I have completed both the basic and advance sequential-oral-sensory (SOS) approach to feeding training, and have since used the SOS approach to manage ‘problem feeders’. However, I have found that the SOS approach to feeding offers valuable insights that can help families struggling mealtimes.
In today’s post, I want to discuss about the Steps to Eating Hierarchy from the SOS Approach to Feeding.
Did you know?
There are more than two steps when it comes to eating? Eating is not as simple as putting food into your mouth and swallowing. Dr. Kay Toomey developed the Steps to Eating Hierarchy, which breaks eating down into smaller, manageable stages. Here is the abbreviated Steps to Eating Hierarchy from Dr Toomey.
I often share this handout with families as a visual guide, as it can help parents understand why their child may be struggling with eating and how to support them. This hierarchy applies not only to young children but also to older children and even teenagers.
Let’s go through these six steps in detail:
Tolerates
The first step in eating is simply tolerating the presence of a food. For some children, this could mean being able to sit at the same table as a non-preferred food without distress. For extreme problem feeders, just seeing a non-preferred food on the dining table (even if it’s not on their plate) can trigger meltdowns. Realistically, if a child cannot tolerate looking at a food, it is unrealistic to expect them to touch, taste, or eat it. Building tolerance is essential before moving on to the next step to eating.
Interacts with
Once a child can tolerate a food being near them, the next step is to be able to interact with food. There are different forms of interaction, such as:
- Using a fork to poke the food.
- Using a spoon to scoop it onto their plate (even if they don’t intend to eat it)
- Passing the food to someone else at the table
A child who can interact with food indicate progress beyond tolerating a non preferred food at the table.
Smells
Smells can be a tricky sense to navigate. Majority of the families that I work with can tolerate food smells without issues and may bypass this step completely. However, some children are highly sensitive to smell. In severe problem feeders, some children may even gag or vomit in response to certain food smells. Some questions to consider include: Can my child tolerate this smell in the room? Can my child tolerate the smell of this food when it is placed right in front of them?
For children who are sensitive to food smells, exposure should be gradual and non-threatening to avoid overwhelming them.
Touch
Touch is a crucial part of learning about the food. Many families often tell me that their child will ‘play’ with food, but not eat it. Touching food is an essential part of learning that stimulates tactile exploration of food, especially for little babies and young children. By touching food, children learn about the properties of food such as:
- Is it hot or cold?
- Does the food crumble or stay firm with pressure?
- Is it dry, squishy, juicy or sticky?
Allowing children to explore food through touch makes them more comfortable with it, increasing the chances of them eventually tasting and eating it. This is why messy eating is crucial, and babies who are not allowed to make mess by being spoon fed constantly will miss out on the opportunities to explore food at a young age.
Touching food is not limited to just using hands, it can also involve touching food on their lips or even just the touching food to the tip of their tongue. The way food feels on fingers is very different from how it feels in the mouth, so allowing hands-on exploration is key to helping children progress toward eating.
Taste
Taste plays a major role in for food acceptance or refusal in a lot of children. When a child puts food in their mouth, do they accept it, or do they refuse it? It is easier to identify whether an older child likes or dislike a food, but babies are still learning about new tastes.
I love this photo of my son’s first taste of sour food in the form of Greek yoghurt at just over 6 months old. His first reaction? A big facial grimace and a full-body shudder. But this didn’t mean he disliked it, it was simply a new taste experience. He was unfamiliar to sour flavours. I gave him time to explore the yoghurt with his hands and on a preloaded spoon, and soon after he took a few more mouthfuls. Instead of making assumptions about whether a child likes or dislikes a food after one attempt, it is important to observe their cues and allow breaks as needed. Repeated exposure, without pressure, is key to helping children get used to new flavours.
Some children may put food in their mouth, taste it, and then spit it out. While this can be frustrating for parents, it is actually a key part of the learning process. According to the Ellyn Satter approach to feeding, parents are responsible for offering food, and children decide whether to eat it. If your child tries a food and spit out of food, avoid criticising them. Instead, continue to encourage them to taste the food. By allowing children to spit food safely, this teaches them they can both accept and reject foods without negative consequences. This also teaches children that they will not get into trouble for rejecting foods, hence increasing the willingness to try foods down the track. If it bothers you to see your child spitting food out, allocate a “No thank you” bowl where your child can place food they are not ready to swallow. This gives them a sense of control while keeping mealtime positive.
Eating
Eating is the final step whereby a child can pick up a food (either with their hands or cutlery), put it into their mouth, chews it into smaller pieces, forms a swallowable bolus, and swallows it. When a child is eating, it is important to encourage them to eat as according to their hunger and satiety cues. Parents should avoid force feeding children as this can lead to increased food refusal and anxiety around eating. Well-meaning parents who try to push their child to eat more may actually cause children to reject foods they previously accepted. Supporting your child at their own pace will help them develop a healthier relationship with food in the long run.
Breaking It Down into Achievable Steps
As you can see, eating is a complex process made up of multiple small steps. If your child is struggling with food, breaking it down into these smaller steps can make the journey feel less overwhelming. Celebrating small wins: whether it’s tolerating food on the table, interacting with it, or simply touching it helps keep both parents and children motivated. Each step forward is progress. If you would like more information about the SOS Approach to Feeding, visit the “Parents & Caregiver” tab for further information on this website.
