Sequential Oral Sensory, SOS, is a transdisciplinary feeding approach that integrates motor, oral, behavioral/learning, medical, sensory and nutritional factors and approaches in order to comprehensively evaluate and manage children with feeding/growth problems. The goal is to increase familiarity and build tolerance to novel foods with a goal of increasing a child’s repertoire of consumed foods through play and interaction.

The SOS approach incorporates a systematic desensitization approach in which a child will move up six major “Steps to Eating.” As a child moves up the steps to eating, they learn about the sensory properties of new foods, develop oral motor skills required for eating and reduce stress and emotional responses to meal times through play.

Each of the six major steps is composed of several sub-steps, which will vary from child to child. In general, there are 32 usual steps, which children with feeding difficulties will progress through. These steps are progressive, such that the child usually will first master step 1 before he/she masters step 2, etc. However, a child does not necessarily need to complete every one of the steps. He/She may skip some of the smaller, 32 Steps AND/OR a child may have more, smaller steps in between each of the usual 32 steps.

At Blue Bird Day School, our staff is educated in the SOS approach and supervised by certified SOS therapists in implementing during our students’ lunch and snack time routines. Meal times incorporate principles of the SOS approach, specifically movement up the “Steps to Eating” hierarchy of interacting with foods through play.

Steps to Eating

1. The child is able to TOLERATE THE PHYSICAL PRESENCE/ SIGHT of the food (i.e. Will be in the same room as the food or at the same table as the food)

2. The child is able to INTERACT WITH THE FOOD (i.e. Uses a napkin or other food to touch the target food) WITHOUT directly touching the food to their skin

3. The child is able to TOLERATE THE SMELL OR ODOR of the food

4. The child is able to TOUCH THE FOOD TO HIS/HEfR SKIN (i.e. Tolerates the food touching a body part, including fingers, hands, face — the closer the physical proximity to the mouth, the more threatening)

5. The child is able to TASTE THE FOOD (i.e. an action which results in the child getting a taste of the food AND processing the taste of that food)

6. The child is able to CHEW AND SWALLOW THE FOOD, or at least some part of the food

Steps to Eating Strategies

• Tailor your modeling along the hierarchy to the tolerance of each particular child
• Make sure that you are not starting at a step that is too high for a child
• Make sure that steps between foods are small enough for the child to tolerate
• If the child does not follow you up the Steps To Eating, it means that you have jumped too far. Just back up, and start with a lower step (or sub-step).
• Many times children will not feel safe to put a food into their mouths unless they know they have permission to spit it out if they cannot handle it. Often we have to teach children to move a food forward in their mouths in order to spit it out first, before they can learn to move it back for a swallow.

Copyright 2000/2010; Kay A. Toomey, Ph.D.

By Dr. Baily Zubel, OTD, OTR/L and Erin Harvey, OTD, OTR/L in collaboration with Alexa Grief, MS, OTR/L