| Abstrakt: |
Speech-language pathologists (SLPs) play an increasingly significant role in the treatment of children with feeding disorders (American Speech-Language-Hearing Association, 2009). Physicians often refer children for feeding therapy secondary to what is seemingly a behavioral issue. This assumed diagnosis usually reflects a child's refusal to eat; a self-limited diet based upon taste, texture, and visual appearance; or difficulty progressing from breast or bottle to pureed or solid foods. However, a child's case history review may reveal gagging, choking, or vomiting incidents with the introduction of pureed or solid foods, in addition to possible medical and developmental issues. Food refusals can develop secondary to these concerns. Additionally, the child's motor skills may not be adequate to handle the food, and the resulting sensory reaction can be described as “fright, fight, flight” (Overland, 2010). Interactions between the sensory and motor systems cannot be ignored (Fisher, Murray, & Bundy, 1991). The use of a purely behavioral approach to treat these children negates the impact of sensory-motor issues on the oral phase of feeding. Though behavioral issues may develop secondary to sensory-motor problems in the mouth, we need to consider the child's refusal as an adaptive, communicative response to a negative experience, rather than as the primary disability to be addressed. Assessment and treatment of the underlying sensory-motor issues should, in many cases, precede behavioral interventions. |
