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SOS Training Conference and Educational Programs

Hosting an SOS Approach to Feeding Conference

Presentations, Handouts, Administrative Forms, and Other Materials

Copyright Permission/Use of SOS Program Materials

Clinical Information Related to SOS

SOS Training Conference and Educational Programs

How much does it cost to attend the SOS Approach to Feeding conference?

The price of each training conference is determined by the Host and varies based on location. For details on specific conference pricing, please visit the conference Host’s website. Find Host contact information and website links located on our SOS Conference Schedule page.

Do you offer continuing education credits?

Continuing education credits are managed and applied for by each individual Host. Please check with the Conference Host to see if they offer the credits or documentation for applying for continuing education credits with the individual associations.  If you are a US based ASHA or AOTA member looking for continuing education while attending an SOS Conference outside of the USA, we do not provide ASHA or AOTA continuing education credits for conferences outside of the USA.

I have not received continuing education credits for the conference I attended. Who do I need to contact?

Please contact the Host of the conference you attended for information on how to receive your continuing education credits. If you are unable to reach the Host or need their contact information, please send your request using the Contact Us form.

Do you offer the SOS Approach to Feeding Conference online?

While the best way to learn the SOS Approach to Feeding program is by attending and practicing directly with other colleagues during a live, in-person conference, we do provide Live Stream offerings of the Main Training Conference 2-3 times/year for various time zones. The details and registration for Live Stream offerings are posted on the SOS Conference Schedule page approximately 6 months prior to the start date.

Once you have completed the SOS Approach to Feeding Main Training Conference, all other SOS Education opportunities are available exclusively online. Learn more about all of our Professional Educational Programs.

What is the difference between the SOS Approach to Feeding Conference and the Advanced Workshops?

The SOS Approach to Feeding Main Training Conference provides the foundation for professionals to accurately use the SOS Approach to Feeding program. SOS is a trans-disciplinary program for assessing and treating children with feeding difficulties and weight/growth problems of all ages, with a special focus on children from 6 months to 6 years old being taught in the Main Training Conference. The SOS Approach integrates posture, sensory, motor, behavioral/learning, oral motor, medical and nutritional factors to comprehensively evaluate and manage children with feeding/growth problems. Because the SOS Approach to Feeding Main Training Conference covers material across a wide variety of disciplines, it is necessary for all professionals wishing to use the SOS Approach to Feeding program to attend this foundational training conference regardless of that professional’s discipline or previous level of clinical experience/training in feeding problems. The learning outcomes for the SOS Approach to Feeding Main Training Conference are:

The Advanced Workshops are additional 2 to 4-hour training opportunities which expand upon the SOS Approach to Feeding Conference to further educate the professional about:

  1. Unique issues and helpful strategies concerning special populations of children with feeding problems (e.g., children with ASD, Food Sensitivities/Allergies/Intolerances, children with G-tubes, working with the older child using Food Science, children with Severe Developmental Delays, working with the 6-16 month old child)
  2. How to refine their clinical skills using the SOS Approach to Feeding program through more in-depth exploration and practice of the critical components of SOS (e.g., effectively using the Oral-Motor Steps to Eating, Food Hierarchies for increasing a child’s oral volumes, working in a partnership with challenging families)

**You must first attend the SOS Approach to Feeding Main Training Conference prior to being able to access any of the online Advanced Workshops.

What other training do you provide other than the SOS Approach to Feeding Main Training Conference?

The SOS Approach to Feeding team provides both a Mentorship Course and a Certification level Course, in addition to our Advanced Workshops to clinicians who have taken the SOS Approach to Feeding Main Training Conference.

1. Online Web Professional Membership:

The purpose of offering memberships online is to give people access to more resources about SOS and feeding challenges to help you in your clinical practice. If you join as a Member, you will have access to over 200 articles, handouts, blogs about a wide variety of subjects related to feeding & SOS from recipes that we like, kitchen products that we find helpful, reviews of WHY each of the general treatment strategies are important and tips for how to get families to do them, answers to common questions professionals ask us, problem-solving strategies for implementing SOS in your clinical setting, etc. A Professional Membership will also keep you up-to-date with changes in the program and/or upcoming events. Depending on your level of Membership, you will receive new written materials at least once a month up to once a week.  This Educational Offering is ongoing and primarily involves you reading what you are sent and what you find on the website.

2. Advanced Workshops:

The 12 Advanced Workshops are 1.5 – 4 hour long videotaped classes about very specific populations of children with unique feeding problems that we do not have time in the main Training Conference to cover in-depth (e.g., Children with Autism; Transitioning Children off G-tubes), and/or about specific topics that we believe will help you to refine your clinical skills in using the SOS program with your patients/clients (e.g., Helping Children Achieve and Maintain the Just Right Arousal Space for Learning; Setting up a Feeding Clinic). These Advanced Workshops were updated and filmed in July 2019 in front of a live audience. As a trained SOS provider, you can watch any of these Workshops that you would like to purchase, in your own home, at your own convenience. Each Workshop price is based on the length of time of the Workshop. If you are a Professional SOS Web Member, you will get a discount on the registration fee for each of the Workshops. If you would like to obtain professional Continuing Education Credits, those are available for Occupational Therapists and Speech Pathologists after taking a short exam at the end of the Workshop. For each Advanced Workshop taken, you will receive a Certificate of Attendance regardless of whether you are getting CE credits or not.

3. Mentorship:

The Mentorship Course is specifically designed for professionals who are actively treating patients/clients using the SOS Approach to Feeding therapy program. In order to participate in the Course, you need to be allowed within your discipline to conduct therapy with a child as you will need to submit a videotaped case study of one of your treatment sessions. The purpose of the Mentorship Course is for clinicians to get guidance from SOS Professors regarding how to effectively implement and accurately use the SOS program in their unique clinical settings that often times do not have the most “ideal” set up for feeding therapy. The Mentorship Course is 12 weeks long and meets LIVE in an online classroom for 1.5 hours each week. Typically, there is/are 1-2 SOS Professors and 6-12 other therapists in each Mentorship Course. Mentorship Courses are offered 3 times a year.  The first part of the Course involves some lectures, but primarily discussions amongst the participants.  There are homework assignments connected to each lecture to help deepen the Therapists’ knowledge base and clinical application of the materials covered.  The second part of the course is watching the videotaped sessions of the participants treating clients using the SOS Approach to Feeding and participating in feedback with the treating therapist.

4.  Certification:

The Certification Course is designed to thoroughly assess a Therapist’s clinical skills and knowledge in the use of the SOS Approach to  Feeding program.  We are aware that many feeding therapists use a combination of feeding programs when they treat their clients/patients.  A Therapist wishing to become SOS Certified is verified by SOS Professors to be only using SOS in their feeding therapy sessions and to be correctly using the program at an advanced clinical level.  This Course is also online, in a LIVE interactive classroom, for 12 weekly 1.5 hour-long classes.  Participants have homework which includes submitting treatment plans for sessions with specific clients they are seeing, and clinical justifications of foods in Food Hierarchies and/or play strategies being chosen for treatment of X problem.  Participants will videotape one client’s session at the start of the Certification Course, receive feedback from SOS Professors and other participants on that session, implement those recommendations given, and then do a second video of a later session with this child to show the progress they have made as a clinician in using the SOS program.  There is a large written examination at the end of the Course.

Learn about all of our Education Programs.

Do you offer a mentorship program?

Yes, the SOS Mentorship Program provides direct guidance and feedback by an SOS Professor on how to best implement the SOS Approach to Feeding program into your Clinical Practice.  Developed for new SOS practitioners and individuals interested in additional support in the implementation of the SOS Approach to Feeding program, the SOS Mentorship Program offers:

The Mentorship course is conducted online for 12 weeks via Zoom.  Each class is 1.5 hours.  Typically, there are 10-12 participants per Course with two SOS Professors.  Professionals have the opportunity to see other clinicians at work and to hear the SOS Professor’s feedback, along with the exchange of creative ideas about how to use SOS effectively across a wide variety of settings and circumstances.  Learn more

** Attendance at the SOS Approach to Feeding Main Training Conference is the only requirement to enroll in the SOS Mentorship Course.

Do you offer a certification program?

Yes, Dr. Toomey has developed a comprehensive SOS Certification Program that provides additional training for therapists who wish to become experts in the use of the SOS Approach to Feeding program. This comprehensive certification program occurs online and includes additional written materials and examinations, clinical supervision and review of your videotaped therapy sessions, feedback to further your skills in creating Food Hierarchies and in using Hierarchy Strategies, and discussion of how to become more effective in your parent education.  Learn more

Certification in SOS is also a requirement for professionals wishing to conduct research about SOS that they will be publishing and/or presenting.  For therapists wishing to conduct other levels of research using the SOS Approach to Feeding program, please send your request using the Contact Us form.

What is the process for becoming Certified in the SOS Approach to Feeding program?

Certification in SOS is meant for professionals wishing to become an Expert Clinician in the SOS Approach to Feeding program specifically.  This course is conducted online via Zoom for 1.5 hours per week for 12 weeks.  There are typically only 5-6 participants per Course to allow for an extensive review of clinical cases and presentation of clinical videos by the professional.  There is weekly homework designed to refine the clinician’s understanding and use of SOS principles and strategies, as well as an examination at the end of the course.  The professional must pass the exam in order to receive Certification.  Learn more

Pre-requisites to becoming SOS Certified include:

What is the difference between the SOS Mentorship and SOS Certification Programs?

The SOS Mentorship course is meant to provide the professional who wishes to refine their clinical skills in using the SOS Approach to Feeding program the opportunity to obtain additional information directly relevant to applying SOS in their work setting and to present a clinical case to the SOS Professors for feedback.

SOS Certification is designed for clinicians wishing to become an Expert Clinician in using the SOS Approach to Feeding program.  Being an Expert SOS Clinician means that the SOS Team has verified the professional’s use of the SOS program as accurate and effective.  Expert Clinicians would be the professionals the SOS Team would first refer a child and family to in any community.  Being an Expert Clinician also allows the professional to conduct research on the SOS Approach to Feeding program.
Learn more

Which one of your conferences would be best to gain training in feeding for 0-6 months?

The SOS Approach to Feeding Main Training Conference is the place for all professionals to begin when starting to use the SOS Approach to Feeding to treat children with feeding challenges.  In this main training conference, participants will be taught basic learning principles that apply to the child in the NICU and the very young infant, as well as with any older child.  Participants will then learn the foundational skills that all children need to acquire for efficient feeding across the first 2 years of life including oral motor, postural, motor, sensory, cognitive and psycho social skills.  Additionally, participants are taught general treatment strategies for children of all ages, and the specific SOS techniques which comprise the core of the SOS Approach to Feeding program used to treat children with feeding and growth challenges.  In the main training conference, there is a focus on children between 6 months and 6 years old, with discussion of applications for older children, adolescents and young adults.

After taking the SOS Approach to Feeding Main Training Conference, we recommend that you take the Advanced Workshop = Feeding the 6-16 Month Old Child – which is offered online.  You may also be interested in some of the other Advanced Workshops, depending on the types of children you are working with. Finally, if you will be treating infants, it will be important to take an Infant Feeding Course specifically.  The best one out there is Dr. Erin Ross’ SOFFI course.  For details, please visit Dr. Ross’ website at www.feedingfundamentals.com.

If I have a complicated case, can I have a professional consultation with an SOS Professor?

Yes, we do offer a Professional Consultation with an SOS Professor. For details, pricing and request form, please visit the Professional Consultation page

Once I complete the SOS Approach to Feeding conference, will I be certified?

Attending the SOS Approach to Feeding Conference provides training in how to use the SOS Approach to Feeding program. Upon completion of the conference, you will receive a Certificate of Attendance.  This allows you to immediately begin to treat and provide therapy to patients.  However, this is NOT Certification in SOS and does not allow a professional to say that they are Certified in SOS.  Certification in SOS is only acquired through the SOS Certification Program (pre-requisite for the certification program is the completion of the SOS Approach to Feeding Conference).

I lost my certificate of attendance. Can I receive a copy?

The certificates and record of attendance are managed by the Conference Host. Please contact the Host where you attended the conference to request a duplicate copy.  If you are unable to reach the Host or need their contact information, please send your request using the Contact Us form.

I am a Nutritionist. Can I attend an SOS Approach to Feeding Conference?

Nutritionists are allowed to attend an SOS Conference if they have a documented Nutritionist degree and/or certification approved by a governing body in their country. Nutritionist students who have not yet completed their full degree are not allowed to attend the SOS Conference.

A Nutritionist degree allows you to provide parent consultation to families of children with feeding challenges. The SOS Training Conference teaches General Treatment Strategies that you will find very helpful for your consultation work. These are recommendations that the research in the field indicates all families should be using with their children to help their children develop a healthy, life-long relationship with food.

Because a Nutritionist degree does not include direct training in the application of pediatric rehabilitation therapy strategies, you will have additional work and training you will need to complete if you want to provide SOS Feeding Therapy directly to children. We recommend that after taking the SOS Main Training Conference, you create an ongoing relationship with an Occupational Therapist and/or Speech Pathologist who is willing to provide you with additional pediatric rehabilitation therapy supervision. That OT or SLP will then let you know when you are qualified to provide feeding therapy independently.

The SOS Approach to Feeding is best learned by attending one of our In-person Conferences because of the direct physical practice of therapy strategies with colleagues and direct oversight by SOS Professors in the In-person SOS trainings. Nutritionists are not permitted to take the Virtual version of the SOS Training.

I am a BCBA. Can I attend an SOS Approach to Feeding Conference?

Yes, BCBA trained professionals are eligible to take an SOS Training Conference. However, depending on the State in which you work, you may be required to be under supervision of another fully licensed professional. If you are required to be under supervision of another professional, then your Supervisor needs to be SOS Trained in order to provide accurate supervision for you. Please submit the name of your Supervisor and when they were SOS trained when you receive an email from an SOS Administrator requesting this information after registration.

Please note that our parent company, Toomey & Associates, Inc. is not an approved continuing education provider for the professional governing body for BCBAs, nor the professional association for BCBAs. Therefore, if you wish to receive continuing education or professional development hours for attending the SOS Conference, you must make this arrangement with your professional organization/governing board PRIOR to registering for the SOS Conference. Please be aware that your request may be denied because Toomey & Associates, Inc. is not an official CEU provider for BCBAs.

I am a COTA or SLPA. Can I attend an SOS Approach to Feeding Conference?

LICENSING STANDARDS – All students and assistants must follow individual licensing/training standards for their State/Country and their professional degree’s supervision standards. When there is a requirement for a students and/or assistants to practice only under professional supervision, the SOS Approach to Feeding program requires those SLPAs, COTAs or discipline equivalent to have a Supervisor who themselves have attended a SOS Training Conference. If your Supervisor has previously attended the SOS Approach to Feeding and you are registering to attend an SOS Training Conference as an assistant or student, please have your supervisor send an email stating that they will provide supervision to you as required by your State/Country’s standards while practicing the SOS Approach to Feeding program, along with a copy of their SOS Certificate of Attendance. If your supervisor is planning to attend an SOS Conference with you, please have your supervisor send an email stating that they will be attending the SOS conference with you and will provide supervision to you while practicing the SOS Approach to Feeding IF this is required by your State, Country or professional degree’s standards to [email protected].

I am a student. Can I attend an SOS Approach to Feeding conference?

Yes, students can attend under the following circumstances:

Note: As is an ethical requirement for all graduate programs, students are not allowed to practice clinical therapy without direct/live professor/clinician supervision.  Supervision is required until the student attains their full degree and licensure.

Is there a student discount?

A discount for students is up to the discretion of the Host of each conference. Please contact the Host of the conference you are considering attending to ask them regarding whether any discounts are available.

I am a BCBA. Can I take the SOS Conference and become a trained SOS Therapist?

We welcome our BCBA colleagues who have completed their Masters Degree in their field to the SOS Training Conferences. Please be aware that we are not a continuing education provider for the BCBA national organization. An individual provider would need to contact their national organization to determine if CEUs could be specially applied for and/or approved before registering for the SOS Training Conference.

A BCBA provider can become an SOS Trained Therapist. If your State requires that your clinical work be supervised by a Ph.D. or M.D. professional, then your supervisor would need to be SOS trained as well for you to use the SOS program with clients. If your State does not require you provide therapy under supervision, then you may use the SOS program with your clients independently. In this situation, our expectation is that you are the treating therapist for that client versus directing a technician or others to carry out an SOS program.

Hosting an SOS Approach to Feeding Conference

How do I host an SOS Approach to Feeding conference?

For information on hosting an SOS Approach to Feeding conference, please submit your request using the Host an SOS Approach to Feeding Conference request form.

Do you offer shorter or customized presentations for schools and other organizations?

Schools or other organizations wishing to have a presentation about the SOS Approach to Feeding program by one of the SOS Professors should contact us directly at SOS Event Request. In your request, please include the following information:

I would like Dr. Toomey or other members of the SOS Team to speak at my event. How do I find out their availability?

If you would like Dr. Toomey or another SOS Professor to speak at your event, please contact us directly at SOS Event Request. In your request, please include the following information:

When will you be hosting an SOS Approach to Feeding conference in my area?

The SOS Approach to Feeding Conference is offered at least once a month in locations around the world.  For a list of upcoming conferences, please visit our SOS Conference Schedule page.

Presentations, Handouts, Administrative Forms, and Other Materials

I would like to share the information on the SOS Approach to Feeding conference that I attended.  Do you have any presentations that I can use?

Yes, we have a variety of presentations available on the SOS Approach to Feeding program.  Created by Dr. Toomey, the following presentations are designed for Conference Attendees to use when presenting the SOS Approach to Feeding to other Professionals and/or Parent Groups. These presentations are offered at no charge to attendees. Available presentations include:

  1. Approaches to Feeding Therapy – Comparisons – Presentation for presenting to colleagues who have a primary Operant Conditioning focus
  2. MD Office Talk – Presentation for presenting to physicians and other primary medical providers
  3. Parent Presentation – Presentation for presenting to families and caregivers
  4. SOS Presentation – Presentation for presenting to other Rehabilitation/Pediatric Therapists
  5. SOS Statistics – Presentation that provides a summary of statistics about the SOS Approach to Feeding presented in the course and data comparisons to other approaches

Request Presentations

How can I order the SOS Handouts or SOS Administrative Forms?

Please visit the SOS Store for information on how to order these products.

How can I order The Great Explorer music?

Please visit the SOS Store to order the Great Explorer music and other products offered for purchase.

I lost my notebook from the conference.  Can I order a new one?

Conference notebooks are managed and printed in a limited quantity by the Conference Host.  Due to the limited number printed for each conference, we cannot guarantee the availability of a replacement conference notebooks.  However, please Contact Us, and we will provide you with the availability of a replacement notebook and the replacement costs.

Do you offer language translations of the SOS Handouts and SOS Administrative Forms products?

Currently, we offer a full set of SOS Handouts in Spanish.  This is available for purchase in the SOS Store.

Additionally, we also have a limited number of handout documents translated in Japanese, Finnish, French, Norwegian, Swedish, Vietnamese and Chinese.  To request these documents, please Contact Us.

How do I reference Dr. Toomey’s work or the SOS Approach to Feeding program on my website or blog?

You must include the following statement on your website or in your blog:

“The SOS Approach to Feeding program was developed by and copyrighted by Dr. Kay Toomey.  Please note, all materials, documents, and forms taken from the SOS Approach to Feeding program are copyrighted and cannot be reproduced in any form without the written permission of Dr. Kay Toomey. For more information on the SOS Approach to Feeding program, please visit www.sosapproach.com.”

Please send your request using the Contact Us form.  Depending upon the type of copyright permission you are requesting, you will receive a Copyright Permission form(s) that is appropriate for the materials you are requesting.  Once completed, please submit the form along with your certificate from the conference to [email protected].

Clinical Information Related to SOS

Is the SOS Approach to Feeding evidence-based?

The SOS Approach to Feeding is very much an evidence-based program.  The Evidence Basis of SOS occurs in 2 primary ways:

#1 = our program is constantly evolving based on what is known from a research standpoint in the field.  We read the newest research on an on-going basis, and we re-write our main teaching conference at least every 3-5 years to include the newest research and all relevant updates to the program.  This is a level of incorporating the evidence into what we do that surpasses most other feeding programs out there. 

#2 = the second level at which SOS is evidence-based comes from research studies using the SOS Approach to Feeding program.  There are currently 14 different studies that document the effectiveness of the SOS Approach to Feeding program when it is used correctly. 

We, at SOS, are very strongly committed to making sure the SOS program is based in the evidence and that it has research studying it.  

Some families tell us they don’t like their children to get ‘messy’ during meals. Can we still do SOS?

Yes – it simply means that you need to help the family understand WHY their child needs to get messy. Consider the following points:

What is the difference between Systematic Desensitization and Flooding?

In psychology, desensitization involves the use of competing relaxation responses (e.g., deep breathing, play) during exposure to a graduated hierarchy of a stimulus known to cause anxiety. The aim is for the person to stay calm as they progress through the small steps towards the end goal. If the person starts to get distressed, the therapist should move back a step in the hierarchy and re-establish calmness before trying to move forward again.

Flooding involves exposing a patient to vast amounts of the feared stimulus. It is expected that the patient would initially be very anxious, but it is hoped that the anxiety will decrease over repeated exposures. Flooding begins at the ‘end’ and assumes the child will eventually ‘get the skills’ to be successful.

Flooding uses the assumption that a person cannot maintain a high level of anxiety for extended periods of time. However, if the child does not have the skill to complete the task, then ‘anxiety’ is not the only problem and flooding is not the answer.

Systematic desensitization allows the therapist to continue evaluating the child with every exposure and assumes the therapist and child will work together to build the skills within the child to become successful.

Consider this analogy: If you wanted to teach a child to swim, flooding would encourage you to throw the child into the water and assume they will figure out how to get to land. Systematic desensitization would encourage you to bring the child to the water, encourage them to put their toes in the water, then their feet, legs, bottoms, body, arms, shoulders, and finally their face, before moving them off the edge and into the open water.

Related to feeding and mealtimes, it is important to remember that distress evokes an adrenaline response, and this adrenaline response will generally suppress hunger to some degree. Therefore, it is best to avoid distress during mealtimes.

What is the difference between Positive and Negative Reinforcement?

Reinforcement is any response to a behavior that causes an increase in the probability of that behavior occurring in the future.

Punishment is any consequence following a behavior that causes a decrease in the probability of that behavior occurring in the future.

Why doesn’t SOS use oral motor tools to teach children to eat?

Many oral motor programs offer a systematic skill development necessary for oral motor strength and coordination. They may use a pre-set series of whistles, straws, or some other type of tool to help build oral motor strength. In your therapy, you can substitute foods for these “tools”. SOS Approach to Feeding focuses on typical development. We do therapy the same way we see typically developing children learn to eat. Typically developing children do not learn to eat with a pre-set order of tools. They learn to eat with food. If children learn to do oral motor activities with the tools, they do not always automatically transfer these to foods. Therefore, tools can often be an extra step in your therapy. Using foods instead of tools may shorten up the total therapy time.

In addition, oral motor programs are frequently done by the therapist to the child. It is a passive action for the child (i.e., therapist putting their finger in the child’s mouth to “desensitize the gag reflex”). This is NOT systematic desensitization (one of the Tenets of the SOS Approach to Feeding). This is flooding. We want the child to be in charge, and we want the child to be putting things in their own mouth.

How do the new IDDSI guidelines apply to the Developmental Food Continuum?

The purpose of the IDDSI is to standardize practice for labeling texture-modified foods and thickened liquids. In SOS we are not typically using texture-modified foods or thickened liquids. In the Developmental Food Continuum we are not discussing or using texture-modified foods. We are describing the use of typical foods. Using the IDDSI system/language, the majority of the food discussed and used in SOS would all be lumped together under “Regular.

In SOS, we will not be changing our descriptions of foods to match the IDDSI, because it is not relevant for the majority of children that we work with. IF we are working with a child who has a modified diet (like thickened liquids) then YES, we would use the IDDSI to describe the level of thickening for liquids or the modified diet we need to use for that particular child.

As a Dietitian, how would I use the SOS Approach to Feeding? Is it helpful for me to take the course?

We frequently have dietitians attend our training conference and they find the information very helpful in their work. Typically, the dietitians we train use our General Treatment Strategies in their daily dietitian work with children (along with the information about the complexity of feeding and feeding milestones). The part of the training conference that is very specific to how to do Feeding Therapy is also helpful for them because it teaches all the professionals how to think about food from a sensory and oral-motor standpoint (these things being what makes the children unable to eat the nutritious foods that dietitians recommend to families). Understanding how the foods they are recommending may or may not match this child’s feeding skills sets is what determines what foods should be suggested so that the child will have a chance at actually being able to eat those foods.

However, most of the dietitians we train do not carry out the feeding therapy portion of the program independently. While the training conference does train everyone how to do an SOS Approach to Feeding Therapy session, most dietitians do not have enough experience and/or graduate-level training in providing rehabilitative therapy to feel comfortable doing the actual therapy sessions themselves without working in close contact with either Speech Pathologists or Occupational Therapists. The dietitians in my Clinic and others we know who are actually doing therapy sessions have usually started by working with a multidisciplinary team conducting live assessments and then participating as a therapist in an SOS Approach to Feeding Therapy Group, where an OT or SLP are acting as the Group Leader. This gives the dietitian that direct clinical experience they need to feel comfortable than seeing children individually for feeding therapy. Most of the dietitians we know who actively do feeding therapy are also getting supervision for their work with an OT or an SLP to assure their use of the program.

Why don’t you use the ARFID diagnosis? What should we use instead?

ARFID is a diagnosis that the American Psychiatric Association created in 2013 to replace the old DSM IV-TR diagnosis referred to as Feeding Disorder of Infancy and Early Childhood. A number of studies indicated that the prevalence of the DSM IV-TR’s Feeding Disorder diagnosis was only about 3-12% of the population of children with feeding challenges (Burklow et.al., 1998; Rommel et.al., 2003; Field et.al., 2003; Williams et.al., 2009). This low prevalence was due in part to a number of exclusions in the Feeding Disorder of Infancy and Early Childhood diagnosis. To receive this diagnosis, a child needed to be under 6 years of age, they had to have weight loss or failure to gain weight for at least one month, and they could not have a medical or mental health disorder that would account for the child’s feeding problem. It is also very important to note that the DSM IV-TR diagnosis was classified under the developmental disorders section of the DSM (Diagnostics and Statistics Manual). We will come back to this point in just a minute.

Due to low usage, the ARFID diagnosis was created to capture a larger group of children. The age criteria was eliminated, as was the requirement for weight loss or failure to gain weight. Now, any child who is not meeting their nutrition or energy needs can qualify for ARFID as long as one of 4 issues is present: significant nutritional deficiency; dependence on enteral feeding or oral supplements; marked psychosocial issues; or weight loss/growth faltering. In addition, if there is a medical or mental health issue present, the child’s feeding difficulty had to be worse than the average feeding problem seen in children with that same medical or mental health issue. The other major change that was made was that this diagnosis was moved out of the Developmental Disorders of Childhood section of the DSM and moved into the Psychiatric Disorders Diagnoses section of the DSM; specifically into the Eating Disorders section.

There are a number of very significant issues with the diagnostic criteria of ARFID and the move of this diagnosis into the Eating Disorders section of the DSM.

#1 – The shift out of developmental disorders into psychiatric disorders has now psychopathologized feeding difficulties from being a medical/developmental/skill acquisition set of problem to being a mental health disorder (Kirkey, S., 2012. Picky eaters could join ranks of mentally ill. Canada National Post. 1-6.). The world’s leading feeding experts disagree with the American Psychiatric Association’s classification of feeding problems as mental health disturbances. This disagreement was part of the impetus for these experts, with Feeding Matters’ help, to create the new Pediatric Feeding Disorder diagnosis. Dr. Toomey says that it is important for professionals to understand “Feeding issues are all in children’s bodies, not all in their heads”. When children don’t eat, it is because something about their body is not working correctly (Dr. Kay Toomey).

#2 – Because ARFID now is considered an Eating Disorder, any professional who is not an expert in Eating Disorders should NOT be assigning an ARFID diagnosis. For a professional to assign an ARFID diagnosis, they should be a physician, psychiatrist, psychiatric nurse, psychologist or another mental health professional who is allowed to give psychiatric diagnoses. In addition, these professionals should be trained enough to also be comfortable assigning an Anorexia Nervosa diagnosis or Bulimia Nervosa diagnosis in order to be qualified to give an ARFID diagnosis. Many professionals do not realize that they now need a different set of qualifications in order to ethically be able to give an ARFID diagnosis and to not step outside of their scope of practice. Additionally, this move of feeding problems into Eating Disorders excludes most Rehabilitation Professionals (such as Speech Pathologists) from giving this diagnosis to their patients.

#3 – The ARFID diagnosis is now so inclusive that almost any child who is power struggling with their parents about food could qualify for this mental health disorder. This overly broad diagnosis occurs, in part, because there is no clear definition of what is “marked interference with psychosocial functioning”. Does this mean the parent doesn’t like how their child eats or what their child eats? Does this mean the child’s eating is bothersome enough that the parent is asking for help from a professional? Does this mean that the child doesn’t like eating in the school cafeteria, but can do it? Or, does this mean that the child is eating by themselves in their bedroom and that they eat none of the same foods as their family members? Having a diagnosis that is this broad is not helpful to us as professionals or parents, in understanding what is happening with our child/clients/patients.

#4 – The last issue I have with the ARFID diagnosis is with the exclusionary criteria because a) most professionals assigning ARFID are not considering the exclusions; b) there is disagreement in the field whether feeding skills deficits should be part of the exclusionary criteria (Dr. Toomey believes they should be); and c) because to be diagnosed with ARFID in the presence of another medical or mental health issue, your feeding problem has to be worse than the average child with that same exact medical or mental health problem. This latter piece of the exclusionary criteria is the biggest problem with ARFID because we do not have in the field enough data to say what the AVERAGE feeding problem is for children with medical and mental health diagnoses. For example, we cannot say what an average feeding problem is for a child with Cystic Fibrosis or Down Syndrome or Gastroesophageal Reflux is. We don’t know what the average feeding problem is with a child with oral-motor problems or Sensory Processing Disorder or an anxiety disorder. While we have some good ideas about what types of feeding problems children with these issues have, we do not have the data to say what the AVERAGE feeding issue is clearly enough to then say that X child’s feeding issues are bad enough to qualify them for ARFID.

Instead, we use the Pediatric Feeding Disorder diagnosis proposed by Goday et.al. in 2019 and encourage you to use this diagnosis as well.

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