The SOS Approach to Feeding – Mealtime Myths

In part 3 of my series on the Sensory Oral Sequential (SOS) Approach to Feeding, we are going to explore some mealtime myths.

Eating is a challenging sensory skill that a child must master as part of normal development. Over time, several myths have emerged about how, when, and why a child should eat. Our acceptance of these myths causes us to place pressure on children to eat, which causes the child to feel anxious about eating, which then causes the body to produce adrenaline and adrenaline suppresses the child’s appetite. It’s a vicious cycle. The SOS Approach to Feeding debunks these myths and teaches that believing in these myths can do more harm than good to a child’s feeding development. Let’s take a closer look at 10 mealtime myths and why they are a myth.

three toddler eating on white table

Myth #1 – Eating is the body’s top priority.

Not exactly. Breathing is the body’s top priority. Postural stability (i.e. not falling on your head!) is priority #2. Eating is priority #3. Eating requires the ability to safely shut off our airways for a brief second while we swallow. If a child cannot manage shutting of his or her airway or if a child cannot manage to swallow a food safely, that child will not eat because that child wants to keep breathing.

Myth #2 – Eating is instinctive.

This is partially true. Eating is an instinct but only for the first little bit of life. From birth to around 3 or 4 months old, our primitive motor reflexes (rooting, sucking, swallowing) help us create pathways in our brains that lay down the motor patterns necessary for eating. After about 6 months of life, eating is a learned motor behavior.

Myth #3 – Eating is easy.

Eating is actually quite complex. Eating involves every single sensory system – taste, smell touch, sight, hearing. The task of eating requires most of your organ systems – digestive, nervous, endocrine, muscular, respiratory – and eating requires that they each be functioning properly.

Myth #4 – Eating is a 2-step process. Step 1: you sit down. Step 2: you eat.

Not at all. There are many steps to eating. The SOS Approach to Feeding has identified that there are 25 steps to eating for typically developing children and that children with feeding difficulties may have 32 or more steps in the process of learning to eat.

Myth #5 – It is not appropriate to touch or play with your food.

No, no, no! It is completely appropriate to touch or play with your food. This is how you learn about the food that is in front of you. Playing with and touching food is part of the process of learning to eat.

Myth #6 – If a child is hungry enough, he/she will eat.

Sort of. This is true for most of pediatric population. For children with feeding difficulties, they will not eat if they are hungry enough and they will starve themselves. For these children, eating hurts or it doesn’t work so they are protecting themselves. It’s pretty simple for these kids – if it hurts, don’t do it; if it doesn’t work, get away from it.

Myth #7 – Children only need to eat 3 times per day.

Not at all. Kids are growing so they have significant nutrition needs. With 3 meals per day, they would need 3 adult sized meals to meet their nutrition requirements. They’re stomachs aren’t meant to hold adult sized meals. Children truly need to eat 5 to 6 times per day to meet their nutrition needs.

Myth #8 – If a child won’t eat, it’s either a behavioral or organic problem.

It’s not an either or situation. It’s both. Organic feeding disorders are the result of an organic disease or disorder such as a structural abnormality (esophageal narrowing), a metabolic dysfunction (urea cycle disorder), or a gastrointestinal disease (gastroesophageal reflux disease). Feeding issues can also start as a behavioral problem such as refusing to sit down at the table, throwing food, or vomiting to get out of a meal. If your child’s lack of eating starts as a behavioral problem, then improper nutrition will cause organic issues. If the lack of eating starts as an organic problem, the lack of enough food will cause behavioral problems.

Myth #9 – Certain foods are to only be eaten at certain times of the day and only certain foods are good for you.

Food is just food. Food is not a breakfast food or a lunch food. Food is not good or bad. Labeling foods snack foods or dinner foods is not helpful when teaching children to eat. If you eat broccoli and turkey for breakfast, that’s completely fine because you are still getting the food that your body needs. If you eat toast and scrambled eggs for dinner, that’s also fine because you are still getting the food that your body needs. Labeling foods as good or bad foods also isn’t helpful when working with a problem feeder. There are definitely some foods that are better for you because they have a better nutritional profile. However, all foods contain calories and sometimes, when working with a problem feeder, it’s just about getting some calories into the child.

Myth #10 – Mealtimes are social occasions and children are to mind their manners.

Manners are great! And important. However, they should not come at the expense of a child getting the nutrition that he or she needs. Mealtimes are excellent teaching opportunities and a child learning to eat is going to get a little messy. Talk about the food. Explore the food with you child. Model how to eat. Manners will come but let’s learn to eat first. Let’s also note that I’m NOT saying to let your little one be a complete wild thing when out at a restaurant. You can still be well behaved while getting a little messy and exploring food. Then maybe at home, we allow ourselves to get a little messier and play with our food a little more.

What questions do you have about the SOS Approach to Feeding or about pediatric feeding therapy? Feel free to comment below or reach out!


The SOS Approach to Feeding

This post is the beginning of a series on the Sensory Oral Sequential Approach to Feeding. Over the next few weeks, I’ll dive more deeply into the basic tenets of this approach and highlight some strategies for working with picky eaters and feeding issues.

A few years ago, I had the privilege of attending a 4-day Sensory Oral Sequential (SOS) Approach to Feeding Therapy workshop. This workshop was extremely enlightening and beneficial to the work that I do with picky eaters and problem feeders. The SOS Approach is the feeding therapy tactic that I use most often with children who are displaying feeding issues. Let’s take a deeper look at what the SOS Approach to Feeding Therapy is.

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The SOS Approach to Feeding Therapy was developed by a Dr. Kay Toomey, pediatric psychologist, and Dr. Erin Ross, pediatric speech and language pathologist. It is a program designed to assess and treat children with weight or growth problems and feeding difficulties.

The program has 4 basic tenets:

  1. Myths about eating. There are many myths circulating about how, why, when, and where a child should eat. These myths interfere with how we understand and treat feeding problems.
  2. Systematic desensitization. This is a treatment for phobias where a patient is exposed to anxiety provoking items or situations. The patient is taught relaxation techniques to deal with the anxiety. This approach is considered the best first treatment to feeding problems.
  3. Normal development. Eating has a normal developmental path that it should follow. This normal path gives us the best blueprint for developing a feeding therapy plan.
  4. Food hierarchies and choices. Utilizing food hierarchies and recognizing the child’s choice in eating and feeding play an important role in feeding problem treatment.

What I like about the SOS Approach to Feeding Therapy:

  • It accounts for the fact that feeding issues have a number of factors into consideration. The SOS Approach to Feeding looks at all of the aspects of feeding issues – posture, sensory, motor, behavioral, emotional, medical, and nutrition – to create an individualized feeding therapy plan.
  • Normal feeding development is key. The entire approach of SOS Feeding Therapy is based on normal developmental stages and skills of eating. By looking at normal feeding development, we can better pinpoint what is happening and create a plan to treat the feeding issue.
  • Feeding goals are based on the child’s skills. Many feeding programs are based on the need to increase the volume that a child eats, which of results in increasing the child’s anxiety around eating. By focusing on improving the skills involved in eating, the SOS Approach treats the root of the feeding issue, leading to increased volume.

Stay tuned for this series that I hope helps you better deal with your picky eater!