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Introduction to the SOS Approach to Feeding Program

(Sequential-Oral-Sensory)

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The SOS Approach to Feeding is a Transdisciplinary Program designed to assess and treat children experiencing difficulties with feeding and/or weight/growth. It was developed across three decades of clinical work by Dr. Kay Toomey, along with colleagues from several disciplines, including Pediatricians, Occupational Therapists, Registered Dietitians, and Speech Pathologists, and is informed by the latest research in the field.  

This program adopts a holistic approach, integrating motor, oral-motor, learning, medical, sensory, and nutritional factors, to identify the underlying causes and skill deficits contributing to a child’s feeding and growth challenges. It is based on, and grounded philosophically in, using typical development as our “blueprint and map” to help teach the needed skills for eating, while recognizing that each child’s individual neural capacity, learning abilities, physical needs, and environment may mean that they have a different path. The SOS Approach to Feeding is designed to meet every child at their current level, building upon their strengths to achieve the next skill.  

During feeding therapy, the SOS Approach focuses first on increasing a child’s comfort level by exploring and learning about the different properties of food. Using a systematic desensitization approach and following a hierarchy of skills and behaviors, children learn to progress with eating various textures of foods. The program allows a child to interact with food in a playful, non-stressful way, beginning with the ability to tolerate the food in the room and in front of him/her, then moving on to managing the smell of the foods, learning about how foods feel on the body and in their mouth, and then enjoying tasting and eating new foods following the SOS Steps to Eating. As children gain better eating skills, we often see improvements in the child’s growth pattern.  

SOS APPROACH TO FEEDING: BASIC TENETS 

ASSESSMENT/DIAGNOSTIC PHASE

The Assessment Phase of the SOS program usually begins with a direct referral. This may be from the child’s Pediatrician but may also be from individual therapists in the community, early childhood interventionists and/or programs, preschools, schools, other medical specialists and/or the child’s parents.  

We acknowledge that accurate assessment and differential diagnosis of Pediatric Feeding Disorder requires a transdisciplinary approach, which is documented as the standard of care in the field. Therefore, the SOS Approach to Feeding Program strives for a Transdisciplinary team evaluation, ideally consisting of the following professionals: Medical, Mental Health, Occupational Therapist, Speech Pathologist, and Registered Dietitian. All five professionals together observe the child eating with his or her primary caregivers either in the child’s home or a clinical setting, evaluating the “whole child” by looking at all seven different areas of human development: organ systems, muscles (including oral motor), sensory integration and processing, learning/behavior/cognition, development, nutrition and environment. During an SOS feeding assessment, the child is first offered their preferred foods, so that their skills with foods they typically eat can be observed. Then the child is introduced to a few new or not-yet-eaten foods, so that the professionals can assess some of the underlying reasons why these foods may be challenging for the child. Throughout the assessment, the child’s strengths and challenges across all 7 areas of human functioning are identified.  

When looking at the 7 different areas of human development that may impact a child’s eating and their feeding challenges, the SOS Approach to Feeding Program evaluates how this may be addressed within the larger Pediatric Feeding Disorder diagnosis. Pediatric feeding disorder (PFD) is defined as impaired oral intake that is not age-appropriate and is associated with medical, nutritional, feeding skill, and/or psychosocial dysfunction (Goday et al., 2019).  

TREATMENT PHASE 

After conducting the initial Feeding Assessment, a personalized treatment plan is created to meet the unique needs of each child. The course of treatment is influenced by various factors such as the child’s and family’s immediate priorities and needs, insurance/financial constraints and the setting in which therapy takes place. Our treatment modalities may encompass individual therapy sessions, group therapy sessions, or a structured home program with ongoing support and follow-up. Regardless of the specific treatment modality, the strategies used remain grounded in the fundamental principles of the SOS Approach to Feeding.  

The SOS Approach to Feeding is a strengths-based, family-centered program that prioritizes intrinsic motivation. The therapist must build a trusting relationship with the child and their family to learn what is intrinsically motivating for them. Food serves as a tool to teach eating skills, considering the food’s sensory qualities and motor demands, and the child’s oral motor, motor, sensory and cognitive skills, along with their past food experiences and ideas. Play-with-a-Purpose is tailored to the child’s individual interests and developmental age. Children learn best through play. Therefore, incorporating the child’s interests at the ‘just right’ level of interaction with the food improves their intrinsic motivation and helps them learn to manage the qualities of that food adaptively.  

Systematic Desensitization is used to teach the child new skills in a way that respects the child’s readiness to learn them. The child is invited to play with an adult, moving up and down a series of Steps to Eating, based on the child’s interests, engagement, and comfort level with the food. The child’s nervous system guides the pace of learning, with therapists adjusting their play and teaching based on the child’s cues. The therapist continuously evaluates the child and responds to the child’s body and communication. Signs of stress or distress in the child signals the therapist to move back down to a lower Step to re-regulate the child. The child is allowed to move through the steps towards learning to eat at their own pace versus being required to comply with an adult’s demand to complete a particular step, eat a specific food, or consume a required volume of food or fluid. Progress is child-led, avoiding demands on eating specific foods or volumes. 

Our Therapy Meal routine optimizes learning experiences with food. Every component of the treatment routine serves multiple therapeutic purposes. The big body warm-up segment ensures the child is regulated before learning about foods. A consistent routine at the table is used to support this regulation and availability of the child for engagement before introducing the food. Then, each food is presented one at a time in the form of a Food Hierarchy. The therapist utilizes Play-with-a-Purpose to facilitate skill development and movement up the Steps to Eating Hierarchy. At the end of the session, a clean-up routine provides a clear ending for the end of the session. 

A parent education lesson takes place at the beginning or end of the described routine. The SOS Approach to Feeding Program actively involves the child’s caregivers in therapy to help them understand their child’s communication and cues, so parents and professionals can create highly individualized home programs. Caregivers are supported so they can be successful in helping their child to engage in meaningful mealtimes in their home and community in a way that respects the child and family’s culture and priorities.  

TREATMENT SUCCESS 

Success in our program is a collaborative journey, where goals are co-created between the child, the child’s feeding team, and their family, ensuring alignment with the family’s unique needs and aspirations. The SOS Approach to Feeding aims for children to develop the capacity to engage confidently with a diverse range of foods, in a variety of settings, with their parents and other caregivers in their lives, as well as with their peers.  The SOS Approach helps children to develop a positive relationship with eating, including the social aspects of mealtimes and dietary variety for nutritional health and appropriate growth. 

Copyright 2024, Toomey & Associates, Inc.

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Introduction to the SOS Approach to Feeding Program

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