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Melanie Potock
BY Melanie Potock

10 Things You Should Know about Feeding Therapy

“I never imagined my child would have trouble eating.”  Those words are often one of the first comments parents have for me when they ask about feeding therapy.  As a pediatric speech pathologist who specializes in feeding, I have the joy of being a “food coach” for kids and their families as we progress through the developmental process of learning to eat a variety of foods.

Whether working with children with special needs such as Autism Spectrum Disorders (ASD), Down syndrome or Sensory Processing Disorder (SPD) or with a child coined the “picky eater” of the family, the ultimate goal of feeding therapy is to establish regular, nutritious family meals that are joyful for the entire family.

Here are the top 10 things I want you to know before starting feeding therapy:

1. It starts with an evaluation

Typically conducted by a speech language pathologist or occupational therapist who specializes in feeding and swallowing difficulties in children, these evaluations can be done in a variety of settings.  In a hospital setting, the evaluation may include a team of professionals, such as a gastroenterologist, psychologist and more.

2. It may not be the first place to start

Talk to your pediatrician about your concerns.  If it feels like more than typical “picky eating” or  it causes you stress in any way, insist on more help.  If you don’t get an answer that feels comfortable to you, get a second opinion or even a third

3. Where to find help

Early intervention services
For children birth to age 3.  Call your local office and ask if they have experienced therapists to evaluate your child for feeding issues.  Evaluations are free and include gross & fine motor skills, speech and more. If your child qualifies based on that evaluation (regardless of income) treatment is provided for free in the natural environment, often in the home.

Call your state’s children’s hospital
and request a “feeding evaluation.”

Private therapists who sometimes do home visits
can be found via the American Speech Language Association’s “find a pro” link .  An excellent source of OTs trained in sensory integration, a strong component of feeding therapy, can be found here.

4. Assessment and therapy

should address the whole child.  In my experience, I’ve rarely met a child that was having difficulty because of just one issue.  For example, kids with chronic acid reflux or GERD quickly learn not to eat, because it hurts.  We can put the child on medication to stop the pain, but the learned behavior (and likely a new sensory component as well) is still there, and needs to be addressed.

5. Family dynamics are part of feeding therapy

Feeding your child is emotional: It’s about nurturing, bonding, love and responsibility as a parent.  When feeding is challenging, it’s stressful and it impacts the entire family on a daily basis.

6. It takes time

First, eating is a developmental process.  When a child has difficulty eating, it means they have stalled in the midst of learning a new skill.  Regardless of their age, the therapist will begin to teach the step by step process wherever they are having trouble (e.g. chewing) as a means to reaching the long term goal of independent, healthy eating.

7. I’ll say it again, it takes time

That’s because your therapist and feeding team will be doing a lot of detective work to learn what factors are impacting your child’s resistance to eating.  Then, those elements need to be resolved one at a time.

8. It takes a village

YOU are the most important part of the feeding team.  You spend the most time with your child, know your child and family best and know what feels right.  Good feeding therapists understand and honor that relationship.

9. It doesn’t look the same from child to child

You may observe other kids in a feeding group or meet other parents who describe different techniques and strategies that your therapist uses with their child.  That’s because every child is different and cookie-cutter approaches to therapy are best, well, when making cookies and that’s about it.

10. Focus on small steps

Therapists have the advantage of charting every inch of progress and often having some time between appointments with your child.  But, when you are immersed in trying to feed your child 3 meals a day plus snacks, it’s not always easy to see progress. Your therapist will give you small goals to work on each week and together, we will celebrate every single accomplishment!

Watch for more articles from Melanie on feeding therapy for infants, toddlers & older children in the near future!

Melanie Potock

Written on January 22, 2014 by:

Feeding specialist Melanie Potock, MA, CCC-SLP and pediatrician Dr. Nimali Fernando are the co-authors of the award-winning book, Raising a Healthy Happy Eater: A Stage-by-Stage Guide to Setting Your Child on the Path to Adventurous Eating. Melanie in an international speaker, training OTs, RDs and SLPs in feeding therapy and offering parent presentations to the special needs community. Dr. Fernando (Dr. Yum) and Melanie (Coach Mel) joined forces to create the Doctor Yum Preschool Food Adventure as part of The Doctor Yum Project, a non-profit focused on helping families create a culture of wellness in their communities. Dr. Yum gives our more recipes than prescriptions - she's your pediatrician in the kitchen! Together, they created the website, the new go-to resource for parents who want to learn how to raise adventurous eaters, even if they have a child who is hesitant to try new foods. Their 5 hour video course, The Picky Eater Course, is specifically designed for both parents and professionals who want to truly understand how children become courageous, joyful eaters and learn to love healthy foods!
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  • Melanie Potock

    Thank you for sharing my love for kids and food! Such a pleasure to write for Friendship Circle!

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  • Melanie Potock

    I understand that in some states, but not my home state, early intervention may charge a small fee for evaluations and treatment. Thank you to the wonderful SLP from Texas who called this to my attention!

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  • Lisa

    I am a pediatric home care nurse caring for a 1 yr old client with developmental delay. He is fed via a g- tube and has an Occupational Therapist working with him on tasting foods. She arrives after his AM feed has already started, about half complete and then almost forces him to put food in his mouth and he cries and pushes her away, creating what I feel is a very negative experience for him! Should she not be scheduling her visits right before a feed time when he would be hungriest and not forcing him?? She also hides his spoon and dish so he doesn’t “see it coming”. Does this seem like proper protocol to you?

    • Melissa Washington

      Get another OT fast!! This is what happened with my son’s first OT and she gave him a bottle aversion.

    • Helotes Stay & Play Childcare

      When a child has a g-tube they are already compromised and to stop the only food that is sustaining a 1 year old mid feeding to then accelerate to forced feeding is abusive. Many tube kids can’t began chew or swallow normally until after 10 years of age. There are a great deal of complicated reflexes and motor skills that have to coordinate with breathing that a g-tube kid would absolutely require training on prior to eating safety. In order to protect the child and yourself I would absolutely video record the behavior then report it (email and in person) to the parent, the OT’s licensing board, the child’s doctor and your supervisors. Most kids with a g- tube have very poor oral muscles and it takes a very trained and patient caretaker to allow the child to eat very specific foods (not fast rate viscosity liquids such as water, nor solids, usually progressions of puréed food, then jello, etc). That OT is a nightmare and is clearly creating an aversion to all feeding. In no time the child will likely began to scream even when you begin the g-tube because they know they are going to be choked out and aspirate in the bullying setting this OT is creating. I would record it every single time so that it is absolutely obvious the trauma and concerted effort the OT is creating is damaging and the sweet little child can only defend himself by hiding the eating tools. Eating should be enjoyable with gained confidence.

  • Steve

    My son was born at 25 weeks and developed NEC. After 3 intestinal surgeries he recovered and is home. He is 1 year old and still havong difficulty eating, both bottle and spoon fed. He fights it most of the time, but sometimes are better than others. We see OT, PT, and an early on program. Things are a little better but not at all where we should be. With the quick history and problems we are dealing with I’m looking for possible alternatives. Maybe someone who has gone through aomething similar. We are thinking of calling another specialist to see if they have something different they may try. We appreciate any feebback that may be helpful. Thank you in advance.

  • Stefanie

    Early Intervention is not free! We got referred to EI for speech. We have to pay $150 a month because of our income and insurance.

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  • Carla Bourdier

    I have a 2 1/2 year old who refuses to eat full balanced meals, he is very picky.
    What happens after they evaluate your child ? Do you have to do the treatment or can you stop at any time? I’m afraid they will put a false label on my child only because he does things at his own pace. His Doctor already did it once and almost gave me a heart attack.

    • Helotes Stay & Play Childcare

      You can stop at any time and you can request a different specialist. The evaluations vary so much and can be very different due to the actual practitioner. If the label isn’t protecting your child seek other help and you can always email the doctor to let them know you do not feel the label is helping so that they remove the label. I have met parents who have went through 7 different speech and feeding therapists because it wasn’t working. However, the 7th specialist was perfect and they knew immediately as it was the first time their child began to get better. The reality is you as a parent can tell pretty fast if something isn’t working so go with your child’s best interest & keep trying to find a therapist, feeding clinic, RD, or doctor who makes things much easier for your child to gain skills. Sometimes you can have a therapist that works well and then the child progresses but the same therapist isn’t able to fix the 2nd problem. Feeding and sensory and social issues go hand in hand so it isn’t just about swallowing the food it can be all sorts of tricky issues that complicate what food your child can safely and comfortably eat. The specialists who wrote these articles discuss this and it really shows how well they are able to work with each child as an individual.

  • Andrew Brown

    I keep reading from different sites about the evaluation process but so far not one has listed evidence base assessment tools to help parents request a specific or list of assessment to address their child issue. It is very important for the parent to know what evidence base assessment to request so as the school can respond to the specific request for evaluation using that assessment tool in a Prior Written Notice.

    • Helotes Stay & Play Childcare

      When the child has a feeding disorder and discusses this with the school usually the school will tell the parent to request a “swallow study” from their pediatrician. This documents a variety of swallowing disorders or at least will alert the school or caretaker the risk for choking / aspiration. The swallow study is usually performed in a hospital setting and takes a few hours. They can also do an upper GI, or if you are able to get a referral to a developmental pediatrician as they usually have a pediatric registered dietician on hand who can team with social workers or the primary care pediatrician to write a letter to the school ordering certain or specific special needs feeding to occur. These orders become the law and for the safety & well being of your child, the school must comply immediately. Without having initiated these steps as a parent on your own, I don’t know that the school would have any sort of actual assessment since feeding is a developmental delay and catorigorized as a medical problem and less of an educational problem. As a parent you know this isn’t correct but the entire assessment initially begins with subjective reporting / concerns expressed by the parent. Then the assessment is usually completely subjective by the doctor to request feeding consults. The feeding experts then log behaviors both observed or brought in by the parent to construct a statement letter (doctors order) that the parent emails to the teacher, nurse, and principal to ensure the school begins complying with strategies to empower the child’s to reduce or eliminate the developmental delay.


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