Refusal to Eat
This sensory strategy can help a child tolerate new textures by exploring food in a non-pressure way.
What is child-led or play-based feeding?
Name one sensory strategy that can help expand a picky eater's food repertoire.
What is food exploration through touch, smell, or play?
Name one oral motor tool that can improve lip closure and saliva control.
What is chewy tube, z-vibe, or straw?
This textured oral motor tool can improve tongue movement and reduce drooling.
What is Z-vibe?
True or False: The Sequential Oral Sensory (SOS) approach has been proven effective for treating feeding difficulties based on research.
What is false?
This visual tool can help children anticipate mealtime expectations and transitions.
What is a visual schedule?
This behavioral strategy rewards small steps toward food acceptance without forcing a child to eat.
What is positive reinforcement or shaping?
This behavioral strategy encourages swallowing by prompting the child to consciously clear their saliva.
What is verbal, tactile, or visual cues?
Name two tools you can use to transition a child from bottle drinking to straw drinking.
What is sucking from a pouch, assistive straw cups (honey bear), etc.
What evidence-based therapy emphasizes oral stimulation to improve feeding readiness in children with sensory or motor delays?
Beckman Oral Motor Therapy
Name two environmental modifications that can reduce anxiety for children with food refusal.
What is reduced visual stimuli, consistent seating arrangement, 1-2 familiar foods to non-preferred ratio, etc.?
How can seating and positioning impact a picky eater's willingness to try new foods?
What is proper support for stability helps reduce anxiety and improve focus on eating?
This positioning strategy can help improve postural stability, helping a child feel more secure during mealtimes and improve secretions.
What is the 90-90-90 rule (hips, knees, and ankles at 90 degrees)?
These tools help children with oral motor delays practice chewing and biting with small, manageable pieces of food, often used in the transition from purees to solids?
What are silicone feeders and side biters?
True or False: A structured mealtime approach helps children with feeding difficulties feel more comfortable and less anxious during meals by proving predictable and consistent mealtime environments.
What is true?
This sensory strategy involves gradually increasing a child's tolerance to new food textures by starting with dry or crunchy foods before introducing wet or mixed textures.
What is texture grading or hierarchal desensitization?
Name the mealtime guide that improves a child's food repertoire by following a consistent mealtime routine.
What is the merry mealtime guide?
Name two sensory strategies that can improve oral awareness and reduce excessive drooling.
What is cold stimulation (frozen spoons, toothette dipped in ice water), vibration tools, oral motor tools, etc.?
This tool is designed to slow the flow of liquids, improving safety for children with dysphagia.
What is flow-controlled valves, specialty straws, or weighted straw cups?
Name an evidenced-based therapy approach that integrates sensory processing strategies to address issues like gagging or food avoidance by helping children better tolerate various textures and smells.
What is sensory integration therapy for feeding?
A 5-year-old child diagnosed with Down Syndrome gags immediately when new foods are presented.
Name one primary impairment and describe the sensory, behavioral, and environmental strategies you would combine to improve the child’s acceptance of novel foods.
Primary Impairment: What is oral sensory processing, oral-motor deficits (due to hypotonia), and behavior?
Sensory, Behavioral, and Environmental Strategies: What is sensory desensitization, oral-motor tools, visual schedules, offering smaller portion sizes, and maintaining consistent mealtime routines?
A 4-year-old child diagnosed with Autism Spectrum Disorder refuses all fruits and vegetables. Their parents report they throw food off the table and do not remain seated at the table for longer than 2 minutes.
Name two primary impairments as well as sensory, behavioral, and environmental techniques you would use to improve their acceptance of these foods.
Primary Impairments: What are sensory processing difficulties, hypersensitivity, and challenges with organization of behavior?
Sensory, Behavioral, and Environmental Techniques:
Visual exposure to fruits and vegetables
Introducing dried fruits or vegetable chips to provide texture variety
Pairing fruits and vegetables with preferred dips to enhance acceptance
Involving the child in meal preparation to increase engagement with foods
Providing a calm and distraction-free environment during meals
Maintaining a consistent mealtime routine to improve predictability and reduce anxiety
A 3-year-old child diagnosed with Cerebral Palsy frequently drools due to low oral tone and muscle weakness. They are currently NPO but are cleared for small tastes. Their parents report they have been hospitalized in the past 6 months due to aspiration pneumonia.
Name two primary impairments and develop a plan of care (POC) consisting of sensory, behavioral, and positioning techniques.
Primary Impairments: What are poor oral-motor control and coordination, impaired swallowing, saliva management challenges, and postural instability?
Plan of Care (POC):
Vibration to improve oral awareness and stimulate sensory input to the inner/outer oral musculature (z-vibe, vital stim, etc.)
Verbal, tactile, and visual cues (prompting the child to swallow using touch under the chin, visual reminders, or verbal instructions) to assist with swallowing coordination and reduce aspiration risk
Upright postural support with proper head and trunk alignment (ensuring the child sits fully upright with a supported head and trunk during feeding) to improve safe swallowing and reduce drooling by maintaining optimal swallowing posture
A 2-year-old with hypotonia and sensory aversion struggles with transitioning to textured foods and has weak lip closure, making straw drinking difficult.
To improve oral awareness, increase oral motor skills, and assist with the transition to solid foods, name two oral motor tools you would use in therapy to target primary impairments.
Primary Impairments: What are hypotonia, sensory aversion, and oral motor delays?
Oral Motor Tools:
A Z-Vibe to increase oral awareness, improve lip closure, and stimulate sensory input in the mouth for better motor control
Kinesio tape to enhance sensory awareness and activate buccal/labial muscles
Silicone feeders or side-biters to allow safe introduction of solids in small, manageable amounts
A beginner straw cup to improve lip closure and coordination for drinking
A 4-year-old with low oral motor tone and poor jaw stability struggles to chew solid foods and maintain lip closure when drinking from a straw. They also have difficulty sitting through meals and often refuse new foods after one attempt.
Based on evidence-based practice, name two therapeutic approaches that can be used together to improve their oral motor skills and mealtime participation.
What are Beckman Oral Motor Therapy and a Structured Mealtime Approach?