Interventions for Feeding and Eating: Sensory and Behavioral Approaches

picky eater

• very selective about foods

• accepts 30+ foods

• will want to eat certain foods for many days in a row

• may grow tired of a certain food, but will accept it again after a break

true or false: food neophobia is abnormal in toddlers and preschoolers

false

problem eaters

• accept fewer than 20 foods

• strong phobic reactions to new foods

• if food rejected after eating it, may not accept it again

• may reject entire groups of foods 

food jags

period of time when child will only eat 1 or 2 foods 

ARFID (avoidant restrictive food intake disorder)

• eating or feeding disturbance as manifested by persistent failure to meet appropriate nutritional &/or energy needs associated with one+ of the following

  • significant weight loss 

  • significant nutritional deficiency

  • dependence on enteral feeding or oral nutritional supplements

  • marked interference with psychosocial functioning

  • disturbances is not explained by lack of available food, cultural practice, anorexia or other medical condition 

pediatric feeding disorder

• nutrition and psychological manifestations similar to ARFID

• increased manifestations with medical complexities including aspiration or cardiorespiratory compromise

• feeding skills and modifications for texture, position or strategy needed 

Satter’s Division of Responsibility for infants

• parent is responsible for “what”

• child is responsible for “how much”

Satter’s Division of Responsibility for older babies (transitioning to family food)

• parent responsible for “what” and BECOMING responsible for “when” and “where” child is fed

• child responsible for “how much” and “whether” to eat foods offered by parent 

Satter’s Division of Responsibility for toddlers through adolescents

• parent responsible for “what,” “when",” and “where”

• child responsible for “how much” and “whether”

Satter’s perspective on picky eaters

• regular meals and structured snacks so child is hungry (but not starving) at mealtime

• family meals

• keep meals positive rather than pressured

• include 1-2 foods on menu that child likes 

• limits and consequences for behaviors at mealtimes 

feeding errors

• failing to have structured meals

• limiting menu to only foods child accepts

• putting pressure on eating 

Satter on conventional feeding programs: negative reinforcement

• children will eat well when they feel positive about eating and food and are comfortable at family meals

• negative parenting and negative reinforcement undermine child’s positive feelings and comfort with eating 

Satter on conventional feeding programs: food extinction

will really undermine child’s eating attitudes and inclination to eat

escape extinction

non-removal of the spoon, physically opening child’s mouth and putting in food 

systematic approximation

adult-imposed eating related activities, such as chewing on washcloth, sitting in chair at table, having child touch, poke, squish, etc food

Satter on conventional feeding programs: systematic approximation

• children will do their own version of systematic approximation without prompting from adults 

Satter on conventional feeding programs: food / energy prescriptions

• children vary with how much they need to eat

• calculated targets for energy intake can drastically overestimate or underestimate a child’s needs and increase child’s resistance or discomfort with eating

• puts pressure on eating 

food or energy prescriptions

setting targets for how much child should eat

Satter on positive reinforcement

praise, compliments, rewards and other forms of outside reinforcement can take away from a child’s inborn desire to eat and pride in mastery

sequential oral sensory (SOS approach)

transdisciplinary program for assessing and treating children with feeding difficulties

• being near a new food

• tolerating aroma of new food

• accepting new food on plate

• touching a new food

• licking the new food

• tasting or biting new food 

what are the steps to eating using the sensory hierarchy approach?

• tolerates 

• interacts with

• smells

• touch

• taste

• eating 

food exploration activities are ____ NOT _____

play; mealtime

what are some food exploration activities?

• helping to open containers or put away groceries

• cooking or pretending to cook

• helping with grocery shopping

• bringing food into playtime 

food chaining approach

• child will eat foods they like for a reason

• gradual and non-threatening way to introduce new foods

• highly individualized and updated throughout treatment

• used in conjunction with other interventions 

how would you determine a core diet using the Food Chaining approach?

• texture preference

• taste preference

• temperature preference

what are some general recommendations regarding the food chaining approach?

• set expectations

• include child in mealtime prep to make food fun

• learn about food

• no grazing

• shift focus off child during mealtime 

food chaining rating scale: 1

this is awful and I don’t want to eat this. I don’t feel good around this food

food chaining rating scale: 2

I don’t like this food, I want to try something else

food chaining rating scale: 3

I’m not sure about how much I like it, but I will try it again

food chaining rating scale: 4

I really like this and want to try more

food chain rating scale: 5

I will eat this food at home or anywhere; I love this food 

food chaining: flavor masking

sauce or dip used to mask flavor of new food; allow a preferred condiment when new food is introduced and gradually decrease amount of sauce

• works best for children who have already accepted sauces or condiments

food chaining: traditional flavors

old favorites used to coax a child to try a new food; help “cleanse palate” to an aversive aftertaste of new food

food chaining: surprise foods

offer new foods that are significantly different from core diet 1x/week; do not pressure child to try it

• child should be involved in preparation or presentation can be a game