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The Finicky Feeders program at the Western Michigan University Pediatric Occupational Therapy Clinic serves children who have a variety of medical diagnoses such as autism spectrum disorder, sensory processing disorder, attention deficit hyperactivity disorder, and neuromuscular disorders that may be associated with feeding. This clinic treats children ages one to 12 years of age. Children served are those with food aversions, food refusal, difficulty with texture transition, self-limited diets, oral incoordination and/or disruptive mealtime behaviors. Children seen at this clinic eat as few as ten different foods and some refuse entire food groups further threatening their nutritional status. Referral sources come from community mental health case workers, clinics or doctors in the Kalamazoo area, and other sources around the Kalamazoo community. The focus of the Finicky Feeders program is to help children who are medically stable with food selectivity increase their mealtime repertoires to include a healthy variety of foods from each food group. Children also learn mealtime behaviors that make family mealtime more successful at home. Parents are taught strategies to help their child develop healthy eating behavior for life.

The role of the OT interns, under supervision of the OTRL, includes providing evaluation of feeding skills, and client-centered intervention. Intervention is directed towards increasing the number of foods that each child will accept, teaching appropriate mealtime behaviors that can be generalized and applied to the home setting, and limiting aversive reactions to different foods and textures. Students develop home programs for their clients every week and document progress toward feeding goals. Interns are guided in developing a strong therapeutic relationship with clients and families and developing client-centered and occupation-based intervention plans supported by appropriate theoretical approaches and empirical evidence. Each student manages a caseload of clients and follows the client for the duration of the academic semester. Students also gain a greater understanding of sensory processing and feeding challenges and learn to apply sensory integration and systematic desensitization approach to the treatment of food selectivity.

Client evaluation process

Evaluation is ongoing throughout the semester. Student clinicians use a food inventory, feeding history interview and several standardized questionnaires to understand the client’s feeding skills and deficits. Regular mealtime observation is used to supplement information obtained through evaluation measures. The evaluation yields contributors to the child’s food selectivity, current mealtime functioning, and understanding of the family mealtime context and goal foods for the semester.

Client intervention process

Intervention is scheduled for one hour once weekly group sessions. Intervention is designed around a sensory integration and systematic desensitization approach to help children add new foods to their diets. Parent education is also provided to introduce strategies that can be used at home to progress increase acceptance of family foods. Through collaboration and communication with caregiver, skills learned in the clinic are generalized to the child’s natural environment.

By the end of the semester it is expected that students will have developed the following basic competencies regarding working with children with difficulties food selectivity:

• Evaluation and intervention process

• Building therapeutic relationships and therapeutic use of self

• Developing client-centered and occupation-based intervention plan supported by appropriate theoretical approaches and empirical evidence

• Providing intervention directed toward improving food acceptance and family

• Implementing one-to-one intervention in the context of a group intervention

• Collaboration with peers in a clinic setting