What is the SOS Approach to Feeding?
The SOS (Sequential-Oral-Sensory) Approach to Feeding is an evidence based clinical program recognised internationally for helping children build a healthy and enjoyable lifelong relationship with food.
The Approach is focused on assessment and treatment of problematic feeding behaviours in a variety of settings.
It is a multidisciplinary approach in which the Speech and Language Therapist, Occupational Therapist, Paediatrician and Dietician all work together with the family to evaluate and deliver intervention on the whole child. This includes considering the child’s sensory systems, motor components, learning and development factors, nutrition aspects and the environment.
Who benefits from this approach?
The SOS Approach to Feeding is ideal for children who present as picky eaters or problem feeders.
Below are some of the common characteristics to both the categories:
- Strong food preference (taste, texture, how the food is prepared and presented)
- Limited variety of food: less than 30 foods
- Difficulty/Refusal in accepting new food
- Gets upset during mealtime more than peers
- Long duration of feeding difficulties
- Long duration of feeding difficulties
- Growth or nutrition problems
How common are feeding difficulties?
Research suggests that between 25% and 33% of children present with feeding or growth issues before the first 10 years of life. Out of the population of children with feeding difficulties, only 33% to 50% outgrow picky eating without professional support; the rest will continue having significant feeding problems over time that impact their growth and lives.
These outcomes are important to understand if your child presents with feeding difficulties. Early intervention is crucial in addressing feeding difficulties. If your child presents with feeding difficulties it is fundamental to ask for help to feeding professionals early in the stage of the problem.
Children of Determination have a much higher risk of having feeding problems. For example, Seiverling et al (2018) found that 61% of children on the autism spectrum have at least one feeding problem. Similarly, Philips et al (2014) reported that children with developmental disabilities are 60% more likely to be underweight or overweight.
What are the main causes of feeding difficulties?
Often parents blame themselves for their children’s feeding difficulties, but this is rarely true. Research shows that 93 to 97% of feeding difficulties are caused by a combination of the child’s body factors and only in 3 to 7% there is a parental component impacting on feeding difficulties.
The main reasons children won’t eat are:
- Pain
- Discomfort e.g. constipation
- Delay in Motor and Oral-motor skills
- Sensory Processing difficulties
- Learned patterns and feeding behaviours
- Nutritional deficiencies
Children who present with feeding difficulties have something about their body that is not functioning well. A comprehensive Feeding Assessment delivered by a trained multidisciplinary team is crucial to understanding the child’s wholistic needs.
What to expect in the initial feeding assessment?
The SOS Approach to Feeding is designed to assess and address all the factors involved in feeding difficulties.
Before the feeding assessment our team will require you to fill a food diary. You will need to record everything your child eats for 3 days to help us understand the presence and severity of the feeding difficulties. You are welcome to send us the food diary along with any previous doctor and therapist reports.
In the initial assessment, our feeding therapists will gather information from you and will observe your child during play and during a meal. You will be asked to bring a meal consisting of three preferred and the non-preferred foods. Our therapists will then observe your child’s initial responses to all aspects of the process and the meal, as well as assess their skills (oral, sensory, motor, postural, cognitive) and their reaction to the foods, the new environment and people.
After the assessment, you will be given recommendations based on the observations and the assessment made.
What to expect during the intervention?
The SOS Approach to feeding intervention consists of direct therapy with the child and education of the parents. Both the components are crucial to achieve an improvement in the feeding habits of the child.
Our feeding therapists will guide you in a learning journey to understand more about your child’s feeding behaviours, deliver strategies and recommendations to use in your home and teach you how to deliver family meals. In the family meals the main goal is to model good feeding behaviours for the child. The parents and the siblings act as role models who set good examples and offer encouragement as needed. Essential factors are imitating child’s eating and make the food fun. Therapists will teach you how to structure meals and snack times and dos and don’ts during family meals.
At the same time, the child will attend therapy sessions with our feeding therapists at High Hopes Center. The aim of these sessions is the therapy meal. During the session the child will be supported to become more comfortable by exploring and learning about the different properties of food. In the therapy meals the child will be supported in interacting with food in a playful, non-stressful way, beginning with the ability to tolerate the food in the room and in front of him/her, then moving on to managing the smell of the foods, learning about how foods feel on the body and in their mouth, and then enjoying tasting and eating new foods following the Steps to Eating.
The goals of the therapy meal are to build new skills that are essential to exploring new foods and to foster positive and successful experiences with a wide number of foods. In addition, feeding therapy aims to decrease resistance to touching, tasting, and swallowing a variety of food. The SOS Approach to feeding is based on systematic desensitization techniques and behavioural strategies, considering the normal development of feeding and using play as it is the most powerful tool to learn new feeding skills.
The final aim of the SOS Approach to Feeding is to increase the range of food the child will tolerate and to increase the volume of food they ingest.
The feeding intervention at High Hopes Center can take place in individual therapy sessions or in group therapy. The length and the frequency of the treatment varies based on the child and/or family needs. After the assessment, our therapists will be able to give you individualised intervention plan based on your child’s needs.
How successful is the SOS Approach to Feeding?
The literature has shown the SOS Approach to Feeding to be very promising and effective. In one study children attending SOS Approach to Feeding sessions between 2000 and 2006 exhibited an average weight gain of 1 pound (0,450 kg) and height gain of 1 inch (2,54 cm) after successfully completing 12 weeks of intervention.
Boyd (2007) has provided interesting information on the number of new foods after the intervention. Data showed that from evaluation to end of the treatment (12 weeks) children had introduced an average of 42% of new foods in their diets.
If you have any concerns about your child’s feeding behaviour, please reach out to our SOS trained feeding therapists who can help you to better understand your child’s needs and set them on a path to better nutrition and growth.
Sources:
- https://sosapproachtofeeding.com/
- Boyd, K. (2007). The Effectiveness of the Sequential Oral Sensory Approach Group Feeding Program. Dissertation Abstracts.
- Phillips, K.L., Schieve, L.A., Visser, S., Boulet, S., Sharma, A. J., Kogan, M.S., Boyle, C.A., & Yeargin-Allsopp, M. (2014). Prevalence and impact of unhealthy weight in a national sample of US adolescents with autism and other learning and behavioral disabilities. Journal of Maternal and Child Health, 18, 1964-1975.
- Seiverling, L., Towle, P., Hendy, H.M., & Pantelides, J. (2018). Prevalence of feeding problems in young children with and without autism spectrum disorder: A chart review study. Journal of Early Intervention, 1-12.
- Toomey, K.A. & Ross, E.S., (2019). Behaviorally based feeding problems. In Suiter, D.M. & Gosa, M. (Eds.), Assessing and Treating Dysphagia: A Lifespan Perspective. NY: Thieme, pages 249-263.
- Toomey, K.A. & Sundseth Ross, E. (2011). SOS Approach to Feeding. American Speech-Language Association, 82-87.