Description

Handouts

Outline

Prevalence of the Problem

• Picky eating
• Problem feeding
• ARFID

The Complexity of Feeding/Eating

• 7 areas of human function
• How children learn to eat (or not)

How to Complete a Comprehensive Feeding Assessment

• Medical/organs
• Oral-motor skills
• Sensory-motor skills
• Postural and motor skills
• Nutrition
• Learning/cognition
• Environment

Differential Diagnoses Criteria, Research and Limitations

• Picky eating
  • Able to tolerate new foods on plate
  • Decreased range or variety of foods that will eat
  • Frequently eats a different set of foods than the rest of the family
• Problem feeding
  • Restricted range or variety of foods
  • Refuses entire categories of food textures
  • Cries and “falls apart” when presented with new foods
• ARFID
  • Accept a limited diet in relation to sensory features
  • Food refusal is related to aversive or fear-based experiences
  • Extreme pickiness; distractible and forgetful

Treatment Approaches – Align Treatment w/Diagnosis

• Systematic desensitization
• Flooding/escape extinction
• Eating disorders

Case Studies: When Assessments Go Well, and When They Don’t

• Picky eating –
  • Case 1 = 2 ½ year old male with limited number of accepted foods he will eat, variable eating from one day to the next, issues staying at the table
  • Case 2 = 2 ½ year old female with restricted food range, over reliance on liquids for calories and swallowing assistance
  • Case 3 = 9 year, 8 month old male with lack of healthy proteins per parents, and no vegetables in his food range
• Problem feeding –
  • Case 1 = 3 year, 10 month old female with a G-tube, born at 26 weeks gestation, complicated medical history
  • Case 2 = 4.25 year old female born with congenital Rubella, poor weight gain, restricted food range, episodes of gagging and coughing, episodes of refusing to eat
• ARFID –
  • Case 1 = 15 year old male with chronic “chok-y” sensation, significant weight loss, hospitalized in an Eating Disorders program
  • Case 2 = 13 year old male with difficulties eating food at school, restricted food range per parental report, refusal to eat vegetables

Practical Feeding Strategies for Pediatric Feeding Disorder

• Routines and environmental supports
• Matching foods to a child’s skillset
• Reinforcement
• Management of maladaptive behaviors

When to Refer

• Red Flags
• Picky Eater vs Problem Feeder criteria

Faculty

Dr. Kay A. Toomey

Toomey & Associates, Inc.

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Dr. Kay A. Toomey, is a pediatric psychologist with over 30 years of clinical experience assessing and treating children with a wide range of feeding challenges. She developed the SOS Approach to Feeding as a family-centered program for assessing and treating children with feeding problems. Dr. Toomey helped to form The Children’s Hospital – Denver’s Pediatric Oral Feeding Clinic, as well as the Rose Medical Center’s Pediatric Feeding Center. She also acts as a consultant to Gerber Products.

Dr. Toomey co-chaired the Pediatric Therapy Services Department at Rose Medical Center prior to entering private practice. She acted as the Clinical Director for Toomey & Associates, Inc.’s Feeding Clinic for six years and SOS Feeding Solutions at STAR Institute for eight years, and speaks nationally and internationally about her approach. Dr. Toomey is currently the president of Toomey & Associates, Inc., and acts as a clinical consultant to the Feeding Clinic at STAR Institute.

Speaker Disclosures:

Financial: Kay Toomey is in private practice. She receives a consulting fee from Nestle Infant Nutrition/Gerber division. She receives a speaking fee from Education Resources, Inc.; and SPD Foundation/STAR Institute. Dr. Toomey receives a speaking honorarium from PESI, Inc.

Non-financial: Kay Toomey is a member of Feeding Matters.