INTRODUCTION TO THE SOS APPROACH TO FEEDING PROGRAM

(Sequential-Oral-Sensory)

The SOS Approach to Feeding is a Transdisciplinary Program designed to assess and treat
children experiencing difficulties with feeding and/or weight/growth. It was developed across
three decades of clinical work by Dr. Kay Toomey, along with colleagues from several
disciplines, including Pediatricians, Occupational Therapists, Registered Dietitians, and Speech
Pathologists, and is informed by the latest research in the field.

This program adopts a holistic approach, integrating motor, oral-motor, learning, medical,
sensory, and nutritional factors, to identify the underlying causes and skill deficits contributing to
a child’s feeding and growth challenges. It is based on, and grounded philosophically in, using
typical development as our “blueprint and map” to help teach the needed skills for eating, while
recognizing that each child’s individual neural capacity, learning abilities, physical needs, and
environment may mean that they have a different path. The SOS Approach to Feeding is
designed to meet every child at their current level, building upon their strengths to achieve the
next skill.

During feeding therapy, the SOS Approach focuses first on increasing a child’s comfort level by
exploring and learning about the different properties of food. Using a systematic desensitization
approach and following a hierarchy of skills and behaviors, children learn to progress with eating
various textures of foods. The program allows a child to interact with food in a playful, non-
stressful way, beginning with the ability to tolerate the food in the room and in front of him/her,
then moving on to managing the smell of the foods, learning about how foods feel on the body
and in their mouth, and then enjoying tasting and eating new foods following the SOS Steps to
Eating. As children gain better eating skills, we often see improvements in the child’s growth
pattern.

SOS APPROACH TO FEEDING: BASIC TENETS

 TENET 1 = Myths About Eating interfere with understanding and treating

feeding problems.
 TENET 2 = Systematic Desensitization is the best first approach to
feeding treatment.
 TENET 3 = “Normal Development” of feeding gives us the best blueprint for
creating a feeding therapy plan.
 TENET 4 = Food Hierarchies/Choices play an important role in feeding
treatment.
 TENET 5 = Play with a Purpose is the best way to teach children feeding skills.

ASSESSMENT/DIAGNOSTIC PHASE

The Assessment Phase of the SOS program usually begins with a direct referral. This may
be from the child’s Pediatrician but may also be from individual therapists in the community,
early childhood interventionists and/or programs, preschools, schools, other medical
specialists and/or the child’s parents.

We acknowledge that accurate assessment and differential diagnosis of Pediatric Feeding

Disorder requires a transdisciplinary approach, which is documented as the standard of
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Toomey & Associates, Inc.
care in the field. Therefore, the SOS Approach to Feeding Program strives for a
Transdisciplinary team evaluation, ideally consisting of the following professionals: Medical,
Mental Health, Occupational Therapist, Speech Pathologist, and Registered Dietitian. All
five professionals together observe the child eating with his or her primary caregivers either
in the child’s home or a clinical setting, evaluating the “whole child” by looking at all seven
different areas of human development: organ systems, muscles (including oral motor),
sensory integration and processing, learning/behavior/cognition, development, nutrition and
environment. During an SOS feeding assessment, the child is first offered their preferred
foods, so that their skills with foods they typically eat can be observed. Then the child is
introduced to a few new or not-yet-eaten foods, so that the professionals can assess some
of the underlying reasons why these foods may be challenging for the child. Throughout the
assessment, the child’s strengths and challenges across all 7 areas of human functioning
are identified.

When looking at the 7 different areas of human development that may impact a child’s
eating and their feeding challenges, the SOS Approach to Feeding Program evaluates how
this may be addressed within the larger Pediatric Feeding Disorder diagnosis. Pediatric
feeding disorder (PFD) is defined as impaired oral intake that is not age-appropriate and is
associated with medical, nutritional, feeding skill, and/or psychosocial dysfunction (Goday et
al., 2019).

Used with permission from Feeding Matters

TREATMENT PHASE

After conducting the initial Feeding Assessment, a personalized treatment plan is created to
meet the unique needs of each child. The course of treatment is influenced by various
factors such as the child’s and family’s immediate priorities and needs, insurance/financial
constraints and the setting in which therapy takes place. Our treatment modalities may
encompass individual therapy sessions, group therapy sessions, or a structured home
program with ongoing support and follow-up. Regardless of the specific treatment modality,
the strategies used remain grounded in the fundamental principles of the SOS Approach to
Feeding.

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Toomey & Associates, Inc.
The SOS Approach to Feeding is a strengths-based, family-centered program that
prioritizes intrinsic motivation. The therapist must build a trusting relationship with the child
and their family to learn what is intrinsically motivating for them. Food serves as a tool to
teach eating skills, considering the food’s sensory qualities and motor demands, and the
child’s oral motor, motor, sensory and cognitive skills, along with their past food experiences
and ideas. Play-with-a-Purpose is tailored to the child’s individual interests and
developmental age. Children learn best through play. Therefore, incorporating the child’s
interests at the ‘just right’ level of interaction with the food improves their intrinsic motivation
and helps them learn to manage the qualities of that food adaptively.

Systematic Desensitization is used to teach the child new skills in a way that respects the
child’s readiness to learn them. The child is invited to play with an adult, moving up and
down a series of Steps to Eating, based on the child’s interests, engagement, and comfort
level with the food. The child’s nervous system guides the pace of learning, with therapists
adjusting their play and teaching based on the child’s cues. The therapist continuously
evaluates the child and responds to the child’s body and communication. Signs of stress or
distress in the child signals the therapist to move back down to a lower Step to re-regulate
the child. 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. Progress is child-led,
avoiding demands on eating specific foods or volumes.

Our Therapy Meal routine optimizes learning experiences with food. Every component of
the treatment routine serves multiple therapeutic purposes. The big body warm-up segment
ensures the child is regulated before learning about foods. A consistent routine at the table
is used to support this regulation and availability of the child for engagement before
introducing the food. Then, each food is presented one at a time in the form of a Food
Hierarchy. The therapist utilizes Play-with-a-Purpose to facilitate skill development and
movement up the Steps to Eating Hierarchy. At the end of the session, a clean-up routine
provides a clear ending for the end of the session.

A parent education lesson takes place at the beginning or end of the described routine. The
SOS Approach to Feeding Program actively involves the child’s caregivers in therapy to
help them understand their child’s communication and cues, so parents and professionals
can create highly individualized home programs. Caregivers are supported so they can be
successful in helping their child to engage in meaningful mealtimes in their home and
community in a way that respects the child and family’s culture and priorities.

TREATMENT SUCCESS

Success in our program is a collaborative journey, where goals are co-created between the
child, the child’s feeding team, and their family, ensuring alignment with the family’s unique
needs and aspirations. The SOS Approach to Feeding aims for children to develop the
capacity to engage confidently with a diverse range of foods, in a variety of settings, with
their parents and other caregivers in their lives, as well as with their peers. The SOS
Approach helps children to develop a positive relationship with eating, including the social
aspects of mealtimes and dietary variety for nutritional health and appropriate growth.

Copyright 2024
Toomey & Associates, Inc.