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Seat at the Table
Monday March 28, 2011


Seven-year-old Colin and his family have more to be thankful for at Thanksgiving since the boy began therapy at Feeding Friends Inc. At age 5, the selective eater still was drinking from a bottle and eating pureed baby food. Extended family gatherings underscored his delays.

By working through his difficulties in the peer-based program run by Colleen Wasemann, OTR, MS, and Shellie Mauch, MS, CCC-SLP, Colin overcame his aversions, progressed to age-appropriate foods, became more social at meals and graduated from the program, which is based in Fishers, Ind.

“That Thanksgiving, he went over to the table, saw all the little kids sitting down and pulled up a chair so he could sit down to eat with his cousins and sister at mealtime,” Wasemann says.

Peer-Based Program

Wasemann and Mauch launched the clinic in 2007 after working together in the state’s early intervention program. “As we were working with children with self-feeding delays, oral-motor delays, as well as oral-sensory delays, we found that the peer piece was really missing,” Wasemann says. “Mealtime is not made to be a one-on-one session between the therapist and the child. It really is the whole family and a social peer event.”

Their clients (called “friends”) may have a specific diagnosis such as Down syndrome or autism, while others may have no specific diagnosis, just a history of age-inappropriate eating habits, such as food avoidance, mealtime tantrums, gagging, choking or vomiting. Friends range in age from 2 to 12. The overarching goal is to get children eating appropriately with their families and in social situations.

Groups are made up of two to six children. Younger groups start with circle time, during which they sing, listen to food-related stories, encounter new foods and practice positive peer interactions. They also work on individualized oral-motor therapy using tools in their personalized oral-motor box.

The group moves on to food and sensory play, which includes the introduction of different textures, temperatures, tastes and smells. Other activities may include washing fruits and vegetables. “That is a big step for them to interact and just touch the fruits and vegetables.”

Groups for older children function more like cooking classes. But all the groups end with an interactive mealtime that includes the friends, the therapists and any parents and siblings who want to participate. Meals are served family style, with food passed around the table.

“We try to set up situations so that everybody is successful,” Mauch says. “We might have them cutting up some food or kissing some food, or maybe giving it a lick. We have them interact based on their ability at that point. We have a familiar food for each child so they are comfortable eating at the table.”

Team Approach, Individual Treatment

Children in the Pediatric Feeding Disorders Program at Kennedy Krieger Institute in Baltimore receive intensive, one-on-one treatment from a wide spectrum of healthcare professionals on either an inpatient or outpatient basis. The program, established more than 20 years ago, includes clinicians from occupational therapy, speech pathology, nutrition, social work, medicine and behavioral psychology.

The average age of patients is 4 years old, but ages range from 1 to 12. While some patients may have developmental delays, others may have medical, behavioral or psychological diagnoses. Some children may have missed the usual feeding milestones because of medical conditions requiring feeding tubes or problems with gastro-esophageal reflux, says Gayle Gross, OTR/L, a senior occupational therapist with the program. Gross works with children one-on-one in between meals, often starting with oral motor strength and endurance activities that do not involve food. Therapy progresses to trying new foods. “We work with them to develop those skills needed to help them tolerate a variety of food textures,” she says.

The Institute reports more than 88% of patients’ feeding issues have been resolved or significantly improved by the time of discharge from the typically six- to eight-week program.

Jodi Petry, OTR/L, MS, BCP, SCFES, a pediatric OT who specializes in feeding disorders at Duke University Medical Center in Durham, N.C., has some patients who travel for hours for treatment because too few therapists are trained to work with children who demonstrate selective eating or sensory food aversion. She frequently trains other therapists to use their critical-thinking skills in treating these children. “You need to figure out which techniques work with which child and recognize it when you see another child,” she says.

For example, inexperienced therapists may jump in to correct deficits in tongue lateralization, when in fact they need to start further away from the mouth. “Some kids are at a really low level because so much has been thrust upon them that they couldn’t handle,” she says. In those cases, building trust becomes a critical first step.

Petry begins her evaluations with sensory play. “I look at a lot of tactile media and see how a child manages [with different textures] on the back of their hand. Some kids don’t eat because they don’t like to touch the food.”

Others may have been kept from different foods by their parents because of previous medical issues. “A mother who watched her child gag and vomit with reflux as a baby may become overly protective and won’t let the child eat anything that they might vomit,” Petry says.

The key is developing good interviewing skills, analyzing patterns in food diaries and evaluating the whole child, not just his or her feeding behaviors, Petry says. “Typically, when you’re looking at a child with feeding difficulties,” she says, “you can never start with the mouth.” •

Anne Federwisch is a freelance writer.

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Monday March 28, 2011
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