Feeding

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Pediatric Feeding Disorders

​NYBAPS pediatric feeding program provides evidence-based assessment and treatment for mealtime problems for young children (12 months and up). While work with children with a variety of medical diagnosis (e.g., gastroesophageal reflux, failure-to-thrive, down syndrome), we specialize in treatment for children with autism who display food selectivity by type and texture.

• Feeding Difficulties (R63.3)
• Other Feeding Difficulties of Infancy and Early Childhood (F98.29)
• Other Disorders of Eating, Avoidant/Restrictive Food Intake Disorder (ARFID) (F50.8)

Feeding problems affect your child’s ability to properly function at home, school and other social settings, impacting their physical, social and psychological development. Your child may lack interest in food, avoid food based on the sensory characteristics of food, or concerned about aversive consequences of eating.

It is not uncommon for children to have very restricted diet consisting entirely of pureed foods or french fries and chicken nuggets from a specific fast-food restaurant. Common signs and symptoms of a feeding disorder include:

• Mealtime tantrums
• Food refusal
• Extreme pickiness
• Distress and anxiety with new foods
• Difficulty with textures
• Difficulty chewing
• Inability or refusal to feed oneself
• Poor weight gain (failure-to-thrive)
• Significant nutritional deficiency
• Feeding tube dependence
• Frequent vomiting

All assessment and treatment is provided in your home (i.e., child’s natural environment). Our therapists travel within the NYC metro area to provide evidence-based treatment to children. In addition to our team, we also work very closely with your child’s existing medical team when indicated (e.g., physicians, occupational and speech therapists, educators) to optimize the treatment outcome. The referred children with (and without) developmental disabilities must have:

• Stable medical status per physician
• Adequate oral-motor skill to consume solid food
• Beginning to understand simple, one-step requests

​Initial Evaluation 
Prior to the initial evaluation, your child’s medical records should be sent to us for review. The initial evaluation is 2-3 hours long. During the mealtime evaluation, we will obtain a medical/feeding history and observe your interactions with your child. You will also be asked to feed your child during a regularly scheduled mealtime. We will assess your child’s skill level as it relates to his/her feeding problem. This process also allows us to determine whether our services are appropriate for your child. If your child is found appropriate for our program, recommendations will be provided to you in order to get your child ready for the assessment and treatment phase.

Baseline Assessment 
Following the initial evaluation, our therapist will conduct three or more baseline meal sessions to establish pre-treatment levels of food acceptance and refusal behaviors. Upon observation of stable baseline behaviors, various treatment strategies will be implemented with your input.

Preference Assessment 
We will also conduct a preference assessment to identify potential reinforcers.

Treatment Development 
Following assessment, the initial treatment consists of intensive consecutive day sessions (i.e., every meal) for 1-2 weeks.  During the onset of treatment, we will work with your child to develop an appropriate treatment plan. Many of these modalities focus on escape-extinction procedures. Initially, your child’s refusal behaviors, including crying, may increase significantly. However, it is from our experience that these behaviors decrease with the accurate and consistent implementation of the feeding protocol, and should not be a cause for a significant concern.
Parent Training
Once a successful treatment plan is established, caregivers are trained to implement that plan with high integrity.  In addition, other individuals working with the child are also trained to implement the treatment plan.
Maintenance
After parent training, follow-up treatment visits are scheduled on a weekly, then bi-monthly, then on a monthly basis to continue to advance your child’s feeding skills. You will also be in contact with our team if any concerns arise before the next schedule visit. The goal of our program is to develop individual treatment plans so your child can be a developmentally-typical eater.

• We also provide treatment for Pica (307.52) and Rumination Disorder (307.53).
• We do not provide services for anorexia nervosa, bulimia, or binge-eating disorder.
• Read a NYT article on a behavioral approach to feeding disorders, here.