What is Food Chaining?

Picky eating is a developmental process that most toddlers work through. If your child accepts less than 20 different foods (multiple flavors of yogurt do not count), your child’s pickyness is more problematic than just picky eating. Your child may be a dysfunctional feeder.

Food chaining is a complex, multi-step process that is used to help dysfunctional feeders learn to accept new foods. Results of your oral sensori-motor feeding evaluation will determine if a food chaining program is appropriate for your child. The process begins with a thorough analysis of the foods that your child already accepts (core diet). This analysis identifies preferencepatterns of flavor, texture, temperature, and appearance. After patterns are understood, under the guidance of your feeding therapist, your child’s core diet will be expanded by exposing your child to new foods that have similar features to the foods that are already accepted. Diversifying your child’s diet will help teach that small changes to core diet foods are safe. This will increase tolerance and enable successful transition to new tastes and textures. The ulitmate goal is to help your child choose a healthier and more nutritious diet to support growth and development. This FAQ has been developed to facilitate your understanding of the process towards enabling your child to willingly accept a healthier variety of foods. It is only to be used as a supplement to feeding therapy not a replacement for feeding therapy. Your therapist has been specifically trained to make changes in your child’s plan dependent on day to day progress identified in therapy.

Vital steps of a food chaining program: Before beginning any therapy program, it is important to identify and address interfering factors that could be contributing to or compounding your child’s dysfunctional feeding and other undesired feeding behaviors.

 Identify and address underlying medical conditions; such as gastroesophageal reflux, digestive problems, constipation, food allergies/intolerance etc. These could cause/contribute to problem feeding behaviors.

 Complete evaluation of oral motor and oral sensory skills by a speech/language pathologist specializing in feeding and swallowing disorders is vital. If a child has poor chewing skills, he or she may limit his or her diet to foods that are soft enough to mash and swallow or foods that dissolve in the mouth. A more precise and mature skill set is required to chew a Chick-Fi-A chicken nugget vs a McDonalds chicken nugget . Just like chewing fruits and vegetables to a swallow safe consistency requires a more advanced skill set than most of the carbohydrates that dysfunctional feeders have a preference for. Children tend to choose foods that they feel comfortable with and are safe to swallow. Intact oral sensori-motor skills for feeding are necessary for safe swallowing.

 Identify sensory issues that may be impacting feeding skills and tolerance. Observe how your child handles sensory information across settings. Some children can tolerate food on their hands but will gag if food in placed in their mouth. Notice if your child is sensitive to toys or clothing of certain textures. If your child has sensory issues, it may be benificial to have an occupational therapy assessment completed to get the maximum benefit out of a feeding program.

 Change both child and caregiver behaviors. This is vital to success. Your therapist will help determine if your behaviors and responses to your child’s behaviors may have or continue to inadvertently reinforce dysfunctional feeding patterns. Falling into patterns of short order cooking, enabling children to graze all day, allowing children to fill-up on juice and milk, failing to continue to present new foods and giving in to feeding refusals by only providing desired foods

are common mistakes caregivers make. Changing both child and parent behaviors are part of what make this program so challenging on one hand and so successful on the other.

 Determine if your child’s current diet is providing adequate nutrition. Good nutrition is key to brain function, growth, and immune system functioning. A registered dietitian may be able to counsel you about ways to improve your child’s nutrition throughout the food chaining process.

 Reduce mealtime stress. Many dysfunctional feeders will develop negative meal times behaviors in response to stress. Developing strategies to deal with these behaviors, reduce mealtime stress and to make meal times more pleasant will help everyone in the family. A behavioral psychologist may also be part of your child’s feeding team to work through anxiety and to develop a plan to address negative feeding behaviors.

Dealing with strong willed and ridged behaviors: It is not uncommon for dysfunctional feeders to accept only one shape, brand, color, etc. of prefered foods. Most dysfunctional feeders are very rigid and strong willed. It is important for parents to learn appropriate responses to their child’s ridgid behaviors and desire for control. Gradual steps to eating non prefered foods are explored to enable your child to learn about the qualities of the foods. Becoming familiar with new foods and increasing tolerance of small changes to prefered foods are the progressive steps towards increasing acceptance of new foods This process will take time. Each progression is a step towards safely accepting and then swallowing new healthy foods.

Identifying family goals and priorities: Discuss with your child’s therapist what foods are important to your family. Based on your goals and the results of the evaluation of your child’s oral sensori-motor feeding skills and core diet intake, foods will be carefully selected to facilitate success. Your child will gradually begin to accept small and then larger changes to his or her diet. We will start with foods that are similar to the core diet. Too large of a transition is often too stressful for children, and the likelihood of success will be low. As tolerated, your “goal” foods will be incorporated in the program. Unfortunately, this is not a simple process and will take time, patience, and dedication.

Dedication

Our promise to you is that we will carefully plan the progression of steps based on your child’s individual needs . Your promise to us and to your child is that you will consistently attend therapy and will follow home program activities and devote the time necessary to change your and your child’s behavior.

Examples of sample food chains: Below are several examples of sample food chains based upon different features of foods. Specific food chains would be developed for your child based upon the core diet analysis and your childs oral sensori motor skill set. As different foods, spreads, and condiments are accepted into the core diet, new chains are created to branch out even further.

Ultimate long term goals of therapy

The ultimate goals for our dysfunctional feeder are that the child feels positively about eating, no mealtime stress and that the child’s food repertoire contributes to a healthy, well balanced diet. No one will like to eat everything, but children should have a diet that consists of some foods of every food group, different textures and flavors of foods.

How long will this process take?

It is hard to predict how long this process will take. A lot depends on the severity of the dysfunctional feeding behaviors, the child’s age, personality and willingness to work with the therapist, the dedication of caregivers to invest in the time and energy to follow the home program activities completely and accurately and the ability of caregivers to change their own behaviors by extinguishing behaviors that inadvertently reinforce dysfunctional feeding behaviors. During the early stages of therapy, it is beneficial to attend therapy sessions more frequently and as progress is made, frequency can be decreased to ensure carryover to the home environment. By the time a child successfully completes the program, he or she should be eating a variety of new foods and should be willing to try foods at home without opposition or stress. The therapy process will teach caregivers the steps necessary for healthy eaters at home.

What should I be doing at home in the early stages to help support the therapy process?

 Initiate family meals where healthy eating and unstressed exposure to new foods are modeled. This simple suggestion is very powerful.

 Ensure stress free meals

 Attend therapy frequently and consistently and complete all home program activities

 Discuss with your therapist any roadblocks to the theraputic process

 Encourage your child to help with clean up by clearing his or her plate at the end of meals. This will help him or her acknowledge the presence of new foods in their space.

 Encourage your child to participate in meal planning and preparation.

 Plan for at least 1-2 foods that your child will eat at each family meal.

 Maintain a consistent schedule for meals and snacks, thus preventing grazing during the day.

Related CPD FAQ’s include: Helping Dysfunctional Feeders, Dysfunctional Feeders, Dealing with Challenging Feeding Behaviors, Ideas for Making Mealtimes Fun, Toddler Dos & Don’ts, and Exploration of Food.

Based on the book Food Chaining by Cheri Fraker, CCC-SLP, CLC; Mark Fishbein, MD; Sibyl Cox, RD, LD, CLC; & Laura Walbert, CCC-SLP, CLC. This recommended reading is available in local bookstores.