OT Observations: Pediatric Feeding Therapy – An Adolescent with ARFID

Peds Feeding 1
Pediatric occupational therapists often work with clients who have difficulty with feeding, eating, and/or swallowing as a result of physical differences, behavioral issues, or psychological disorders.

Yesterday was quite an unusual day for fieldwork, as I was able to observe an initial evaluation session with a young client who was being treated for an eating disorder. When my classmate/fieldwork partner and I initially heard the diagnosis, I think both of us immediately jumped to conclusions about the client we would be seeing. This is probably due partly to our own personal experiences both in and out of the OT clinic, but also by the dominant narratives about people with eating disorders that are shown in popular media. In my experience, I have really only seen shows and read narratives of young (middle school to high school age), Caucasian females with disordered eating habits. However, the client we saw fit few of these stereotypes!

Instead of the “scary skinny” young girl we might have expected to see, our client was a tall, talkative 16 year old male who was classified as obese in his medical records. He was an agreeable and intelligent young man who expressed himself clearly, and whose goals included being able to go to restaurants with friends and find something on the menu that he felt comfortable eating. “Josh” had a repertoire of only 10-15 foods that he would eat (like hot dogs, pepperoni pizza, cucumbers, and ranch dressing), and reportedly he would rather “go hungry” than eat a non-preferred food. In addition to his limited diet, Josh was dealing with a somewhat unstable home situation, gastroesophageal reflux disease, and crippling anxiety about his performance in school that frequently caused him to miss multiple days out of school at a time. Josh was being seen at the OT clinic because he had been diagnosed with Avoidant/Restrictive Food Intake Disorder (ARFID), and here is a brief description of the disorder from Sheppard Pratt’s Center for Eating Disorders website:

 ARFID was introduced as a new diagnostic category in the recently published DSM-V.  The ARFID diagnosis describes individuals whose symptoms do not match the criteria for traditional eating disorder diagnoses, but who, nonetheless, experience clinically significant struggles with eating and food.  There are many types of eating problems that might warrant an ARFID diagnosis – difficulty digesting certain foods, avoiding certain colors or textures of food, eating only very small portions, having no appetite, or being afraid to eat after a frightening episode of choking or vomiting. And most of all, individuals with ARFID may have problems at school or work because of their eating problems – such as avoiding work lunches, not getting schoolwork done because of the time it takes to eat, or even avoiding seeing friends or family at social events where food is present.

Although the other components of the disorder are also very significant, an occupational therapist is most likely to become involved when the client’s disorder disrupts his or her engagement in occupations like eating in new surroundings, going to school, or “seeing friends or family at social events where [non-preferred] food is present,” which are examples of the real occupational performance issues that Josh faced as a result of his eating disorder. Continue reading


(As in, What the Fieldwork!)

Ball Pit
Pediatric therapy fieldwork is just like this ball pit. It’s all fun and games at first, but you have to beware of the hidden dangers!

So my second round of Level I fieldwork began at 7:45 AM today, and it was a whirlwind of an experience! I was at a large research hospital’s outpatient pediatric clinic, and I probably saw about 7-8 kids today. For my spring Level I rotation, my program has me in two different sites for 10 weeks total, with myself and a classmate/partner spending five weeks at each site. Until March, I will be spending one day per week at this first pediatric site, and after spring break I will be at a new site with a new partner. The “partnering” and “50/50” fieldwork is new to my program, but I enjoyed having another person to talk to and bounce ideas off of today as I observed the therapists and engaged with the kids.

While my CI “Jay” was a friendly, experienced therapist who had been practicing for 10+ years, a lot of the things I saw in her practice and the setting in general were somewhat disconcerting and at times discouraging to me as a budding OT. However, because I believe in having a strengths-based approach to life and other pursuits, I’m going to start with what I liked about working with Jay and my classmate “Lily” at the site!

Continue reading

New Feature: “OT Observations”

The “OT Observations” feature describes my experiences observing and learning from various occupational therapists in practice. Currently I am volunteering at an outpatient therapy clinic and observing the work of the therapists there.

This past October, I began volunteering in a local pediatric and adult outpatient therapy clinic. Multiple therapeutic disciplines are represented, and there are adult and pediatric occupational, speech and physical therapists at the clinic. I spend the majority of my time observing and/or playing with the clients of the therapist I’ll call “Helen.” Helen is an amazing therapist, a fantastic role model and another person who has been instrumental in helping me learn about and become more passionate about occupational therapy!

Just a little bit about Helen, for context – she’s been an OT for 17 years and she works with children and adults. She’s worked in home health, hospital and private outpatient settings, and has the vast amount of experience one would think goes with such a long career in OT! She is the first therapist who I’ve seen administering feeding therapy, early intervention with an infant, sensory integration treatments and basically any kind of pediatric therapy. I thought I wanted to work solely with adults in the future, but Helen has had a large part in changing my mind about that!

Initially, I only planned on volunteering until the end of the semester, in order to meet a graduate program’s volunteer hour requirements. However, being able to see all of the therapists and their different styles in action has kept me there for the past 6 months! I don’t know what I’m going to do when I have to leave, but I’m glad I have had the chance to see and learn about so many different things while I’ve been there.

I’m creating this “OT Observations” feature so that I can record and keep track of what I’m seeing now and perhaps link it to things I will learn in the future. Although my observations will be heavily inundated with my own commentary and musings, I hope they will be helpful for anybody interested in learning more about occupational therapy as well.