I know many parents have difficulty getting their ONH/SOD kiddos to eat higher textures and seem to get stuck at the stage two baby food stage. I was one of those parents. For years I fought my child to get her to eat. Every meal was a battle, kicking, screaming, flailing arms, knocking bowls of food over, throwing bowls, spoons, anything, gagging, vomiting, having to start all over, extreme frustration on both our parts. It was a nightmare. I was in tears almost every day, and was at the end of my rope. We were receiving speech and OT therapy, working on feeding with no success. Finally, I decide to research myself, and look into pediatric feeding disorder clinics. Someone had to be able to help us. I found a clinic in the Hershey Medical Center in PA. The Penn State Pediatric Feeding Disorders clinic. I filled out there screening form, and OMG was in tears because of it. I called the clinic to see if the accepted out of state patients. I was willing to do anything at this point. They did, and we made an appointment. The best decision I have ever made. Within days of our first appointment, meal times became happy events again, within 3 months, my daughter was onto chopped table food. The best thing, she gained 5 lbs in those 3 months. We had trouble learning to chew as well, another appointment, made huge progress. We did have to do 4 weeks of intensive day treatment to fully teach my daughter how to chew, but again, well worth it in the end. My insurance covered the entire intensive day treatment, I just had to pay a daily copay. The link for the feeding clinic is http://www.pennstatehershey.org/web/feedingprogram/patientcare/services/evalclinic. It was the best decision I have ever ever made.
The texture fading program I am about to describe that we used with my daughter comes directly from my experience in the clinic. I will also detail exactly how I increased the texture. We did this 5 times every day, breakfast, lunch, dinner, and 2 snacks. Our daycare and school program also followed it. I sent in detailed reports direct from her doctor on how to proceed. Having everyone on board is essential.
Texture fading Program Basic Steps
1. Set a timer, and limit your time for each feeding/attempt. Set it for no more than 20 minutes. This makes it manageable, because you know there is an end to it. Do not let your child leave without one complying event. Your child must know that the expected behavior is what will allow the child to leave, not just the timer. The first session or two will be the worst will you are teaching your child this concept. If you are in the middle of presenting a bite or anything, finish that before the child leaves.
2. Ignore any and all bad behavior. This is called extinction. Any attention they get for bad behavior encourages the behavior to continue. I know this is tough, but that’s where the timer comes in. My daughter would scream cry kick throw the bowl, throw the spoon, vomit, gag, everything, and extinction really works. It took maybe a day of ignoring the bad behavior and reinforcing the good behavior to see a dramatic drop in the bad behavior, after a few days, it was all but gone.
3. Find a few toys that are highly motivating for your child. It doesn’t even have to be a toy, if it’s a certain tv show, or movie, use that, set up near the tv, and use a minute of the tv show or video to reward compliance. Whatever you do, do not use this reward method at any other time than during these feeding sessions. Your child HAS to learn that the only way he can get/play with this reward is by doing the appropriate feeding related activity.
4. Start with the most basic of steps and use positive reinforcement. So instead of starting with getting your son to keep food in his mouth, start with just getting the spoon to touch his lips and reward it, as soon as the spoon touches his lips, even if he is crying. Use only highly motivating toys you decided in 3. Continue this until he is accepting the spoon touching his lips consistently and without complaint. The reward will get him to understand that the spoon on his lips is a good thing, and he will become compliant and accepting of it. Consistently is at least 3 days with almost no rejection. Yes this can be a slow process.
5. After that, move to putting the spoon in his mouth with no food on it, and reward. After he is consistently doing that, begin with touching a spoon with food to his lips. Once he is consistently allowing food to touch his lips, only then begin putting food in his mouth on the spoon. Always always use positive reinforcement and never acknowledge any bad behavior. You want to reinforce the behaviors you want, ie getting the spoon on his lips, in his mouth, the spoon with food on his lips, in his mouth.
This can be a very slow process, but if you do this as many times a day as possible, it will go quicker than you think. Once you get him on foods, you will use the same principle for increasing textures. To increase textures, this is what I did. I got a food processor, and any and every type of food I could think of, and used things like soups, steak, chicken, beef, mashed potatoes, sweet potatoes, carrots, green beans, and fruits J So I first started out making smooth texture foods. I timed how long it took to puree each food to a smooth texture and made a list of it. Then I took the pureed food (usually mixed a meat and veggie with gravy added in to make it smooth, or mashed potaoes, but had to use a “glue” to hold the meat together). And froze it in ice cube trays. This will become apparent in a minute or two as to why I did this. I first got my child completely eating all my home made food. After that, I made food with a slightly higher texture. So that list of times need to make smooth textures, I would take 10-20 seconds off depending on the food, meats I took less time off, fruits and veggies I took more off (I always used steamed veggies, and soften fruits). Again, I put these into ice cube trays and froze them. So why is this important? The best way to increase texture using the texture fading program is to increase textures slowly and consistently. That’s why I timed processing my food and made the frozen food into consistent size cubes, and used the same number of cubes.
So once your child is consistently eating your homemade stage 2 baby foods, here is how you do the texture fading program. Begin with 4 cubes of current texture. Current texture is whatever texture your child will happily eat without gagging, vomiting, or any other bad behavior. Now, remove 1 cube from the current texture and replace with 1 cube of new texture (the food you processed for 10-20 seconds less than current texture). Have a bowl of current texture available as well. The steps are as follows: 1 bite increased texture, reward, 1 bite current texture (I usually used fruits for this step and the meats and veggies for the higher texture), reward, sip of liquid, reward, repeat until timer goes off. Do this for every meal and snack until your child has consistently accepted the higher texture for at leats 3 days (if you go too fast, you will see huge regression in eating skills).
So now your next step is to take your current texture and replace 2 cubes with the higher texture you have frozen. Repeat the same process you did with 1 cube. Continue until your child is eating this texture for 3 days. Next, replace 3 cubes of current texture with higher texture and repeat process. Continue until all 4 cubes are the higher texture. Once all 4 cubes have been replaced with higher texture, this is your new current texture.
So now you have a new current texture that has a higher texture than before. So, make another batch of food with the 10-20 second decreased processing time. This is your base. Record your times on the list, because you will need to shave more time off again for the next higher texture. Next make a new set of food, decreasing processing time for 10-20 seconds. Repeat the entire process to reach the higher texture, replace 1 cube, then 2, 3, and finally all 4 cubes. Continue with this process, increasing your textures by decreasing your processing time.
As your textures get higher and higher, your child should begin to chew naturally. Chewing is a direct response to the increase in textures in our mouth. Some children do not learn to chew on their own and may require intervention with a pediatric feeding disorders clinic. I am in the NE area, near Buffalo, and I looked all through the NE, and the clinic I went to with my daughter is one of the very very few pediatric feeding disorder clinics that will teach children how to chew.
One last major point to keep in mind. Yes you are using a timer. This sets a time limit for both you and your son, make him part of it, turn the timer on to start, turn the timer off to end. The one major thing to keep in mind in NEVER let him leave without one last complying event. You never want him to think that he can kick, scream, fight and then leave without complying. You want him to learn that complying is what gets him what he wants.
This may seem like a huge undertaking, but it will seriously be the best thing you can do with your child. I had my daughter onto chopped table food (which is very coarsely ground food) within 3 months using this program. She gained 5 lbs in those 3 months and prevented us from getting a g-tube as well. The only reason we hadn’t been on one yet was because the feeding disorders clinic in my local area dropped the ball on her nutrition. At 4 years, she was off the charts for weight and was considered failure to thrive.
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