Occupational Therapy Techniques for Feeding and Toileting
This article focuses on summarizing the case study titled “Occupational Therapy Interventions to Support Feeding and Toileting in Children From Birth to Age 5 Years” published in The American Journal of Occupational Therapy (AOTA) and detailing the interventions that have been shown to work in children struggling with feeding and toileting.
Feeding
Children who struggle with meals due to behavioral or sensory issues respond well to consistent, repeated exposure to non-preferred or new foods when paired with positive reinforcement.1 Structure and routine are also important factors. Parent education is a crucial component of helping a child that struggles with meals, especially in strategies such as “positive reinforcement, response shaping, and extinction” in response to feeding challenges.2 These intervention techniques work well when paired with tangible rewards; however, social rewards are not as effective but are still a valuable tool.3
Toilet Training
Toileting is successfully taught to typically developing children through the use of behavioral approaches. Increased fluid intake, consistent routines, positive reinforcement, and avoiding punitive language have all been proven methods to aid with potty training (toileting).
Case Study
The following case study looks at how the above-mentioned occupational therapy techniques can be applied. This case study focuses on Owen, a 33-month-old boy, who was recommended for occupational therapy due to his parent’s concern about behavior around meals and toilet training.
Feeding Behavior
Owen presents disruptive behavior at the table and only eats a select few foods. Owen accepts crunchy food like crackers, some fruits, and french fries. At breakfast, Owen is more agreeable because he is given his preferred finger foods. Throughout the day, Owen will drink water or nutritional shakes. Dinner is the time when Owen’s behavior becomes difficult. He doesn’t want to sit at the table, throws food, and gags on new or non-preferred foods. Owen’s parents will provide him with a separate meal of foods that he prefers at dinner and eat their meal once he has gone to bed.4
Toilet Behavior
Owen’s toilet behavior lacks structure. He doesn’t indicate if his diaper is soiled or wet and does not eliminate into the toilet. Owen will hide if he’s had a bowel movement. With proper verbal and visual cues, Owen will retrieve clean diapers for himself. He can undress but does need help getting dressed. His parents’ main concern is that he’s not as independent as he should be compared to his peers.5
Goals
The occupational therapist working with Owen developed goals, each supported by evidence and recommendations by the American Journal of Occupational Therapy. According to AOTA and the Occupational Therapy Practice Guidelines for Early Childhood: Birth-5 Years, the following evidence is recommended for cases like Owen’s: “parent behavioral training programs to decrease parental stress and undesired mealtime behaviors,” “repeated-exposure feeding approaches to increase food acceptance,” “Parent coaching regarding nonpunitive toilet training language use to reduce toileting refusal,” “family-centered, routine-based interventions to improve parenting behavior, satisfaction, and well-being.”6
Intervention
Owen’s occupational therapy sessions took place at home or school and were scheduled around the times when he experienced the most issues with feeding and toileting, such as early evenings or around lunchtime at school. The sessions also served as a coaching process for both Owen’s parents and teachers.
The OT recommended that Owen’s parents stop preparing a separate meal for Owen because he needs repeated exposure to non-preferred or new foods. The OT also stressed how daily activities should be more structured and routine; this way Owen understands what’s expected of him. Meals also need a “division of responsibility,” where the parents get to decide the time, place, and what he will eat, but Owen can decide how much he will eat based on the cues his body is giving him.7
Since the therapy sessions with Owen involve a lot of parent coaching so that the parents can implement all techniques daily, the OT would coach the parents through the use of guided questioning and reflection. This helped identify problems such as snacking on the way home from school when dinner is around the corner. During mealtime, the parents are to reinforce positive behavior and ignore/redirect negative behaviors.8
Toileting involved increasing fluid intake and finding strong, positive reinforcers for when successes were made. This included an app with cartoon characters that used visual cues. Neutral phrases were developed to avoid any punitive language around any toileting mistakes.9
At school, the OT observed the behaviors at lunchtime and coached the teachers on the importance of consistent exposure to non-preferred foods in a way that was consistent with what Owen’s parents are doing. The OT also observed toileting behavior post-lunch and recognized that Owen was very disorganized and distracted on his way to the bathroom. A structured routine was necessary so that Owen would be able to go to the toilet each day at the same time.
Key Takeaways
This study showed how to apply different interventions in the case of toileting and feeding. Feeding improves through repeated exposure to new and non-preferred foods. Both feeding and toileting improve through structured routines, parent education, positive reinforcement, and visual and verbal cues.
The author recommends that “occupational therapy practitioners should also incorporate reinforcement, chaining, shaping, and exposure strategies to improve toileting independence, mealtime success, and parent confidence and well-being,” as well as “the incorporation of occupation therapy into the natural settings of early childhood education.”10
-
1. Gronski, Meredith P., “Occupational Therapy Interventions to Support Feeding and Toileting in Children From Birth to Age 5 Years,” American Journal of Occupational Therapy. 75, no. 5 (2021): “Feeding,” para. 1,https://doi.org/10.5014/ajot.2021.049194.
2. Gronski, “Occupational Therapy Interventions,” “Feeding,” para. 1.
3. Ibid, “Feeding,” para. 2.
4. Ibid, “Case Study: Owen,” para. 3.
5. Ibid, “Case Study: Owen,” para. 4.
6. Ibid, “Case Study: Owen,” para. 5.
7. Ibid, “Sample Intervention 1: Home,” para. 1.
8. Ibid, “Sample Intervention 1: Home,” para. 2.
9. Ibid, “Sample Intervention 2: Home,” para. 1.
10. Ibid, “Conclusion,” para. 1.