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Monday Medical: Kids — play with your food

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If there’s one thing most kids have heard at the dinner table, it’s, “Stop playing with your food.”

But playing with food is actually an important way for children to learn about foods. That’s especially true for children who have health conditions, such as Autism spectrum disorder, Down syndrome, fragile X syndrome or other sensory or oral-motor issues, all of which can lead to challenges with eating.

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“We want kids to be comfortable with food,” said Sally Hertzog, speech-language pathologist with SportsMed’s Pediatric Therapy Services in Steamboat Springs. “If they don’t feel pressured to eat something, they may be more likely to interact with and enjoy food.”

Hertzog and occupational therapist Laura Bratt were both recently certified in the Sequential Oral Sensory Approach to feeding, which was developed by Dr. Kay Toomey through the course of 20 years to help children who have difficulties with eating. Those difficulties can include a very limited diet, eating very slowly or in small quantities or even refusing food, all of which can lead to poor nutrition and challenges in gaining weight.

Pediatric Therapy Services now offers a Pediatric Feeding program several times per year. The program is headed by Hertzog and Bratt and will eventually involve a pediatrician and a dietitian.

The program’s first aim is to determine why a child is avoiding foods. Weaknesses in the mouth or throat might make it hard to chew or swallow foods, while sensory issues can be accentuated by the act of eating, which involves touch, sight, smell and taste. Learned behaviors also come into play: If a child has a negative experience with a certain food or feels fear or pressure when eating, he or she might avoid that food in the future.

Next, the child is slowly introduced to new foods. The child first learns to tolerate having the food nearby, then to interact with it with a spoon or paintbrush. Eventually, the child moves to smelling and touching the food. Tasting and finally eating the food come last.

“You’re working from distal, or from a distance, to proximal,” Hertzog said. “You’re trying to get food closer to a child’s mouth through a progression of steps: tolerance, interaction, smell, touch, taste, eat.”

Each stage of the process can present challenges: Some children can’t stand the feel of gooey foods on their hands. That’s where the play enters.

Therapists might encourage a child to paint yogurt on his or her lips like lipstick or push it around to build a house. Or a child might blow bubbles in a new drink — which requires touching the juice to their lips.

“They look at it as a game,” Hertzog said. “They’re not thinking about eating it; they’re thinking, ‘This is fun.’”

The program takes place in a group setting, so children can watch their peers experiment with new foods. To graduate, children are comfortable eating 10 different foods in each of four categories: protein, starch, fruit or vegetable and liquid.

Parents play an important role in the process and are taught how to incorporate the techniques at home, so progress can continue.

And while success can take time — parents shouldn’t expect their child to start gaining weight or eating a well-rounded meals immediately — children are building skills that will help them for a lifetime, all while gaining a sense of accomplishment.

Hertzog described one child who had never tasted a carrot before, and through the program, she has done just that. “She was proud she could tell her parents she had tried a carrot,” Hertzog said. “It’s very rewarding to the staff, but it’s also rewarding to the child.”

For more information about the new Pediatric Feeding program, call Pediatric Therapy Services at 970-879-8826 or SportsMed at Yampa Valley Medical Center at 970-871-2370.

Susan Cunningham writes for Yampa Valley Medical Center. She can be reached at cunninghamsbc@gmail.com.

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