Interview Series: Feeding Therapy with Lisa Coosman, OTR/L, MS

How your picky eater may benefit from food therapy

Dealing with picky eaters as a parent can be difficult. From dinners at home to nights out with the family, it can seem like a daunting task to get your child to eat. But how do you know if that picky eating might be a sign of something else and your child might benefit from food therapy?

We reached out to Lisa Coosman, OTR/L, to discuss with us the ins and outs of feeding therapy and what it means for your child. She dives into what it takes to be an Occupational Therapist, what signs you should look for, and tips and tricks for best supporting a child with food aversions.

How do you know your picky eater needs feeding  therapy?

It is typical that children go through stages of being picky eaters. It is important to look at the foods they are eating over the course of 2-3 days. Therapy might be beneficial for your picky eater if:

• Mealtimes are stressful for your family

• Your child is eating less than 30 different foods

• You find yourself fixing a different meal for your child for every meal

• Your child gags or vomits when presented with new or disliked foods

• Refuses a group of foods that have the same texture

What link do you see between childhood anxiety and food related issues?

We are seeing higher stress levels in our kids than ever before. There is so much that is out of our kids control, but food intake is something that a child may feel that they have some control over. As a society, we are also guilty of busy schedules and quick meals. Overall, children have less time to smell, taste and process the foods they are presented with. It is also easier to just give our children the foods we know they will eat because we have a limited amount of time to sit and eat. All of this contributes to the overall stress of the child and impacts their relationship with food. 

What are some other behaviors that might be linked to kids that would benefit from feeding therapy?

Sensory processing is our ability to experiences a sensation, understand and make sense of it and then respond. We see many kids that are struggling with their ability to process sensory information which can impact all areas of their life including feeding. If a child is overwhelmed by auditory input and the tv is always on at mealtime, they will likely have a negative association with their food and mealtime. Many children may have difficulties with textures or smells which have a direct correlation with the foods they eat. 

What is the training like to become a Feeding Therapist? 

Depending on the setting, you might find that an occupational therapist or a speech language pathologist would be the professional you would encounter as a feeding therapist. While either one may work on feeding, it is recommended that parents seek out a therapist that has had extensive training and experience with kids with feeding difficulties. 

I would recommend also seeking out a therapist that is not just trained in one particular program, but rather a wide variety of strategies so that they can adapt the treatment approach to meet the needs of each particular child. It is important to assess what components are involved in your child's feeding difficulties, oral motor, sensory, behavioral, and social emotional.

Additionally, a therapist that approaches feeding in a calm, positive manner and can easily establish rapport with your child is going to facilitate more progress. Feeding therapy takes time because in many cases, kids have a lot of negative experiences and emotions tied up around food. A therapist that looks at feeding from all aspects, will be able to help your child make faster and more sustainable progress. 

What can parents and children expect from a feeding therapy session?

It all depends on the child. It is recommended to start slow and predictable to help the child gain confidence and keep their arousal level at an optimum level for learning and attention. It is important to let the child have a sense of control an understanding that the therapist will not push or make them go beyond their level of comfort. The first goal is often to just have mealtimes/ table time be a positive experience. The expectation might be that the child can play and engage with foods presented and not necessarily bring them to the mouth or eat them. 

Are there tricks or tips for parents to try at home with a picky eater?

Be creative

• Use condiments to allow kids to dip their food- ketchup, ranch, Nutella

• Cut sandwiches, deli meat, and cheese with cookie cutters.

• Try different intensities with food such as sour or spicy.

• Let kids decide about how to combine the food – Pepperoni wrapped around a goldfish cracker becomes a “Fish taco”

• Have them help with planning, cooking, grocery shopping and meal preparation

Play, play, play

• Kiss the food.

• Get messy with the food — it is how they will learn and gain comfort with food.

• Pretend play — make cars out of carrot sticks, use pretzel rods dipped in peanut butter as drumsticks.

• “Food rockets” — Allow kids to take a bite of something non-preferred and spit it out in the trash or bowl. This may go against every fiber of your being, but give it a try. You may have fun.

Be a good role model

• Eat the foods you are expecting your child to eat.

• Avoid talking about how food tastes in a negative manner.

• Use phrases such as, “I can crunch this carrot.” “You can crunch it.” — rather than “try this” or “take a bite”

• Talk about the taste, texture, temperature

• Pick foods to try together

• Explore the food

• Talk about what the food looks like, feels like, how you could change it.

• Using language that encourages kids to explore “I wonder what would happen if we open up this snap pea.”

From your perspective, what are the differences between a food aversion and an eating disorder? And when should a parent be concerned that their child's picky eating is more than just pickiness? 

Deciding to get therapy can be a stressful decision. The question I often encourage parents to ask themselves is...are these concerns impacting function for my child or our family? Obviously, when there are concerns about a child's nutritional intake, that is a more clear indicator. However, when mealtimes are stressful, that can impact the whole family. Many families find that they begin making separate meals, giving kids an IPad or just managing tantrums during every mealtime.  

What age is most common for kids to start having food aversions? What ages do you work with?

For some kids, they might have difficulties from birth. However, some kids might begin struggling as they start more challenging textures such as stage 2 or 3 baby foods or even transitioning to table foods. Kids could also develop food aversions if they have had a traumatic experience or they are allergic/ sensitive to certain foods. We work with kids 0-18 years and do a full assessment to determine what aspects are impacting their feeding issues. 

How best can a parent support a child who needs feeding therapy?

Parents can support their child by recognizing small gains. If a child is able to play with a food that previously caused an adverse reaction, that is a huge win and should be celebrated. It is not always about the food that the child eats.  

How can parents contact you?

Parents can call our office at 636-928-LEAP(5327) with questions. We are always happy to do a complimentary consultation with parents to help them determine what is the best course of action for their family. 

Curious to learn more about feeding therapy for your picky eater? Wondering if your child could benefit from anxiety therapy or if you need to look at reaching out to an Occupational Therapist?  Contact Compassionate Counseling St. Louis to set up a free 15-minute phone consult. We’ll talk about what’s going on and best next steps - and if we’re not the right fit, we’ll connect you with other wonderful St. Louis-based resources, like Lisa!