SOS Approach to Feeding

SOS is Research Driven and Evidence Informed. Below are some of the references that justify the SOS approach to feeding therapy.

• Recognizing that society has many myths around eating and mealtimes which are not helpful when trying to support children who struggle to eat. Research disputes these myths showing they are false. (Acar et.al., 2021; Ahmed et.al., 2017; Archambault & Coceani Paskay, 2019; Balantekin et.al., 2020; Birch & Doub, 2014;  Black & Hurley, 2017; Bryant-Waugh et.al., 2010; Burklow et.al., 1998; Carruth & Skinner, 2000;   De Jesus et.al., 2019; Delaney & Arvedson, 2008; Delaney et.al., 2021; Emond et.al., 2020; Field et.al., 2003; Franceschi et.al., 2021; Frerichs et.al., 2016; Green et.al., 2017; Harrison et.al., 2015; Hirsh-Pasek et.al., 2022; Jansen et.al., 2017; Khamis et.al., 2019; Krom et.al., 2020; LeReverand et.al., 2014; Liu et.al., 2017; Loth et.al., 2023;  Mason et.al., 2005; McSweeney et.al., 2013; Motion et.al., 2001; Mura Paroche et.al., 2018; Overby et.al., 2020; Rachwani et.al., 2015; Ramos et.al., 2021; Reilly et.al., 1999; Reynolds et.al., 2023; Rohlfs-Dominguez et.al., 2020; Ross & Fuhrman, 2015; Ryals et.al., 20016; Seiverling et.al., 2019;  Selbuz et.al., 2019; Simione et.al., 2018;  Suarez et.al., 2017;  Telles & Macedo, 2008; Torola et.al., 2012; van der Veek et.al., 2019; van Vliet et.al., 2021; Ventura & Birch, 2008; Wilensky et.al., 1996; Williams et.al., 2009;Yi et.al., 2013). View the Top 10 Myths

• Continuing to evolve our clinical reasoning and practice as new research is published with:

  • 267 scholarly articles and research studies comprising the foundational information about feeding development and the unique challenges faced by children with feeding difficulties as taught in the SOS Main Training Conference,

  • 130 studies providing support for the therapeutic strategies and techniques that comprise the SOS Approach to Feeding program, and

  • 14 studies about the efficacy of the SOS Approach.

• Acknowledging that accurate assessment and differential diagnosis of Pediatric Feeding Disorder requires a transdisciplinary approach which is documented as the standard of care in the field (Goday et.al., 2019).

• Documenting progress clearly in every session using the Steps to Eating allows precise tracking of skill acquisition and recording of other important measures of change (e.g., increased comfort around food, more independent use of problem-solving strategies, safe and enjoyable participation in family meals). This documentation provides data regarding more nuanced progress beyond just eating of new foods or specific volumes.

In SOS, Play-with-a-Purpose matches that child’s individual interests and cognitive age. This means we:

• Embody the idea that learning to eat can be enjoyable. Children learn best through play, and incorporating their interests at a level they are physically capable of playing improves their intrinsic motivation.

• Recognize that children play and learn differently at different cognitive ages. Maximizing children’s engagement in meaningful play requires knowledge of how each child understands the world. A child’s understanding of and ability to interact with the world changes as they develop cognitively.

• Utilize Systematic Desensitization to teach a child new skills that respects the child’s readiness to learn those skills, which is different than what many programs using extinction, exposure and/or negative reinforcement procedures call “desensitizing” a child. These adult-controlled procedures are flooding the child.  When systematic desensitization is used correctly, the child is always in charge of the pace of progress.  A child is invited to play with an adult, moving up and down a series of Steps to Eating based on the child’s interest, engagement, and comfort level with the play.  The Therapist continuously evaluates the child and responds to the child’s cues.  When a child indicates that they are becoming stressed or distressed during the play, the adult’s job is to back down the Steps to Eating and to help the child become re-regulated.  The child is allowed to move through the steps towards learning to eat at their own pace versus being required to comply with an adult's demand to complete a particular step, eat a specific food, or consume a required volume of food or fluid.

• Allow a child to move up and down the Steps to Eating as they are ready helps the child remain in the present moment to learn and build new brain pathways instead of masking, shutting down or tuning out.

• Acknowledge that children may have experienced other external stressors prior to coming to therapy, potentially making it more difficult for them to engage in learning to eat. Because a child’s readiness to play can change from session to session or week to week, SOS Therapists always adjust how they interact with each child to respect that child’s readiness that day to play and learn.

SOS utilizes food to help a child learn how to eat.

Eating is the most complicated sensory task that children participate in due to the simultaneous integration across all 8 sensory systems.

The sensory properties of food change constantly from one presentation to the next, and during chewing and swallowing. Therefore, using food (versus toys, objects or tools) to help build sensory skills is more effective and efficient.

1. Looking at the food: First we must tolerate the physical presence or the look of the food. This might even include just being in the same room as the food.

2. Interacting with the food: Then, perhaps, we can interact with the food without directly touching the food to your skin, maybe by using a kitchen utensil like a mini food chopper or a fork. 

3. Smelling the food: Next, our body needs to process and manage the smell or odor of a food. 

4. Touching the food: The play then expands to include touching the food with your fingers, hands, body, and mouth. Think about that baby first learning to eat!

5. Tasting the food: Tasting comes next, which might look like quickly poking the food with the tip of your tongue, or maybe putting the food in your mouth, and spitting it out.

6. Chewing & Swallowing the food: Finally, we are ready to practice chewing and swallowing so that eating can officially begin.

Yes, supporting children in being able to get adequate nutrition to flourish in a manner that matches their skill and comfort level.

Some children may be primarily ‘social eaters’ who participate in meals and eat for enjoyment but receive most of their nutrition through supplemental tube feedings or shakes.

Others may always have a more limited diet but can learn to adapt the food available to them (such as in a restaurant, a friend’s house or when traveling) in a way that comfortably meets their basic nutritional needs.

SOS understands that eating similar foods can be useful for some children while at the same time supporting enough variety in the diet to maintain good nutrition and to avoid “burning out” and losing foods from their food repertoires.