Feeding Therapy, or Feeding Intervention programs are developed for children who show signs of food selectivity and designed to expand their food repertoires, volume, texture, and other food-related problems. Picky eating can be cause for concern when children do not receive the nutrients they need to thrive.
Research shows that food selectivity often fails to resolve without intervention. Research indicates that the sooner an intervention can occur, the more likely good eating habits will be established and last.
Key identifiers of food selectivity:
- Limited variety of food
- Limited types of texture
- Not eating enough
- Gagging when given a new food
- Vomiting when given a new food
- Refusal of foods
- Inappropriate mealtime behavior
Family coordination is incorporated and treatment is generalized to the home environment, for an end goal of accepting a variety of food, eating together with the family, and increasing the overall nutritional value of meals.
Learn more about how family involvement in this therapy is crucial to the effectiveness of treatment.
Areas targeted within a feeding program:
- Expanding food and liquid variety
- Increasing Volume
- Use of utensils
- Reduction of vomiting
- Cup drinking
Meet the Feeding Team!
Ben Sarcia, MA, BCBA, LBA, BSL
I am a member of the International Association for Pediatric Feeding and Swallowing (IAPFS), as well as a Ph D student in the field of Behavior Analysis. My passion for the treatment of feeding disorders was engendered in 2009 as a graduate intern when I interned at Southeastern Pennsylvania Autism Resource Center (SPARC) in West Chester, Pennsylvania. After obtaining my certification in behavior analysis (BCBA) in 2014, I began working in the Pediatric Feeding Disorders Continuum at the Kennedy Krieger Institute in Baltimore, Maryland. It was here that I was able to gain experience working with children with feeding disorders in an inpatient setting and I also was given the opportunity to conduct and publish research related to the treatment of food selectivity. In 2016 I joined the team at the Verbal Beginnings Center and since that time I have been able to serve families that perhaps otherwise would not have been able to participate in this type of therapy, given the demands of most treatment programs. I have had the opportunity to work with children from age 18 months to as old as 18 years, selective eaters to 100% feeding tube dependent, and even with children who had never learned how to chew. Our team is eager to work with your child and family to develop lifelong healthy eating behavior!
Ahra Jung, M.A., BS – RBT
I earned my Bachelor’s degree in Psychology from Stevenson University in Baltimore, Maryland. As an undergraduate student I interned at Kennedy Krieger Institute on the Neurobehavioral Unit (NBU) working with individuals with severe problem behavior. During my time as an intern, I was first exposed to ABA and saw the positive impact it had on the lives of those individuals and their families. From that moment on my initial plans to continue my education in counseling immediately shifted and I was determined to learn more about ABA in hopes that I could make a positive impact for those families seeking services. In 2010, I began working full-time at Kennedy Krieger Institute on the Pediatric Feeding Disorders Unit working with children requiring various feeding needs such as liquid dependency, g-tube dependency, or food selectivity just to name a few. I joined the Healthy Beginnings team in August of 2019. I recently graduated with my master’s degree from Arizona State University in Special Education with a focus on Applied Behavior Analysis. I hope to become a BCBA in the upcoming months and continue to work with our children and families in Healthy Beginnings.
Dr. Stephanie Nostin, PhD, CCC-SLP, BCBA, LABA
I am a licensed speech-language pathologist and behavior analyst that has extensive experience in feeding and swallowing disorders. I received my PhD in applied behavior analysis from Simmons University in Boston, Massachusetts in December of 2020. I have worked with the pediatric and geriatric populations within school, long-term rehabilitation, acute rehabilitation, hospital, and nursing home settings. I joined the Verbal Beginnings team in February of 2023 as the Director of Comprehensive Services. I have been a leader in the field of speech pathology and applied behavior analysis for almost 20 years. My passion is to promote interdisciplinary collaboration, coordination of care, and best practices among newly matriculated and seasoned professionals.
Clark M. Elliott, MA, BCBA, LBA
I am a Board Certified Behavior analyst with experience in both pediatric feeding disorders and skill acquisition. I received my masters in Applied Behavior Analysis from UMBC in 2021, and became certified and licensed to practice in the state of Maryland in early 2022. During my time at UMBC, I acted as a Behavior Data Specialist and Clinical Specialist I in the Pediatric Feeding Disorders Continuum at the Kennedy Krieger Institute from 2019 to 2022. I originally sought out Verbal Beginnings as a place of employment due to their strong values and emphasis on care, in addition to the existence of the Healthy Beginnings program. While my first year at Verbal Beginnings was spent assisting with the Early Beginnings program in the main center, I have recently come back to the area of feeding where I am excited to use the experience and tools I learned to benefit both the clients and families I will get to work with!
Gwen Pringle, BCBA
I am a Board Certified Behavior Analyst (BCBA) with Behavior Specialist licenses in both Maryland and Pennsylvania. I have extensive experience in early intervention and school based interventions. I began my career as a Kindergarten teacher, while I finished my degree in Special Education. I have taught in many classrooms including Autism Support, Emotional Disturbance, and Multiple Disabilities. I pursued my passion in working with children with Autism by earning my Master’s Degree in Applied Behavior Analysis at Temple University where I interned at Southeastern Pennsylvania Autism Resource Center (SPARC) in West Chester, Pennsylvania. After obtaining my BCBA certification, I worked in a school specifically for individuals with Emotional Disturbance. Since then, I joined the Verbal Beginnings team in 2021 and have returned to working with children with feeding disorders in a family training model at the Verbal Beginning Center in Millersville. I now have the opportunity to work with children in expanding their food repertoire and independent feeding skills. We have an excellent team at Verbal Beginnings that is excited to support your child’s needs in gaining healthier eating habits!
Ryan Sandoval – RBT
I earned my Bachelor’s Degree in Psychology from Towson University. During my studies. When I first learned about ABA therapy I knew it would be an excellent opportunity and great fit. I love working with children and have worked with individuals on the spectrum since high school where I helped lead my school’s chapter of Best Buddies. I worked part time as an in-home RBT for a little over a year with verbal beginnings before transitioning to the feeding department healthy beginnings. Currently, I am excited to begin working full time with healthy beginnings to make a difference in the lives of kiddos and their families! Eventually I plan on obtaining my Masters Degree in Mental Health Counseling. I hope to apply what I learn in ABA to counseling to help create better outcomes for clients.
Jose Guzman – RBT
I will be obtaining my Associates degree in Social Science, Administration, and Health Core (SSAH) from Montgomery College in Fall 2023. I plan to transfer to Bowie State University to obtain my Bachelors degree in Psychology. I have worked with children in many different settings and across a wide range of ages. In Particular, I have served as a sports coach, Sunday school teacher and babysitter. Currently, I lead the Kids ministry at my home church where I have implemented systems to provide children on the spectrum a safe, appropriate, and comfortable environment. My interest in the field of Applied Behavior Analysis (ABA) grew exponentially after I took an introductory course for “Special Education” in my second undergraduate year in 2021. I began my ABA career in July 2022 where I have been doing In-home therapy and continue to do so today. I recently joined the Healthy Beginnings team and it has inspired a deeper interest in the ABA field and more specifically in atypical eating behaviors. It’s been very rewarding working under Ben and it is an honor to serve both the children and families we work with!
Julia Brzozowski, MS, BCBA, LBA
Julia earned her undergraduate degree in psychology at the University of Massachusetts Amherst before going on to obtain her master’s in Applied Behavior Analysis at Regis College. Julia has gained experience in the field at the May Institute for Early Intervention and as a behavior technician at the Regis Autism Center and Kindle Behavior Consultants. She received her BCBA certificate in October 2020 and she then began practicing as a BCBA and Staff Trainer of Behavior Technicians at Kindle. Julia is currently a Clinical Supervisor at Healthy Beginnings and is committed to fostering teamwork and a positive relationship with her staff, her clients and their families.
Why doesn’t my child eat?
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.
Is my child too old for feeding therapy?
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.
What can I expect from the Feeding Program?
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.
What does a feeding protocol entail and what do I have to do?
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.
When should I make changes at home?
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.
How do you measure 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.
How do I maintain the progress that my child made in your feeding program?
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.
Will you use rewards?
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.
What do I have to do for insurance to cover feeding therapy?
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.
Resources and Videos
Evidence-based feeding intervention utilizing the principles of Applied Behavior Analysis (ABA) is one of the only interventions that has proven to be effective through research and replication.