Feeding therapy?

[ravinlunachick]

My son's beloved OT resigned while we were on summer break. :( He had been seeing her for over 2 years.

 

Anyway, I will supposedly be hearing from a new OT soon, and he will resume his weekly sessions. I am starting to wonder if I should ask to focus on feeding instead of fine motor as he has been. He also gets OT at school for the exact same issues.

 

We've noticed lately that he is becoming more self limiting in his diet. He is small for his age, but still on the growth charts, so no one has really seen this as a pressing need. Dh and I are worried about his nutrition. He will eat ONLY the following foods:

 

Meat: ground, deli meat, or hot dog/nugget texture only.... No solid meat

 

Fruit: apples and rarely bananas.... This is a recent development in the past 18mos or so. Until then, he ate no fruits at all, and still won't drink juice. He doesn't care for Popsicles or smoothies at all.

 

Veg: only "hidden", as in spaghetti sauce... Even then, he can be funny about it. Half the time, he will refuse the pasta and sauce and just eat the meatballs.

 

Grains: We buy only whole wheat bread, and he LOVES sandwiches (only deli meat & cheese). He is crazy about crackers and chips (see below). Speculation has been that he prefers crunchy to soft because he gets better input from it and doesn't over stuff his mouth with it (a problem due to his Apraxia). Pasta and rice are unreliable, but he likes burritos very much.

 

Dairy: practically none except for sliced cheese on a sandwich and a rare bite of ice cream.

[ravinlunachick]

Sorry, tablet was wonky and cut me off!

 

We don't mind the limited dairy, because he used to be allergic. As an infant, he could tolerate zero milk in my diet until 10mos or so. Then at 2.5 he broke out in hives for weeks, and tested positive for allergies to milk, corn, and peanuts. 6 months later, he passed all of them. Go figure.

 

DS would eat nothing other than tortilla chips with hummus if we let him. He asks for it 46592 times per day! We limit his to one single serve container per day or less. For a while, we quit buying it, but he still wants chips. That is the only thing he ever melts down in public over. Chips. And they're around every corner in the grocery store! :glare:

 

So, what do you think? Should we have the new OT try to work on this? DS uses a communication app on the iPad to speak, but he is not fluent enough to be able to tell us WHY he won't eat certain things. We have no idea if it is texture, smell, color, taste, or what.

 

He is 41 inches tall and weighs 43.5lbs. He will be 6 Jan. 1st.

Edited August 1, 2012 by ravinlunachick

[Dobela]

I would definately talk to the new OT about this, but, from my experience, an SLP is the better choice. All of my dd's feeding therapies have been with SLPs of various capacities. None of her OTs have even really wanted to discuss it with me and have always deferred me to the SLP with the most experience. They worked on her low tone, her sensory issues, and so on even when she did not have any obvious speech or language issues. If he doesn't qualify for speech otherwise then you can ask your PCP for a referral strictly based on the feeding issues.

[Amirah]

quick question, off topic and sorry to hijack thread but does OT help with feeding issues? because my son is 3 and he has texture issues and is very limited in food

 

he currently eats chicken legs(no skin and can only be boiled), carrots if boiled, whole wheat bread, bananas, apple sauce and yogurt. thats it anything else he throws up. we give him a multivitamin and iron supplement but its not helping and i really would like to get him to eat something else

[ravinlunachick]

That's interesting, Dobela. The OTs at this practice do all the feeding therapies ; she even mentioned to me that her "feeding kiddos" would get scheduled first because they are the highest priority. Previously, we thought it more important to focus on ds's fine motor and adaptive skills, and she said since he was not underweight it might be difficult to get insurance to pay for it anyway. I've heard, though, that it may be covered as related to his autism.

[SkateLeft]

My son has been doing weekly feeding therapy with an OT for over a year now. I'd never heard of SLPs doing feeding therapy. All of the feeding at his therapy center is done by OTs. I suppose it would make sense for an SLP to take over if it was a motor issue, like tongue control or motor planning.

 

Since my son's feeding difficulties are sensory issues complicated by OCD, it's not something our SLP would be involved in handling.

 

To the OP, I'd bring up your concerns to your new OT and see what they think.

[SkateLeft]

quick question, off topic and sorry to hijack thread but does OT help with feeding issues? because my son is 3 and he has texture issues and is very limited in food

 

he currently eats chicken legs(no skin and can only be boiled), carrots if boiled, whole wheat bread, bananas, apple sauce and yogurt. thats it anything else he throws up.

 

If his feeding issues are sensory, and it sounds like they might be, then OT can help. It really depends on the OT and their experience.

 

My son had general OT for a few years before he was ready for feeding therapy. When we first had evaluated for feeding, the OT said he still had a way to go with general sensory issues before she could really start focusing on food. He only has about 5 foods that he will eat, and he eats no meat at all.

[mommymonster]

Of course, bring the issue up, but if you want to try something at home, you might want to read the book "Food Chaining" by C. Fraker. It has really helped my son. It is hard work, but so worth it.:001_smile:

[wonderchica]

As discussed, both OTs and SLPs can do feeding therapy. Both can bill for it. You may find one or the other (individually) doesn't do it, but "technically" either can. Sometimes insurance may have a preference for one or the other.

[LostSurprise]

I got the idea that SLP and OTs cover different things. SLPs cover more tongue, swallowing, and mouth problems. OT works with body positioning, posture, hand-mouth coordination, depth perception, etc. Behavioral psychologists work with refusal. I don't remember who deals with sensory problems, OT?

 

Anyway, maybe they could do a feeding evaluation for you? (SLP/OT/psych)

 

We're having an evaluation done by a feeding clinic and he will see an SLP, an OT, and a P before they decide what he needs.

Edited August 3, 2012 by LostSurprise

[Tokyomarie]

I got the idea that SLP and OTs cover different things. SLPs cover more tongue, swallowing, and mouth problems. OT works with body positioning, posture, hand-mouth coordination, depth perception, etc. Behavioral psychologists work with refusal. I don't remember who deals with sensory problems, OT?

 

Anyway, maybe they could do a feeding evaluation for you? (SLP/OT/psych)

 

We're having an evaluation done by a feeding clinic and he will see an SLP, an OT, and a P before they decide what he needs.

 

You are quite correct in noting the differences in the specific areas that SLPs, OTs, and pyschologists generally cover in their evaluation and treatment of feeding disorders. Many SLPs and OTs do become adept at handling aspects of feeding that are not typically under their discipline because of course attendance and experience gained in the clinic. If they happen to practice in an area that is not flush with clinicians trained to handle feeding issues, they may become the defacto expert in their location.

 

In general, I would agree that if a child's feeding issues are complex and/or are not responding to initial efforts at therapy with whichever clinician has been the entry point into therapy that an interdisciplinary evaluation where clinicians from all three disciplines collaborate could be very helpful for problem solving.