Feeding and Medical Challenges

Sequential Oral Sensory (SOS) Approach to Feeding

January 11, 2017   /

The sequential oral sensory (SOS) approach to feeding is a rehabilitative program used for problem feeders. The goal of the program is to increase the child’s comfort level by exploring and learning about the taste, texture, smell, and consistency of food. It is an interdisciplinary approach relying on a team of physical therapists, occupational therapists, speech therapists, and dietitians.

The program integrates sensory, motor, oral, behavioral/learning, medical, and nutritional factors. The SOS approach to feeding is based on the “normal” developmental steps and skills of feeding. Parent education is an integral component of the program. The SOS approach to feeding was designed by Dr Kay Toomey and associates, with refinements during the past 15 years.

Progression of the SOS approach
The assessment part of the program considers all of the physical, mental, and emotional problems that can cause eating problems. Nutritional deficits are identified and treated. The typical developmental steps toward feeding are used to create a program of desensitization. For instance, children must become comfortable with having food around. Many children with feeding problems do not want to sit at the table with certain types of food present. Once the children become able to sit with the food, they are taught to “play” with the food—to touch it, etc.

Deep pressure touch or massage often is incorporated into the program to make it as unstressful as possible for the children. Children are never force-fed. Foods that are similar to the children’s “safe food” are introduced first, and the similarities, such as taste, texture, or color, are stressed (eg, green beans and peas are the same color and are both vegetables).

Children who can benefit
Children with the following conditions are candidates for the SOS approach to feeding:

  • Poor weight gain
  • Weight loss
  • Continued choking and gagging during mealtimes
  • Vomiting
  • More than one incidence of nasal reflux
  • Ongoing respiratory problems stemming from poor breathing-eating coordination
  • Inability to transition to pureed foods by 10 months or solid foods by 12 months
  • Inability to transition from bottle to cup by 16 months
  • Aversion to or avoidance of an entire food group or texture group
  • A food range of less than 20 foods
  • Crying and/or arching at most meals (infants)

Length of the program
The SOS approach to feeding should take 12 weeks to complete.


References and recommended readings
Food aversions and the gut/brain connection. Center of Development Web site. http://www.developmentaldelay.net/page.cfm/272. Accessed April 25,  2013.

Sequential oral sensory (SOS) approach to feeding. Children’s Theraplay Web site. http://ctplaymn.com/services/treatment_methods.html#sos. Accessed April 25,  2013.

S.O.S. approach to feeding. Kids Can Do, Inc. Children’s Therapy Center Web site. http://www.kidscando.org/sos.html. Accessed March 26, 2013.