, we believe it is important to look at the “whole” child and to assess all the possible contributing factors in a feeding problem through the use of a Multidisciplinary Evaluation Team. (recommended assessments from)

Developmental Pediatrician

Dietitian

Occupational Therapist

Speech Pathologist

This way we are all committed to helping you and your child identify what is interfering with your child’s eating and how to improve their growth and interactions with food.

In order to best help us prepare for your child’s evaluation, we would like you to carefully read over the following information and to complete the enclosed forms; the Family and Medical History Form, Feeding History Form, 3 Day Diet History, Sensory History, Release of Information, Patient Rights Form, HIPAA Policy, and Billing/ Payment Policy. Please complete the forms in as much detail and as readable as possible. Many items on the forms can be simply answered by checking YES or NO in the appropriate space. If you give a YES response, please explain this answer thoroughly in the space provided or on the back of the page. If you can not, or wish to not answer a question, leave it blank. If a question does not apply to your child., you may write in NA for “not applicable”.

Please return your completed forms by emailing them () or mailing them AT LEAST 1 ½ WEEKS in advance of your scheduled appointment date. If you are not able to mail them before the one week deadline, please just bring the forms with you to the appointment. IF YOU ARE BRINGING YOUR FORMS WITH YOU TO YOUR APPOINTMENT, YOU NEED TO ARRIVE AT LEAST 15 MINUTES PRIOR TO YOUR SCHEDULED APPROINTMENT TIME so our staff can review the paperwork.

REQUEST FOR MEDICAL RECORDS:

Enclosed you will find a form for requesting medical records and giving us permission to communicate with other professionals also treating your child. Please make as many copies of this form as needed, and submit one to each of the other professionals caring for your child. At a minimum, please complete the form and submit it to your child’s primary care physician. It is most helpful to us if your child’s doctor can at least send us a copy of the growth chart before the day of their appointment. If your doctor or any other therapist would like to speak to the Team prior to the appointment, please have them call Elizabeth Mahaney at 813-240-3237. We gladly welcome any and all forms of communication with the other professionals treating your child, so as to be most helpful to everyone involved.

Please also read the agreement and HIPPA forms www.SuthTampaTherapy.com

3 Day Diet History Form

Instructions:

You are being asked to record all foods and drinks eaten/ drank by your child for 3 days in a row. The following directions will guide you in filling out the form. You need to complete this history and send the information to the Feeding Center with the rest of your forms, OR you will need to bring it with you to your appointment.

1.  Please fill out ALL the information at the top of the first page.

2.  Please record the DATE and DAY of the week for each day. Record ALL food and drinks eaten along with the TIME your child ate or drank them. It is best to carry the history form with you and to record items immediately so that nothing is missed.

3.  Include an EXACT description of the item and your best guess of the portion size of the amount eaten. Write the brand name of formula your child is on (i.e. Enfamil, Prosobee, etc.), what type of juice he/ she drank (i.e. apple, grape, etc.), any special recipes for drink mixtures your child uses (i.e. 24 calorie Isomil + 1 tsp Polycose), and any additions to foods (i.e. ¼ cup mashed potatoes + 1 Tbsp margarine). Be sure to include dressings, sauces, gravies, or anything extra.

4.  It is suggested that you may wish to use measuring spoons and cups when serving your child for these 3 days to report the amounts eaten/ drank better.

Example:

Date / Time / Food/ Drink Item / Amount / Bottle / Cup / Mouth / G-tube
1/1/02 / 4 pm / Gerber applesauce #2 / 1 ounce / a
White Bread / ¼ slice / a
Ham lunch meat / ½ ounce / a
Mayonnaise / 1 tsp / a
White grape juice / 1 ounce / a / a
7 pm / Similac Formula / 4 ounces / a / a
9 pm / Pediasure with fiber / 8 ounces / a

3 Day Diet History

OFFICE USE ONLY
Ht: Wt: Date: .
Estimated Needs: Calories
Protein
Fluid
Eval Individual Group

Parent/ Guardian Name: Daytime Phone #:

Child’s Name: Date of Birth:

Vitamin or Mineral Supplement: NO YES Name & Amount:

Formula Mixing: Number of scoops:

Amount of Water:

I put water in the bottle first then the formula powder.

I put the formula powder in the bottle first then the water.

The formula is liquid in a can and I do not add anything.