I recently had the pleasure of attending a 4 day SOS Approach to Feeding workshop in Sydney, run by Dr Kay Toomey and Dr Erin Ross from the STAR Institute (a feeding disorders clinic in Colorado). Since returning to Brisbane, I’ve had several questions about the program, so thought it might be helpful if I answered a few of the questions here.
What is the SOS approach to feeding?
SOS (Sequential-Oral-Sensory) Approach to Feeding is a transdisciplinary program for assessing and treating children with feeding difficulties and weight/growth problems. This program was developed in the US by a psychologist (Dr Kay Toomey) and a speech pathologist (Dr Erin Ross) from the STAR Institute Colorado.
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 treatment plan.
TENET 4 =Food Hierarchies/Choices play an important role in feeding treatment.
What makes SOS different to other feeding programs?
It’s transdisciplinary: SOS was developed in collaboration with other health professionals, including paediatricians, occupational therapist, dietitians, speech pathologists and psychologists.
It recognises that feeding issues are multi-factorial: It integrates posture, sensory, motor, behavioural, emotional, medical and nutritional factors.
It focuses on normal development: SOS is based on the normal developmental stages and skills of normally developing children.
Goals are skill-oriented rather than volume oriented: Many traditional feeding programs can focus on volume eaten. SOS focuses on working towards children eating a variety of tastes and textures of developmentally age-appropriate food. It does this with a focus on teaching skills, with the understanding that increasing variety and range of food eaten will naturally lead to increasing volume.
It is family-centred: SOS recognises that eating behaviour doesn’t occur in a vacuum, and so family involvement is central to both assessment and treatment.
It is flexible: Treatment plans are individualised but therapy can be implement with one child or in a group. It’s important to note that the principles of SOS can be applied to any child who is seeing an SOS trained therapist however to be doing “the SOS feeding protocol” requires adherence to specific components of the program (this ensures consistency and treatment success that is proven with research).
It uses a systematic desensitization approach to eating: This is a gold-standard evidence-based treatment approach for anxiety disorders, so makes perfect sense to be applied in this context. This method is used so that children can focus on skill development, build experience with a wide number of foods, and move up the “steps to eating” hierarchy while the therapist helps the child remain calm and avoid sensory and emotional overwhelm.
What do I like about it?
It treats children with respect.
It acknowledges that eating is THE MOST difficult sensory task a child has to do.
Rather than viewing food refusal as defiance/refusal/oppositional behaviour, it frames “maladaptive behaviours” as a stress response due to being unable to manage the task at hand. By framing behavioural issues as part of a skill-deficit, it sets the tone of respecting the child’s readiness for the task, and encourages compassionate treatment of the child focused on increasing skills and building confidence.
It doesn’t force, or trick, children into eating.
It supports parents.
Being a family centred treatment approach, SOS recognises that eating behaviour doesn’t occur in a vacuum. But it also emphasises that families are not the cause of feeding difficulties! It acknowledges the interplay of factors that can contribute to the creation and maintenance of problem feeding.
It highlights the importance of parent education – so that we can up-skill families so they can successfully transfer therapy gains to the home environment. I love this as I am a big believer that I have done my job as a therapist when I make myself redundant.
It is nuanced.
SOS draws together sensory, oral-motor and psychological issues in treatment planning. This allows for individualised treatment plans rather than a “one size fits all” approach. It can be offered both as individual therapy or as a group program.
The SOS Approach to Feeding has a strong evidence-base both for short term gains but also evidence that indicates that treatment continues to generalise post therapy completion.
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