Feeding Therapy

Feeding disorders are common among children with developmental disabilities, as well as children considered to be typically developing. While we may never truly know why your child avoids certain foods, selectivity and refusal may have been related to a prior medical condition. Often times the medical issue may no longer be occurring, but the behavior (refusing certain foods) persists. Additionally, food refusal is a common feature of autism spectrum disorder and was originally a part of the diagnostic criteria. As behavior analysts, we seek to identify the consequences maintaining food refusal in order to develop a plan to promote healthy eating.

No. We work with children from age 18 months to 18 years. It’s never too late to develop healthy eating habits through proper nutrition.

Initially, a BCBA will observe and collect data on the current mealtime behavior with both caregivers and therapists in order to identify any patterns and establish a baseline (what the behavior looks like before intervention). From there, therapists will feed your child utilizing the techniques supported by empirical literature in the field of Applied Behavior Analysis. This often includes the use of reinforcement and strategies to reduce refusal at mealtime. Feeding staff have been given extensive training in all procedures and must complete specific competency assessments before they are allowed to conduct meal sessions.  

Research has demonstrated with consistent intervention food refusal will decrease, and healthier eating behavior will increase. Throughout the feeding process, it is important to remember that refusal took time to emerge and thus, appropriate mealtime behavior will also take time to develop.  

It is common for a child to respond differently to a therapist than they would respond to a caregiver, as they do not have a history with the feeding therapist. Therefore, caregiver training is an important component of any feeding therapy program.  

It is important that your child be hungry prior to feeding sessions. Therefore, we request that you do not feed your child one hour before scheduled meals. It is also important to wait an hour before feeding your child after a meal session, even if the child did not eat during that session.

An individualized protocol will be developed for your child. This protocol includes specific instructions as to what to do during meals, as well as what not to do. It is very important that any caregivers feeding your child implement the protocol the same way each time and that only caregivers that have been trained are utilizing this protocol. For the child to be successful, it is very important that caregivers are adhering to the protocol and not making any changes without communicating with the Clinical Supervisor. Often times, there are multiple components to a mealtime treatment protocol. If one of the components is implemented incorrectly or changed prematurely, it is likely that the child will identify this, which could lead to the protocol becoming ineffective. 

It is very important that no changes in meals are made at home until caregiver training has been conducted. This includes offering any of the new foods being targeted in feeding therapy. Doing so may slow progress. 

Throughout treatment, data are collected and analyzed. Data collection enables us to determine how often bites are taken or refused and thus guide treatment decisions. We also collect data on treatment integrity (how well caregivers feeding the child implement the protocol) in order to determine if the protocol is being implemented correctly.  

Stay in touch! Research has indicated that families who stay in touch with their therapy team do better. Minor setbacks related to illness can occur. Additionally, children who have made progress can sometimes temporarily take a step backwards. Therefore, communication is essential in ensuring that the protocol continues to be applied correctly, as well as determining if any changes are necessary. Before intensive feeding therapy ends, we will have you feed your child at home in order to ensure that the behavior generalizes to other environments. We will also ask you to come back periodically for follow-up appointments.  

Our approach is to implement the least intrusive procedures needed. However, many children require some type of external reinforcement in order to motivate them to take, chew, and swallow bites of new or non-preferred foods. Therefore, we may use toys, movies, music, or games as rewards. We encourage you to communicate to us things that your child likes. If there is a reinforcer that can be saved only for mealtime, children tend to do better with feeding therapy. Throughout therapy, we will assess to determine if reinforcement is still needed or if it can be faded out of meals once compliance is increased and remains consistent. 

If your insurance company covers ABA services for your child and your child has the ASD diagnosis, then the feeding program is covered. The feeding team will conduct an evaluation related to your child’s mealtime behavior. After a review of the results of this evaluation with the caregivers, the recommendations will be submitted to your insurance company as a request for ABA coverage for feeding therapy. The only cost to you is what your plans considers as patient responsibility. To check your plan benefits, click here.

Feeding concerns are common across diagnoses, not just autism. We meet children that have no diagnosis at all, but that never progressed to eat solid foods or even past the baby bottle. The treatment is the same regardless of ASD diagnosis or not.