Description

Handouts

Outline

There is a prevalence of the problem.

• Picky eating
• Problem feeding
• ARFID

It is the complexity of feeding and eating.

• 7 areas of human function
• How children learn to eat (or not)

How to complete a feeding assessment.

• Medical/organs
• Oral-motor skills
• Sensory-motor skills
• Postural and motor skills
• Nutrition
• Learning/cognition
• Environment

Criteria, research and limitations are differential diagnoses.

• Picky eating
  • Able to tolerate new foods on plate
  • Decreased range or variety of foods that will eat
  • Frequently eats a different set of foods than the rest of the family
• Problem feeding
  • Restricted range or variety of foods
  • Refuses entire categories of food textures
  • Cries and “falls apart” when presented with new foods
• ARFID
  • Accept a limited diet in relation to sensory features
  • Food refusal is related to aversive or fear-based experiences
  • Extreme pickiness; distractible and forgetful

Align treatment with a diagnosis is one of the treatment approaches.

• Systematic desensitization
• Flooding/escape extinction
• Eating disorders

Case studies on when assessments go well and when they don’t.

• Picky eating –
  • Case 1 = 2 ½ year old male with limited number of accepted foods he will eat, variable eating from one day to the next, issues staying at the table
  • Case 2 = 2 ½ year old female with restricted food range, over reliance on liquids for calories and swallowing assistance
  • Case 3 = 9 year, 8 month old male with lack of healthy proteins per parents, and no vegetables in his food range
• Problem feeding –
  • Case 1 = 3 year, 10 month old female with a G-tube, born at 26 weeks gestation, complicated medical history
  • Case 2 = 4.25 year old female born with congenital Rubella, poor weight gain, restricted food range, episodes of gagging and coughing, episodes of refusing to eat
• ARFID –
  • Case 1 = 15 year old male with chronic “chok-y” sensation, significant weight loss, hospitalized in an Eating Disorders program
  • Case 2 = 13 year old male with difficulties eating food at school, restricted food range per parental report, refusal to eat vegetables

Feeding strategies for children with feeding disorders.

• Routines and environmental supports
• Matching foods to a child’s skillset
• Reinforcement
• Management of maladaptive behaviors

When to refer.

• Red Flags
• Picky Eater vs Problem Feeder criteria

Faculty

Dr. Kay A. Toomey

Toomey & Associates, Inc.

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Dr. Kay A. Toomey. He has over 30 years of experience assessing and treating children with a wide range of feeding challenges. She developed a program for assessing and treating children with feeding problems. The Children’s Hospital – Denver, as well as the Rose Medical Center’s Pediatric Feeding Center, were formed by Dr. Toomey. She is a consultant to the company.

Prior to entering private practice, Dr. Toomey co-chaired the department at Rose Medical Center. She spoke nationally and internationally about her approach as the Clinical Director for the Feeding Clinic for six years. Dr. Toomey is a clinical consultant to the Feeding Clinic at the STAR Institute.

Speaker disclosures.

Kay Toomey is in private practice. She is paid by the Infant Nutrition/Gerber division. She is paid a speaking fee by Education Resources, Inc. Dr. Toomey is a speaker for PESI, Inc.

Kay is a member of Feeding Matters.