Originally published on Jan. 14, 2018.

It can be difficult to identify when you're making progress with feeding therapy. A child eating a food can feel very far away when you are doing messy play sessions.

One of the tools we use a lot in Speech Therapy is a desensitisation hierarchy. This is a great way of setting goals, and measuring progress. You may have come across the 'Steps to Eating' model from 'SOS Feeding Therapy'. A hierarchy and the Steps to Eating are much the same thing.

A desensitisation hierarchy is simply the steps that we all move through in approaching a new food, before we will eat it. As adults, we are often very quick to do this, and so haven't noticed, but trust me, we all do these things (on a side point, how often as an adult do you try a new food? Hardly ever, I suspect). One of the things that is so great about using a hierarchy is that is helps us to remember that children are usually acting pretty logically in response to food, from their own perspective, and not nearly as randomly as it can feel to a Parent.

I'll outline the hierarchy here, and we will explore it a bit more through other posts in the future.

So, the hierarchy goes:

  • Tolerate I will be in the same room as the food, it is safe for it to be around. This also might extend to feeding equipment, like a bottle, spoon or high chair. Sometimes we need to start with supporting a child to feel comfortable around these things first.
  • Look I will look at the food! (Not complicated, that one!)
  • Interact I will explore the food, but not with my hands. In previous posts, we've talked about the role of the hands in eating and why they are especially sensitive. Interacting might mean exploring food with utensils, or maybe using a 'safe' food, like a breadstick, to explore.
  • Pick Up This is a big step, because it involves the hands
  • Taste/Lick This means what it says, that tongue tip coming out and tasting, and nothing more. This is often the stage where Parental frustration creeps in, it is sooo close to being eaten.
  • Put in mouth Letting go of food in the mouth can be a big deal for children. Where does it go? If your child has never eaten, they will not know. And many children with feeding difficulties will have differences in their sensory processing and motor skills, and not know how to move the food around to prepare it for swallowing
  • Eat A complex process including having the oral skills to break down the food before swallowing

So, how do we use the hierarchy in Therapy?

  • To give reassurance Perhaps it feels like your child is never going to eat, but when we look at what stage they are on in the hierarchy, they may be further on than you think.
  • To give a baseline Knowing where your child started with a food helps us to know when they have made progress. Children may be on different stages of the hierarchy with different foods, so this can help you to keep track.
  • To measure progress and set goals Eating a food is a big goal for some children. Using a hierarchy helps us to break things down into smaller, and more manageable steps. For smaller children, their progress will emerge out of their messy play sessions, it is a question of us adults slowing down and using the hierarchy to help us to understand what we are looking for. With older children, I might use the hierarchy to help them talk through what their goals are with different foods.

In terms of your messy play sessions, it can be helpful to focus on just one or two foods to introduce alongside the hierarchy. This will help keep your Therapy focussed, be less confusing for your child and help us to make progress. Regular play with the same foods will give your child a better chance of progressing through the hierarchy than trying lots of new foods, without much repetition.

We're going to keep talking here about messy play, breaking down the hierarchy into smaller steps if needed, and small signs of progress at each stage. Keep your eye out for new posts.

Posts from 'Find the Key Speech Therapy' are intended for information. They should not and cannot replace advice from a qualified Speech and Language Therapist who knows your child. 'Find the Key Speech and Language Therapy' always advises you to seek appropriate professional support.