Feeding problem: Behavioral or Sensory?

Hi! I have a patient with Down Syndrome. Current concern is regarding the child’s feeding participation. The child starts to eat solid food again but recently, she was diagnosed with esophagitis and her pediatrician advised to stop the intake of solid food and go back to giving soft-textured food. I currently have difficulty in helping the child eat soft food as she has tactile defensiveness and she is aversive to playdoh and other soft-textured things and playing with food seems to be a problem also. However, when her home school teacher tries to give the soft-textured food during snacktime, the child is able to eat about 5 spoonfuls of it. And I’m wondering if this is a sensory issue or a behavioral issue?

Thank you so much for your responding!

@tots-mary @OTmomma @BreeMilani @abg_speechtherapy @Slpmomma @Alinclusivetherapy @Giselle_Tadros @GinaOT @Speechwithjwo @Twowayspeech does anyone have any tips here?

I’m an SLP who works with feeding kids. Sounds like it’s a bit of both. I don’t know if you’ve heard of SOS feeding therapy but it’s a program by Dr Kay Toomey. It works on chaining foods for desensitization. I do a variation of it with my kiddos and it works great. They actually end up being their own therapists and interacting with food independently. It’s based on feeding development and following the child’s lead. If you have any questions let me know. I’ve used it with all kinds of children- nonverbal, Downs, picky eaters, etc.


Hi OT-Philippines,

Yes, there is a strong relationship and interweaving between sensory and behavior. Many times they see-saw with each other. When the child is experiencing a sensory overload then you see the behavior. With feeding it is so important to really develop success and trust with a client before moving to the next level. Also with feeding, even if a child has eaten something before it does not mean the brain remembers it, and each feeding can feel like a new experience.

I completely agree the SOS feeding course is something you should look into. This is especially true since you are an OT. It was one of the best continuing education classes I have done.

When I work with my feeding kiddos (some are diagnosed with down syndrome). I tend to think about.

  1. exposing them to new experiences with and without food to feel successful.
  2. decrease hypersensitivity to drive motor skills both in the hands and the mouth.
  3. Developing actual feeding skills like chewing, tongue lateralization, straw drinking, etc.

Besides SOS, also check out Melanie Potock (she has wonderful Facebook lives), Talk tools feeding class, and classes by Marsha Dunn Klein to help build skills.

Let me know if you have any other questions.

-Janice SLP


Hi. Thank you for this! I’ll try to look into SOS Feeding Intervention. I’ve read some articles with great feedback regarding this intervention and I would love to know more about it.

Thank you so much for your response! It came across my mind that it could be both, behavioral and sensory. I’ve just started gaining the child’s trust as she was very defiant and prefers self-directed activities. However, the parents expressed that the child needs to take in soft-textured food as she was diagnosed with esophagitis and eating solid food would worsen her condition. I don’t want to force feeding also as this may result to more aversion than exploration.

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If you have any questions just reach out to me. I love this program.

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Is SOS good for extremely Picky Eaters?

Yes I’ve found it works amazing. Sorry my email never sent that you followed up.