Picky Eaters vs Problem Feeders vs Avoidant/Restrictive Food Intake Disorder (ARFID)

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Dr. Kay A. Toomey Related seminars and products

Toomey & Associates, Inc.

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Dr. Kay A. Toomey, is a pediatric psychologist with over 30 years of clinical experience assessing and treating children with a wide range of feeding challenges. She developed the SOS Approach to Feeding as a family-centered program for assessing and treating children with feeding problems. Dr. Toomey helped to form The Children’s Hospital – Denver’s Pediatric Oral Feeding Clinic, as well as the Rose Medical Center’s Pediatric Feeding Center. She also acts as a consultant to Gerber Products.

Dr. Toomey co-chaired the Pediatric Therapy Services Department at Rose Medical Center prior to entering private practice. She acted as the Clinical Director for Toomey & Associates, Inc.’s Feeding Clinic for six years and SOS Feeding Solutions at STAR Institute for eight years, and speaks nationally and internationally about her approach. Dr. Toomey is currently the president of Toomey & Associates, Inc., and acts as a clinical consultant to the Feeding Clinic at STAR Institute.
 

Speaker Disclosures:
Financial: Kay Toomey is in private practice. She is a clinical consultant for The Feeding Clinic @ STAR. She is a professional consultant for Nestle/Gerber Food Products, Inc. Dr. Toomey is an author and receives royalties. She receives a speaking honorarium from PESI, Inc.
Non-financial: Kay Toomey is a non-paid advisory board member of Feeding Matters. She is a member of the American Psychological Association; the Colorado Psychological Association; Society of Pediatric Psychology; and Society for Developmental and Behavioral Pediatrics.

 

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Objectives

1. Identify physical, motor, sensory, oral-motor, environmental, nutritional and behavior factors necessary to consider, to properly assess feeding problems.

2. Delineate differential criteria for determining a child’s diagnosis as a typical eater, picky eater, problem feeder or a child with ARFID.

3. Evaluate the diagnosis of ARFID to discover sensory sensitivity, fear of aversive consequences and/or apparent lack of interest in eating or food.

4. Utilize practical treatment strategies to advance children’s feeding skills, improve family meal routines and increase children’s intake of more nutritious foods.

5. Conduct more thorough and accurate diagnoses, to implement the right treatment approaches for the distinct types of feeding/eating problems.

6. Discriminate when a child needs additional evaluation and intervention by specialists for more intense treatment.

Outline

Prevalence of the Problem

• Picky eating
• Problem feeding
• ARFID

The Complexity of Feeding/Eating

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

How to Complete a Comprehensive Feeding Assessment

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

Differential Diagnoses Criteria, Research and Limitations

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

Treatment Approaches – Align Treatment w/ Diagnosis

• Systematic desensitization
• Flooding/escape extinction
• Eating disorders

Case Studies: 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 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 healthly 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

Practical Feeding Strategies for Pediatric Feeding Disorder

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

Target Audience

• Psychologists 
• Social Workers
• Counselors
• Pediatric Occupational Therapists
• Pediatric Speech Pathologists
• Pediatric Feeding Specialists
• Physicians and/or Psychiatrists
• Registered Dietitians
• Day Care Providers
• Teachers/Educators
• Nurses

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