Feeding Therapy Introduction

 For those of you without tube feed children, you probably don't know why a child would need feeding therapy.  Well, there are truly children in this world who refuse to eat.  I don't mean being a picky eater, or one who struggles to eat vegetables.  I am talking about kids that have had so many physically traumatic medical events, or children with heightened sensory issues, or children who have suffered allergies, GERD, or constant vomiting, that their ability and desire to intake orally is not sufficient enough to survive.  Not only are there medical reason for food refusal, they have developed behavioral issues because of the medical issues.

Many may also wonder why parents and guardians would put forth Herculean efforts in order to get their children to eat orally when the child has a g-tube?  Some parents do decide to not push for oral feeds, and that's their prerogative.  However, there are parents like myself who want to push their children to perform tasks like other children their age.  We want our children to develop normally and meet important developmental milestones. We desire our children to overcome the heavy challenges placed in front of them.  We want our children to sit down with their friends and family and eat, just simply eat.

How do parents and therapists most effectively help a child with a feeding disorder eat?  There are many philosophies about how to best help a child eat.  I think the answer for each family will be based on the severity and medical needs of their children.  However, a family must be careful to follow the philosophies that are based on scientific evidence, not ones that are based on "feel good" ideas.  Always ask a feeding clinic what their success rate is and how that rate was determined.   If there is a high success rate you can feel confident you can find some success there as well.

You will also need to look for clinics that follow a multi disciplinary model. You need a pediatrician or GI doctor following closely with the feeding.  You will need Occupational Therapist and a Speech Language Pathologist as they help build the muscles and swallowing skills needed to eat orally.  You will need a nutritionist to follow your child's weight gain. You will need a behavior therapist to modify behavior that prevents your child from eating.  Even if you do not have a clinic that has all the disciplines together in one place, you will want to find doctors and therapists that will coordinate with each other.  As the parent you may need to be the one that coordinates the professionals and make sure they are all working together for your child.

You will find many clinics that focus on making the child feel good in the meal, and making a meal a happy time.  This may be a good place to start getting the child with eating disorders to be able to touch the food and become desensitized to the different textures of food.  In some instances this therapy can help kids who do not have severe feeding disorders.  However,  for most severe children it does not help them change their behaviors when it come to eating enough to support themselves.  For this advanced therapy behavior modification with strict protocols prescribed by a BCBA (Board Certified Behavior Analyst) is needed.   Behavior analysts observe and record behavior,  then they use solid data which indicates what works to reinforce or change behavior. These behaviorists are the real magic makers.  They tie all the therapy and medical needs into real behavior changes.

Watch out for therapies that want the child to only touch the food, kiss the food then throw away, or to chew the food and spit.  You must be very careful not to increase the child's inappropriate behavior toward food.  This may seem like an good way to get the child to eat, but any therapy that allows the child to "escape" from actually swallowing the food will ultimately lead to that behavior being reinforced.  That is why you really need to find a clinic or behaviorist that understands how critical it is to work on intake, not just food exposure.