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WA HEALTH GROUP FOOD SCHOOL-Fussy Eating in Kids tackled with the SOS approach

Updated: Jul 8, 2021

The term ‘fussy eating’ has been around for a long while. What exactly is fussy eating? A child who does not want to eat a variety of foods offered? A child who throws a tantrum at meal times? Or.. A child who just is unable to progress along the usual stages of oral-motor sensory steps to eating? Or a combination of all?


  • Children ages 12 mths and up

And ONE or MORE of these..

  • Ongoing poor weight gain (Failure to thrive/ dipped 2 major centiles on growth chart)

  • Inability to transit to baby food purees by 10 mths old

  • Inability to accept solid table foods by 12 mths old

  • Inability to drink from an open cup by 16mths of age

  • Still on baby food purees by 16mths

  • Aversion or avoidance of all foods in specific texture or nutrition group

  • Food range of less than 20 foods, PLUS dropping off foods previously accepted, with no new foods replacing those lost

  • Crying and tantrums at MOST meals

  • Meals are a battle

The SOS (Sequential Oral Sensory) approach to eating was first developed by Dr Kay Toomey, a paediatric psychologist, as a family centered, program for assessing and treating children with feeding difficulties. It is believed that there are two different groups of children in regards to feeding difficulties:

1) Picky eaters; and

2) Problem feeders

Picky eaters generally do not have any pre-existing medical issues that might contribute to feeding difficulties. Problem feeders on the other hand MAY be currently experiencing a/multiple medical condition(s) that may affect feeding. It is hence important to assess the level of oral motor skill the child has (which may not necessarily be matched to the child’s age), start from his/her level and work up the steps of eating. Examples of oral motor skills include the ability to manage different textures/shapes/hardness of food etc in the mouth.

A child who has not developed the skills to move foods in the right direction in the mouth with the help of the tongue will not be able to progress up the steps to eating, until he/she is taught how to. According to the SOS approach, there are a total of 32 steps before eating. These steps are broken down into sub-categories:

1) Tolerance of a particular food

2) Interaction with the particular food

3) Smelling the particular food

4) Touching the particular food (takes more than 1 step from hand to mouth!)

5) Tasting the particular food (Not necessarily swallowing), and eventually

6) EATING the food

In this approach, it is believed that variety comes first, followed by volume. Our dietitian has been accredited and trained to assess and identify the needs of these children from the different groups and to treat accordingly, at the same time, applying concepts to healthy eating when appropriate. This approach is based mainly on play therapy, unlike the usual dietetic consultations/education sessions, and usually run from 6-12 session before you might see any improvements. An initial consultation will usually involve any hands on therapy, as this session is designed to learn more about your child, eating environment, social and medical history. For follow up sessions, be prepared to have your kids hands dirty as foods will be involved (naturally!).At the moment, we are conducting clinic and home-based therapies. No referrals are required at this stage.

For more information, please contact one of our friendly staff on (08) 6162 2616 for an initial assessment.

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