What is the SOS Approach to Feeding?

When appropriate, the Brooklyn Feeding Academy utilizes the SOS (Sequential Oral Sensory) approach. The SOS feeding program is a non-invasive developmental approach to feeding. This approach was developed by Dr. Kay Toomy, a leading child psychologist specializing in childhood feeding disorders. The program focuses on increasing a child's comfort level exploring and learning about the different properties of foods, including texture, smell, taste and consistency. The SOS approach allows your child to interact with food in a playful, non-stressful way.

The SOS approach follows a hierarchy to feeding, beginning with the basic ability to tolerate food in the room, in front of him/her, touching and eventually tasting and eating foods.

Parent education and involvement is an important part of this feeding approach. We work directly with parents while they participate in each feeding session learning to identify physical signs and "body language" indicating over-stimulation and to assist with setting up the home program.

This approach can be utilized in individual, home based settings, as well as with small groups of 3-4 children. Brooklyn Feeding Academy has partnered with Dynamic Solutions in Carroll Gardens to conduct weekly interdisciplinary feeding groups with a SOS trained occupational therapist.

Your child will receive a comprehensive evaluation and individual therapeutic plan utilizing the SOS approach to feeding.

Is my child a candidate for feeding therapy?

If you answer yes to one or more of the following signs, your child may be a candidate for an evaluation…

  • Ongoing poor weight gain (rate re: percentiles falling) or weight loss
  • Ongoing choking, gagging or coughing during meals
  • Ongoing problems with vomiting
  • More than one incident of nasal reflux
  • History of traumatic choking incident
  • History of eating & breathing coordination problems, with ongoing respiratory issues
  • Inability to transition to baby food purees by 10 months of age
  • Inability to accept any table food solids by 12 months of age
  • Inability to transition from breast/bottle to a cup by 16 months of age
  • Has not weaned off baby foods by 16 months of age
  • Aversion or avoidance of all foods in specific texture or food group
  • Food range of less than 20 foods, especially if foods are being dropped over time with no new foods replacing those lost
  • An infant who cries and/or arches at most meals
  • Family is fighting about food and feeding (i.e. meals are battles)
  • Parent repeatedly reports that the child is difficult for everyone to feed.
  • Parental history of an eating disorder, with a child not meeting weight goals.

A child who exhibits these difficulties may be appropriate for a feeding evaluation. As part of the assessment, the parent and child will be observed eating a variety of preferred and non-preferred foods. We will observe your child for signs of oral motor difficulties as well as sensory defensiveness which may contribute to your child's eating difficulties. Upon completion of the evaluation, a comprehensive assessment complete with findings and recommendations will be provided for you as well as your pediatrician if desired.

10 Myths associated with eating...

The creators of the SOS approach to feeding have developed a list of commonly accepted myths associated with eating and mealtime.

Myth Number 1 - Eating is the Body’s first priority

    Truth – Breathing is the body’s first priority
    Postural stability (the ability to stay upright and not fall on your head) is second Priority
    Eating is third

    If you can’t breathe properly you can’t eat.
    It’s also tough to eat if you’re not properly supported in an upright position.

      - Your child will receive an assessment of their eating “environment” to optimize therapeutic success.

Myth Number 2 – Eating is instinctive
    Truth – Eating is instinctive for the first month of life
    Infants have an instinctive appetite drive necessary for survival for the first month of life.
    Eating from 1-6 months is reflexive
    From 5-6 months, eating becomes a learned behavior
      - We will work with your child to assist them in re-learning about food and re-introduce foods in the child’s own time.

Myth Number 3 – Eating is easy
    Truth - Eating is inherently complex, requiring coordination of all organ systems in addition to every muscle of the body. All of the senses have to be correctly operating to successfully eat.

      - We will evaluate the challenges to eating faced by your child. We will talk to you about factors in your child’s history as well as present day issues that inform your child’s interaction with food and mealtime behavior.

Myth Number 4 – Eating is a two step process
    1- You sit
    2- You eat

    Truth – Like any other developmental process, eating requires many small steps to “master”. The SOS approach utilizes 32 discrete steps to learning about eating. These small steps really allow us to gauge your child’s progress in a meaningful way. Your child will fall within this continuum with every food and allow us to accurately “dial in” an individualized program.

Myth Number 5 – It is not appropriate to touch or play with your food
    Truth – “Wearing” your food is completely appropriate as an aspect of learning to eat. Kids learn a great deal about food BEFORE it ever gets near their mouths.

      - One of the basic principles of the SOS approach is the playful exploration of new foods without the immediate expectation that the food will be eaten. Kids get a chance to interact with food at their level of readiness.

Myth Number 6 – If a child is hungry enough, they will eat. They will not starve themselves
    Truth – This is true of 94-96% of kids. For those 4-6% of other kids eating is a real issue that results in significant weight loss due to pain, discomfort, or their oral muscles just not working correctly. If eating doesn’t work for a child, they will avoid the activity at all cost. The result over time, typically results in appetite suppression secondary to the stress involved in eating.

      - In addition to playful exploration of food, the SOS approach utilizes “skill building” based on your child’s unique challenges to approaching age appropriate foods and textures.

Myth Number 7 – Children only need to eat 3 times daily
    Truth – In order to meet daily caloric requirements kids would have to eat adult sized meals if they only ate 3 meals daily. Given their attention spans and their small stomachs, kids need 5-6 small meals daily.

      - We will assess your child’s typical eating pattern and look for opportunities to optimize intake. If indicated, we’ll consult your child’s pediatrician and/or nutritionist utilizing a team approach to support weight gain.

Myth Number 8 – If a child won’t eat, there is either a behavioral OR an organic problem
    Truth – Current research indicates between 65-95% of kids with feeding issues present with a combination of behavioral and organic origin. If your child has physical problems with eating, behaviorally based avoidance typically presents itself. If a child presents with behavioral or environmental reasons for not eating, compromised nutritional status may cause health problems. The important point is creating dichotomy in the origins of a feeding problem is not useful.

      - We look at the child and family as a whole taking all pertinent factors into account in the development of your child’s individual therapeutic plan.

Myth Number 9 – Certain foods are only eaten at specific times of the day or only certain foods are “healthy for you”
    Truth – Food is food. We like to classify food as breakfast food, dinner food, snack food or junk food. Food is a protein, carbohydrate, or fruit/vegetable. While some foods have more nutritional value than others it is not useful to label foods as “good or bad” or to only be eaten at a certain time of day. If a kid likes to eat chicken and peas at breakfast, no big deal. Different cultures certainly embrace a wide variety of taste profiles at different times of day. Additionally foods labeled as ” junk” often play an important role in providing the stepping stones to learning about food given their unique sensory and taste profiles.

      - It is rare (food allergies excepted) that any food is “off the table”. Our goal is to optimize learning and have your child examine the many wonderful properties of food. The goal is a fun and positive learning environment.

Myth Number 10 – Children should be seen and not heard during mealtime
    Truth – Mealtime should be fun. Kids eat better when food is engaging, interesting and attractive. Kids usually eat better when mealtime conversations are focused about the food and teaching the “physics” of food.

      - We’ll work with the entire family to restore (or establish) mealtime as a part of your everyday routine with the goal of reducing any “stress or anxiety” that may be associated with your child’s eating.