The Nuance Between a Responsive & Behavioral Approach to Feeding Therapy: Part 2

Part 2: The Case For a Responsive Approach to Feeding Therapy (Missed Part 1: Applied Behavior Analysis (ABA) Professionals & Feeding Intervention? Find it HERE.)   Drawbacks of Behavioral Methods in Feeding Therapy Practitioners who use behavioral modification methods in their therapy sessions do so because they believe them to be useful tools for achieving their agenda of getting a child to eat. I have worked with therapists who use them, have been directly referred patients from inpatient behavioral feeding programs, and have seen many behavioral protocols that parents have been asked to follow within these programs/therapies. My core belief system rejects the idea that it is my job to “get” a child to eat, and therefore it is not necessary for me to use any tool that may cause anxiety in child I am treating, which is often the case when these methods are used. I have heard ABA clinicians use the term “break the child” in reference to the point in therapy where a child ultimately gives up and begins complying with “taking bites” in therapy; this smacks of dehumanization and is cruel, in my opinion. Another explanation for “giving in” could be found in trauma theory. Research is needed to examine if giving in and eating is actually a trauma response. “When the dorsal vagal nerve shuts down the body, it can move us into immobility or dissociation”…that comes after “fight or flight”, where a child is trying to avoid eating whatever the adult is presenting. A child who ‘zones out’ after fighting tooth and nail to avoid something they perceive to be dangerous is not ‘complying’. They are...

The Nuance Between a Responsive &. Behavioral Approach to Feeding Therapy: Part 1

Part 1: Applied Behavior Analysis (ABA) Professionals & Feeding Intervention Your child’s ABA therapist wants to develop a feeding plan for him right away. What should you know? Applied Behavioral Analysis (ABA) began in the 1930’s with BF Skinner, who believed that radical behaviorism was the lens through which we needed to view human motivation. Even though there have been many advancements in our understanding of behavior and motivation, his work continues to be used as the basis for an entire therapeutic and business model. With the advent of neurological imaging technology and the scientific measurement of cognitive processes (DeSouza et al., 2012; Kühn et al., 2014), behaviorism has ceased to be a leading theory of learning. Nevertheless, there has been a surge in the number of ABA clinics and providers around the country, with many integrating ‘feeding plans’ into their therapy sessions with children. I was recently asked to explain how I view the role of behavioral modification principles in feeding therapy and how the therapy model/approach that I practice and promote is different (see part 2 for my answer). Many feeding therapy programs (inpatient and outpatient) and some therapy providers (Speech-Language Pathologists-SLPs, Board Certified Behavior Analyst-BCBAs, etc) use ABA (Applied Behavioral Analysis) methods to “get” children to eat more or different foods than they are currently comfortable eating.  The proponents of these approaches point to research that heavily relies on low-level evidence such as “individual case-control studies, case series, or expert opinion without explicit critical appraisal or based on physiology bench research or “first principles” with small sample sizes” (often one child). I offer my perspective on behavioral approaches as someone trained in college by...

Keeping Your Kids Hydrated in the Heat

It’s summertime and as the weather heats up, staying hydrated is even more important, especially for our little ones! Dehydration can lead to loss of energy, lethargy, irritability, headaches, difficulty sleeping, constipation, fainting and if severe, can lead to more dire consequences*. Sometimes that cranky toddler is really a thirsty toddler, but with regular opportunities to drink and take in food with high water content, almost all children do just fine. (Use common sense around activity on hot days and sun exposure. Some kids are more sensitive than others, so watch your child and maybe skip that all-day soccer tournament when the temperature is in the 90’s!) Here are some tips to keep your children well hydrated and happy during the summer months. Pushing children to do anything around eating and drinking can backfire, so avoid pressuring them to drink more. Instead, try these ideas:   For the child who enjoys strong or interesting flavors, consider offering tart juices like cranberry or pomegranate, or add lime or lemon juice to water. If they seem to enjoy the carbonation of soda, offer flavored seltzer water or mix sparkling water with juice. Turning up their nose at plain water? Consider adding water flavoring like Mio, Hansen’s Natural Fruit Stix, or watered-down juice or Gatorade. Get shaped ice cube trays and make ice from juice or water for a fun addition to water. Let them pick out a special new cup that they can drink from at home and on the go. Keep an insulated cup in the car during days spent driving around in the heat. Show your child how to use the...

The Trauma Trap: Impact on Families and Feeding

Trauma: • an injury (such as a wound) to living tissue caused by an extrinsic agent • a disordered psychic or behavioral state resulting from severe mental or emotional stress or physical injury • an emotional upset   We don’t usually use the word trauma when discussing feeding disorders, but we should.   Children who have experienced significant emotional stress during feeding because of GI discomfort, poor oral control, cardio-respiratory issues, or forced feeding are at risk for disordered behavioral responses around feeding for many months (or years) to come. Infants born prematurely exhibit feeding problems due to neurological and respiratory immaturity and the myriad of issues that can arise while in the NICU. These challenges follow them out of the NICU and into the home, and while being able to go home is a milestone in and of itself, there are many more milestones to overcome when it comes to feeding. “During development, the cognitive, motor, emotional and ‘state’-regulating areas of the brain organize in response to experiences. And in each of the diverse brain systems which mediate specific functions, some element of previous experience is stored.” (Perry, 1999) The infant’s early experiences (good or bad) and their responses during feeding down the road are inevitably linked. Take Nash*, an 18 month old (corrected age) who struggles to get through a meal without gagging and vomiting. Born at 30 weeks gestation, he relied on a naso-gastric (NG) tube for nutrition for 6 months, which involved the trauma of reinsertion when the tube had to be changed as well as the chronic discomfort inherent in the placement of a...

Confessions of a Mommy Feeding Therapist

Working with families who struggle to feed their children on a daily basis, I often hear, “Your kids must be great eaters!” or “I bet you don’t have any trouble at the table with your kids!”.  Well, let me tell you, it isn’t quite that simple. As a feeding therapist, I am confident that what I am suggesting to parents will at least help, and not hinder, their child’s progress with eating. When I am working with someone else’s child, I can see their issues objectively. That makes it fairly easy to navigate next steps and to tease apart what may be going wrong. I have done loads of research and reading on the topic, wrote a book, and provide therapy for children from newborns to teenagers. I do trainings for other therapists, physicians, and students. So you would think I would have all the answers with my own three kids, right? Not so much. At home, things are a little more complicated. Do my kids sit at the table and eat at most meals? Yes. Are mealtimes a beautifully harmonious experience where all three of my children eat complicated dishes with a smile on their face? Hasn’t happened yet- I am still waiting. So what does a feeding therapist’s family mealtime actually look like?  Here is a window into my world: Setting:  We eat at our kitchen table for all meals, using family-style serving. I do a lot of “pile-on” and deconstructed meals and we don’t pre-plate the kids’ food. I work full-time and the kids have lots of activities, so our meals are fairly simple, and I get take-out about once a week....

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