The Sequential – Oral – Sensory (SOS) Approach to Feeding

Our expert dietitian Ricki-Lee provides her evidence-based, systematic desensitization program designed to overcome feeding difficulties.

Fussy Eating Prevalence

Despite the rise over the past four decades in obesity and mean BMI in children and adolescents (5-19 years) more children and adolescents are moderately or severely underweight than obese (192 million underweight vs. 124million obese). Studies suggest 25-33% of children struggle with some type of feeding and/or growth issue during the first 5-10 years of life. Only ~50% of children grow out of this pickiness. Children who have persistent feeding difficulties often go on to have significant delays in motor, language and behavior milestones at 18 and 30 months of age. Similarly, children with developmental issues will often present first with feeding problems.

There are many myths related to fussy eating, including that “If a child is hungry enough, they will eat”. 3-5% of children with feeding difficulties will “starve” themselves resulting in hospitalization or G-Tube placement. Another common myth is that fussy eaters have “behavioral” or “organic” problems. Studies show only 2.58% of children admitted for “behavioral” feeding problems, did NOT have an underlying medical issue that inferred with their feeding.  The truth is, eating is a multi-step progress, starting with a physical/organic aspects of the feeding task. Learning and environmental factors influence whether a child continues to and what they eat.

What is the SOS Approach?

The SOS approach is an evidenced based approached to assess and address all factors involved in feeding difficulties. The SOS approach believes that the “child is always right” and that their behaviors are a communication method to express feeding fears or difficulties. It applies systematic desensitization and “normal feeding development” to achieve sensory and oral-skills progression. The approach also focuses on parent education to allow general treatment strategies to be transferred into the home environment.

SOS therapy acknowledges that eating is not an easy process for some children. It works forwards the six major steps to eating (sight, interaction, smell, touch, taste, chewing & swallowing). It incorporates play with a purpose to increase the child’s confidence by exploring and learning about the different food properties.

The earlier the child begins SOS feeding therapy; the faster outcomes will be achieved. It is faster to correct a 2-year old’s relationship with food than a 12 year hold. Feeding therapy can make mealtimes easier for people of all ages, including adults.

What is involved?

Before your feeding assessment, you will forward you an in depth medical, developmental and feeding questionnaire. This needs to be received completed by the office 48 hours before your feeding assessment. The feeding assessment consists of 2 sections and will take place over 1.5hours.

The first phase is completed with the feeding therapist and parent where the questionnaire will be discussed in addition to an opportunity to discuss other concerns. Phase 2 is the visual feeding assessment with the child. Parents are requested to bring two foods of different consistencies the child WILL eat and two foods of different consistencies the child will NOT eat. This session is lead by the parent with the feeding therapist in observation. The feeding session is also recorded for discussion later.

After the conclusion of the feeding assessment, the feeding therapist will complete a comprehensive report detailing the findings. A follow up appointment is required with the parent to discuss and plan the child’s feeding therapy depending on the outcomes. Feeding therapy is completed in two formats; 1) individual and 2) small group. The feeding therapist will advise which is most suitable for your child depending on the outcomes.

Who benefits from SOS Therapy?

If the child has experienced any of the below they will likely benefit from SOS feeding therapy.

  • Ongoing poor weight gain (dropping percentiles on the growth charts)
  • Weight loss
  • Pre-term birth
  • Chronic or persistent choking, gagging, or coughing during meals
  • Chronic or persistent problems with vomiting
  • Has a birth defect or genetic disorder (ASD, ADHD, Anxiety Disorder, ADD, Cognitive delay, Down syndrome, Dyslexia, Emotional disorders, Fragile X syndrome, Learning disabilities, Sensory Processing Disorder, Sensory Integration Dysfunction, Tourette’s Syndrome)
  • One or more incident/s of nasal reflux (vomiting or spitting up out their nose)
  • Has been identified as having low muscle tone or a muscle disorder
  • Arches and/or cries at most meals
  • Did not achieve developmental milestones on time
  • Consumes less than 20 foods consistently.
  • Avoidance towards all foods in a specific texture (wet, squishy, crunchy, etc.) or nutrition group (meat, vegetables, starches, fruits, etc.)?
  • Preference towards ultra-processed or uniform foods (e.g. crisps, sausages, chicken nuggets, crustless toast)
  • Accepted foods are being dropped over time with no new foods being accepted
  • Periods of Naso-gastric feeding, Tube or PEG feeding OR other non-oral feeding methods
  • History of traumatic chocking incident and failure to return that food back into the diet
  • Unsuccessful transition to puree by 10 months
  • Unable to transition to solid foods by 12 months
  • Unable to transition from breast/bottle to a cup by 16 months
  • Continuation of baby foods by 16 months
  • Most meal times are described as a battle or fight to get child to feed
  • The child is disinterested in mealtime and foods presented.
  • The child is difficult for everyone to feed

If you are experiencing feeding problems, issues with weight- gain, or weight- loss, contact our dietitians to discuss how they can help you.

Written by Dietitian Ricki-lee Driver

Ricki-lee is passionate about supporting and empowering clients to achieve their health-related goals. Since graduating with an Honours in Nutrition and Dietetics from the University of the Sunshine Coast, Ricki-lee has obtained experience across a variety of sectors including private hospitals, aged care facilities, private practice, and specialist teams. Ricki-lee applies a patient-centred approach to enable clients to overcome health barriers and facilitate diet and lifestyle independence.  Ricki-lee has special interests in adult and childhood obesity, bariatrics and disability.