post

Identifying the right feeding goals for your child and overall family: Age-appropriate eating goals and challenges for children with PFD

Published by Meg Simione, PhD, CCC-SLP on Dec 17, 2024

Whether you’re at a family reunion, Thanksgiving or a life cycle event, so many gatherings center around food. For families with a child who has pediatric feeding disorder (PFD), these moments of celebration instead become overwhelming.

As a young speech and language pathologist, I was struck by the fact that some children can’t fully participate in food-centered occasions. In my large Italian family, all our celebrations and most memorable moments revolve around food. Food is my family’s way of expressing love and bonding.

This awareness led me to focus on feeding therapy and research in order to help more children participate in their families’ rich cultural traditions around food.

In the decades since, I’ve learned that our job as feeding therapists is to support skill-based feeding within the context of each family’s culture and goals. This requires deep listening and understanding a family’s story before setting goals and recommending step-by-step skills to achieve them.

This is especially true for parents of children with complicated diagnoses of PFD.

Supporting appropriate feeding milestones for children with PFD

As a parent of a child with PFD, finding the right goals for your child’s feeding development can help you support their growth while staying realistic about your family’s needs.

Typically, feeding milestones are broken down by age ranges. Still, this remains a little fuzzy.

Guidelines from the American Academy of Pediatrics (AAP) recommend children begin transitioning from exclusive breast milk or formula to solid foods at 6 months and eat a variety of table foods by the time they turn one. More research is needed to fully understand how most children transition to solids and why some children struggle with food transitions.

These guidelines from the AAP and age-based goals, in general, often don’t apply to many children with PFD.

Instead, a feeding therapist can help you set meaningful, achievable feeding goals supporting your child’s growth and development while aligning with your family’s values.

The following are five recommendations for setting age-appropriate feeding goals for children with PFD.

  1. Focus on what matters to your family
One of the most important steps in setting feeding goals for your child is understanding what matters most to your family. Some families might focus on having family meals together at the table, while others may prioritize ensuring their child eats a particular food.

Communicate with your feeding therapist about what’s important for you and your child so they can tailor feeding goals to your child.

  1. Set realistic, skill-based goals
Many parents of children with PFD experience anxiety when their child isn’t reaching milestones at the “right” time. While developmental guidelines exist, it’s important to remember that all children grow and develop at their own pace. This pace may be slower or look different for children with pediatric feeding disorder (PFD), and that’s okay.

Instead of focusing solely on developmental steps, consider setting realistic goals for your child’s abilities. Assuming your child is getting the nutrition they need to grow, take time to celebrate small steps like holding a spoon, touching a food with a new texture or showing curiosity about a new food.

  1. Stay flexible
Setting developmentally appropriate and family-centered feeding goals means staying flexible. The best time to begin a time-consuming feeding therapy plan might not be when a parent or family has a lot going on.

The key is to balance your feeding therapist’s expertise with what’s realistic for your family. When you meet with your child’s feeding therapist or doctor, bring up what matters most to you. Don’t be afraid to say you feel overwhelmed or need help with certain aspects of your daily routine. Goals should reflect both what your child needs developmentally and what’s most important for your family.

  1. Look for “just right” feeding challenges
Fostering new feeding skills means finding foods that are just the right difficulty level for your child. In one study, we found that children need to be offered foods that strike the right balance of safe, age-appropriate foods that are just challenging enough to help children develop feeding skills.

For example, children who eat easily dissolvable foods, such as graham crackers and puffs, need to exert little effort to chew and swallow these foods, while the hard texture of other foods require more chewing. In the study, it wasn’t until the children were given foods with a slightly challenging texture that we actually started to see some more mature skills.

With the help of a feeding therapist, find slightly more challenging foods that encourage your child to advance while still being safe.

  1. Trust your instincts
As parents, it’s natural to worry about your child’s progress. But remember, you are the expert on your child. Trust your instincts when making decisions that feel right for your family with your feeding therapist. Your feeding goals should reflect your family’s circumstances, and there’s no “one size fits all” approach.

If you ever feel like feeding therapy is becoming too much or doesn’t align with your family’s priorities, it’s okay to speak up. Your healthcare provider should be willing to adjust the plan and focus on what matters most to you.

Remember, anything you can do to reduce that stress for yourself as a parent also goes a long way toward supporting your child and yourself.

Your child’s feeding development is just one part of the bigger picture. By setting meaningful feeding goals for your family, collaborating with your provider, and trusting your instincts, you can create a feeding plan that supports both your child and your family’s overall well-being.

Meg Simione, PhD, CCC-SLP, a research scientist at Mass General for Children, speech-language pathologist, and an assistant professor of pediatrics at Harvard Medical School.

Search our provider directory for a feeding therapist who understands PFD near you.

The power of assessment: How validated diagnostic tools fuel feeding therapy

Published by Feeding Matters on

For many families, the road to a pediatric feeding disorder (PFD) diagnosis is long and winding.

The journey often starts with a caregiver’s or a provider’s concern that leads to a referral to a pediatric feeding therapist for evaluation. Ideally, the feeding therapist will conduct a thorough feeding assessment and use a validated assessment tool, such as the Feeding Matters Infant and Child Feeding Questionnaire or Feeding Flock’s assessments.

While a detailed assessment is critical to developing a treatment plan and goals, accessing help remains challenging. This is because parents of children with PFD are often concerned long before their child’s provider recommends a specialist, especially if the child’s weight and growth is stable.

In her 30 years as a pediatric feeding therapist and co-founder of the UNC Healthcare pediatric feeding team, Krisi Brackett, PhD, CCC-SLP, C/NDT, has seen this scenario hundreds of times. “Parents know something is off with the way the child is feeding, but it may not get the attention it deserves if the child is gaining weight, which can mean a delayed referral” she says.

Any parent feeding their child while sleeping, making special meals, or spending hours a day getting their child to consume a few ounces knows that staying on the growth chart is not always a good indicator of whether a child needs more support. “Parents are compensating for their child’s feeding issues, so it may not look as concerning to the pediatrician when their weight is stable,” says Brackett. “They’re not always expressing what they must do to keep their child safe and eating.”

Feeding therapists’ role as ‘gatekeepers’ to diagnosis and treatment

When children do get a referral, it’s typically to a pediatric feeding therapist with a background in occupational therapy (OT) or speech-language pathology (SLP). Feeding therapists work in two out of the four feeding domains: feeding skill and psychosocial, while other professionals treat medical and nutritional domain issues.

“Feeding therapists often feel like the case managers and gatekeepers of the feeding difficulty because we may be the first ones in and we’re the professionals assessing, working closely with families and the child and asking for referrals to other providers,” says Brackett. “I feel very lucky to work on an interdisciplinary feeding team where we can address all of the domains of PFD. Most children with PFD do not start with a feeding team, they start with an individual provider.”

Assessment tools can vary once families find their way to a feeding therapist. This is due to several factors:

  • PFD is a new diagnosis, added to the International Classification of Diseases, 10th edition, in 2021. Not all clinicians are aware of it.

  • Graduate programs only recently began including pediatric feeding disorders and intervention in curricula. Most feeding therapists learn on the job from a mentor.

A 2023 study on feeding assessment tools, published in The American Journal of Occupational Therapy, found that 65% of the clinicians used a nonstandardized tool.

The new PFD diagnosis reflects the condition’s complexity. Valid, reliable assessment tools can be useful for clinicians making a diagnosis of PFD.

The need for raising awareness about research-based assessment tools

Brackett has seen a growing awareness of the need for collaboration between multiple disciplines who treat children with PFD in recent years, leading to better care for children and their families.

“Consistent assessment is crucial because it helps us prioritize intervention and identify the other professionals who need to be at the table,” says Brackett.

A one-time assessment can provide a starting point, but regular monitoring with a consistent assessment tool allows therapists to track the child’s progress, identify changes and adjust treatment plans as needed. “Feeding intervention is complicated, involving many factors and moving parts. If we are stuck and the child isn’t making progress, we have to regroup and ask what we are missing,” says Brackett.

What makes a good feeding assessment?

A robust feeding assessment goes beyond asking parents about a child’s eating habits. The following are the core components of an effective feeding assessment:


Medical and developmental history

A thorough review of the child’s history provides context for feeding challenges. This could include health issues, like a NICU stay, developmental milestones and any issues that may have influenced the child’s feeding development.


Caregiver interviews

A robust PFD assessment and treatment requires parent collaboration. Standardized parent report tools can be a good starting point to identify parent concerns. By hearing directly from parents, feeding therapists can gather detailed information about the child’s eating habits and identify any patterns or concerns. This process should also help parents feel heard and supported.


Physical examination

A physical assessment is essential for determining structural or functional issues affecting feeding. This typically involves an oral sensory-motor assessment and broader examination, such as respiratory health, fine and gross motor ability and positioning needs.


Eating observation

Watching the child eat provides real-time insight into their feeding process. During feeding observation, therapists assess oral sensory motor skill and swallowing function. Therapists can observe how the child reacts to different food types, how they handle textures and tastes and whether they display discomfort or aversion. Therapists can help support caregivers who are feeding their children by coaching and giving strategies to improve success at mealtime.

Simple feeding assessment tools that even parents can use

Having more clinicians and parents become aware of PFD increases families’ access to assessment tools, like the Feeding Matters tool and Feeding Flock tools. These tools are purposefully simple to use and free so that anyone can access them. The Feeding Flock tools have been translated into several languages, are endorsed by Feeding Matters and are currently being used in an NIH study.

Besides clinicians, parents can also use these tools to advocate for their child’s care. “Having standardized and validated tools brings credibility to your request for a referral in a way that’s different than just asking to see a specialist,” says Brackett.

Thorough evaluation with trained professionals and access to comprehensive, validated assessment tools are the first steps in helping families get a roadmap for treatment. From there, clinicians can identify the right strategy for each family and child. “There is no one way to do feeding treatment, and I always say the right way to do it is the way that works for the family and the child, and that is something that we have to figure out,” says Brackett.

Krisi Brackett, PhD, CCC-SLP, C/NDT, is co-founder of the UNC Healthcare pediatric feeding team and a member of the Feeding Flock. She blogs about feeding at www.pediatricfeedingnews.com

NEW GELMIX RECIPE SEARCH TOOL

Published by Gelmix on Nov 21, 2024

This blog post is part of a corporate partnership with Gelmix.

Introducing the New Gelmix Recipe Search Tool for Dysphagia Diets

We’re thrilled to unveil a new, user-friendly Gelmix Recipe Search Tool, specifically designed to support families and healthcare providers who need to thicken breast milk and infant formula for safe feeding in alignment with the International Dysphagia Diet Standardization (IDDSI) guidelines. This tool makes achieving the precise liquid consistency for dysphagia diets easier and more accurate than ever before.

The Challenge of Thickening Formula for Dysphagia Diets

For individuals managing dysphagia—a condition that affects swallowing—getting the right liquid thickness is critical to ensure safe swallowing. However, not all infant formulas thicken the same way, and the process can be impacted by factors like temperature and wait times. This can make it difficult to achieve the IDDSI-standardized consistency that many infants with dysphagia need.

How the Gelmix Recipe Tool Simplifies Thickening

Our new Gelmix Recipe Tool tackles these challenges by offering detailed, formula-specific recipes and mixing instructions. Users can search by formula type and access recipes for three different IDDSI consistency levels:

• Slightly Thick (Level 1)

• Mildly Thick (Level 2)

• Moderately Thick (Level 3)

Each recipe provides precise measurements, mixing steps, and recommended wait times. With just a few clicks, users can follow guidelines for Gelmix mixing and achieve the exact thickness needed to meet IDDSI standards, creating safer feeding experiences.

The Science Behind Our Recipes

All the recipes in our tool have been carefully tested by Parapharma Tech to be used with the IDDSI framework and with the IDDSI flow test available for purchase here: https://www.healthierthickening.com/product/iddsi-funnel-2-pack/. For more information on these global standards, you can visit IDDSI.org.

More Recipes Coming Soon

If your preferred formula isn’t listed yet, don’t worry! We’ll be adding new recipes regularly. In the meantime, feel free to reach out for personalized assistance, and we’ll be happy to help.

Quick Guide: Mixing Gelmix with Infant Formula

Here’s a step-by-step guide to help you get started with thickening using Gelmix:

1. Warm the prepared formula to at least 100°F (38°C).

2. Sprinkle Gelmix into the warm formula according to the recommended recipe in our tool.

3. Cap and shake the bottle vigorously for 30 seconds until Gelmix fully dissolves.

4. Allow time to thicken as recommended, then give the bottle another shake just before feeding.

For complete recipes and more information, visit: https://healthierthickening.com/recipes/.

The challenges and triumphs of breastfeeding with PFD: Addressing common concerns and offering expert advice

Published by Feeding Matters on Aug 12, 2024

For a function that’s so natural, breastfeeding is surprisingly difficult for many new mothers and infants. Feeding challenges, like reflux, oral aversion or even dysphagia, can make breastfeeding feel insurmountable.

And while there’s nothing wrong with relying solely on formula to feed your baby (despite the shame some natural parenting evangelists espouse online), many moms are determined to make some amount of breastfeeding work.

mother breastfeeding her child while sitting in a relaxed position

Nicole Lattanzio, RD, IBCLC can attest that breastfeeding is often possible, even in some of the most challenging cases. Working in the NICU and with virtual clients, she has supported countless moms and babies with breastfeeding and nutrition. Some simply need latching and positioning advice, but other more complex medical cases need significant support.

There are three requirements for successful breastfeeding:

  • Feeding your baby

  • Protecting the milk supply

  • Having a positive experience at the breast

For infants with feeding challenges, aligning these three goals can take time and creativity.

The most challenging and most rewarding case Lattanzio recalls was a preemie with a G-tube, feeding difficulties and significant oral aversion. Her mom was committed to making breastfeeding work. Once the infant was released from the NICU, Lattanzio helped with lactation support while a speech therapist worked on oral skills and strength. Lattanzio is also a dietitian and monitored the infant’s growth and feeding tolerance. At first, the baby didn’t have the interest or skills to transition to breastfeeding. Instead, they focused on getting the baby comfortable resting skin-to-skin.

newborn baby with feeding tube through their nose, doing skin to skin with their caregiver

They did G-tube feedings while the baby nestled skin-to-skin. Gradually, they transitioned closer to a breastfeeding position, including giving her a pacifier as the G-tube was going. Next they worked on latching with a nipple shield and used some syringes into the nipple shield. At eight months, the infant had her first full meal at the breast. “It shows that babies at almost any age can learn to breastfeed. It was so cool to see that she got through that whole process, and the mom had her full milk supply,” says Lattanzio.

Whether you want to maintain your milk supply for bottle feeding or want to breastfeed, Lattanzio offers lactation advice for moms of infants with feeding challenges.

Understanding breastfeeding challenges

Swallowing is a complicated process that when broken down into parts can seem miraculous. Expert researcher Georgia Malandraki, PhD, CCC-SLP, explains the anatomy of a swallow in a way that makes anyone appreciate why the skill can be difficult to master.

On its own, difficulty breastfeeding does not mean a child will develop pediatric feeding disorder (PFD). However, many children who do have PFD also struggle to breastfeed.

Breastfeeding challenges can vary from simple to complex, but some of the most common issues include the following:

  • Reflux

  • Aspiration

  • Oral motor dysfunction or coordination issues

  • Respiratory problems that make it difficult to coordinate sucking and breathing

  • Premature birth that causes a lack of skills

  • Oral aversion

  • Incorrect latch or positioning

  • Tongue-tie or lip-tie


How can I identify if my baby is experiencing these issues?

Signs of breastfeeding challenges may include frequent spitting up, arching of the back, irritability during or after feeds, coughing, choking, crying, pulling away or difficulty latching. Early detection and consultation with your pediatrician or a lactation consultant are key to addressing these challenges effectively.

Tips for successful breastfeeding even with feeding challenges

Not all babies with feeding challenges and medical complications will breastfeed, and that’s okay. Babies and even postpartum mothers benefit from any amount of skin-to-skin and pumped milk. Infants fed entirely by formula still get the nutrition they need to grow. Key to successful breastfeeding is a relaxed mom, so be kind to yourself as you navigate whatever works for you and your infant.

caregiver doing skin-to-skin with their baby

Following are Lattanzio’s recommendations to support breastfeeding for an infant with feeding challenges.

Try different feeding positions

An obvious place to start for breastfeeding troubleshooting is to experiment with different positions. Positioning can make a big difference for a baby who may experience some reflux, colic, or aspiration (be sure to monitor this with a clinician because this can be dangerous).

Different breastfeeding positions can help your baby latch more effectively and reduce discomfort. Some infants with reflux or aspiration challenges benefit from being held upright, where gravity can help keep milk down.

Experimenting with positions can help you find the one that works best for your baby and you, promoting better milk flow and reducing feeding difficulties.

Be patient and open to feedback

Feeding challenges can be frustrating for both you and your baby. It’s essential to be patient and give yourself time to adapt and learn what works best. Be open to feedback from lactation consultants or healthcare providers who can offer valuable insights and techniques tailored to your baby’s needs. Remember, every baby is different, and what works for one may not work for another. Patience and willingness to adjust can make the breastfeeding journey more manageable.

For Lattanzio’s mom and baby, who finally successfully breastfed at eight months, she says, “This baby was very sensitive to positioning, so it was a lot of trial and error. Mom was very patient and open to adjustments and feedback, which set them up for success.”

Leverage breastfeeding tools as appropriate

For many babies, using breastfeeding tools, like a nipple shield, can help with latch difficulties. Especially for infants with feeding challenges and medical complications, a nipple shield can provide a larger target for the baby to latch onto and help regulate milk flow, making feeding more comfortable.

caregiver feeding a baby milk through a syringe

With the support of a lactation consultant, Lattanzio has helped mother use a syringe with the nipple shield. Consult a lactation specialist to determine whether these tools suit your situation.

Don’t force your infant to breastfeed

Breastfeeding, especially when there are feeding challenges or medical complications, can take a lot of trial and error. This might mean you have a few successful sessions and your baby shows disinterest.

Insisting on breastfeeding when your baby shows some signs of stress or overwhelm can cause breast aversion. “Skin to skin is usually a nice relaxing place for babies and later try to ease back to breast,” says Lattanzio.

If that doesn’t work, get some support to reassess what’s going on instead of forcing breastfeeding.

Pump with a hospital-grade pump to maintain your milk supply

If your infant isn’t breastfeeding full-time, you’ll need to pump if you want to maintain your milk supply. This is true even if your baby has many partial feedings. “I’ve seen preterm babies who are breastfeeding okay, but they’re sleepy. That can impact the milk supply,” says Lattanzio.

bottle of freshly-pumped breastmilk with parent and baby blurred in the background

Many more convenient types of pumps, like the wearable ones, aren’t strong enough to maintain your milk supply. You’ll want to get a hospital-grade one if you’re using a pump often or exclusively. These pumps are designed to mimic a baby’s natural nursing pattern and are more efficient than standard pumps.

Initially, maintaining your milk supply means pumping eight times in 24 hours. “You can sleep for a stretch of time, but every time the baby is being fed by a bottle, you still have to pump in order to keep up your milk supply to be where it needs to be,” says Lattanzio.

Build a network of support

If nourishing an infant with feeding challenges feels challenging, that’s because it is. Your pediatrician, a lactation consultant, a dietitian and a speech therapist can all provide valuable insight to help you and your baby get what you need.

With eight feeds a day, plus pumping, feeding an infant with medical complications is literally a full-time job. Family and friends can offer practical assistance, such as preparing meals, helping with household chores and providing emotional support.

Finally, keep in mind that it’s okay if breastfeeding doesn’t work out as planned. Prioritizing your well-being as a mom means finding a feeding method that works for both you and your baby.

Sometimes successful breastfeeding means reassessing goals, says Lattanzio. “If the goal initially was exclusive breastfeeding, maybe we come to the point where it’s about finding a good middle ground where they’re comfortable, happy and it’s sustainable.”

Nicole Lattanzio, RD, IBCLC is a registered dietitian, board-certified lactation consultant, and mom of four. She works in a level III NICU in Phoenix, Arizona and runs the popular Instagram page @infant.nutritionist, where she shares about starting solids, navigating feeding challenges, tackling toddlerhood and more.

The silent struggle of PFD: Why the prevalent pediatric disorder continues to be under-diagnosed and under-discussed

Published by Amy Delaney, PhD, CCC-SLP on

For a pediatric disorder that affects 1 in 37 children under age 5 –– making it more common than autism –– pediatric feeding disorder (PFD) remains significantly misunderstood and undiagnosed. This is unsurprising in some ways, as the Pediatric Feeding Disorder: Consensus Definition and Conceptual Framework my colleagues and I authored was only released in 2019. PFD only became an International Classification of Diseases (ICD) code in October 2021.

The consensus paper and code aligned pediatric clinicians, allowing for more consistent assessment and diagnosis. Despite these advancements, gaps remain, particularly in primary care and among caregivers, who often lack an understanding of feeding progression and the potential risks for any child to develop feeding difficulties.

Helping more children earlier, whether they have PFD or signs of feeding challenges –– requires a multi-pronged approach to raise awareness, including:

  • More translational research that directly helps children and families

  • Raising awareness of PFD among primary care providers and pediatric allied health professionals

  • Clearly defined feeding milestones for transitioning to solids

  • Educating caregivers about feeding


Ensuring clinical research directly supports families

Age 6-12 months, when children transition from milk to solids, is a critical time for feeding development. Unfortunately, it’s also the least researched stage of child development. Infants change quickly in multiple, parallel ways, making research that controls for variables complicated.

baby with brown curly hair sitting in a high chair and holding a spoon up to their mouth

One important way to support early diagnosis is to improve feeding guidelines for all children, an area of focus in my Neurodevelopmental Feeding and Swallowing Lab.

Current guidelines from the American Academy of Pediatrics recommend that children begin transitioning from exclusive breast milk or formula to solid foods at 6 months and eat a variety of table foods by the time they turn one. That’s a lot of change in a short window with little direction.

We need more research to answer questions like:

  • What are the primary influencers for feeding development?

  • What are readiness skills for eating solids?

  • When should different foods and textures be safely and positively introduced?

  • What are the risk factors for children who struggle?

We have robust nutrition literature on the exact macro and micronutrients and calories children need throughout their first two years of life. However, we are behind on research that focuses on feeding skills and abilities.

To that end, I’m proud to see a new generation of scientists researching all areas of feeding.


Identifying red flags of feeding difficulties early

While research is a long game, children affected by PFD have a short window to best address developmental challenges.

Learning to chew and swallow is among children’s most complex early skills. This makes transitioning from milk to solids in the first two years, particularly from ages 6 to 12 months, the most vulnerable time for children to falter.

baby crying while caregiver attempts to put a bottle in their mouth

Because many children aren’t adequately identified for feeding difficulties until they are older, they miss the optimal window for intervention. In some cases, children most at risk for being overlooked are those considered low-risk, healthy, neurotypical children. Because they aren’t monitored for developmental challenges as closely as a premature baby, for example, early signs of feeding challenges go unnoticed. These children could potentially avoid developing PFD if identified earlier.

For example, a child who starts solids and then gets sick with a virus may have a setback in feeding development. A few times of food refusal while not feeling well can then become a habit. The caregiver often has little knowledge about how to move through solid food textures. The child misses feeding experiences, making it more difficult to introduce new foods and textures later. Early challenges or setbacks like this may not turn into a significant case of PFD, but in some cases, they do.

Following are some red flags parents may notice:

  1. Persistent coughing or gagging: Some coughing or gagging is common but frequent occurrences during meals may be signs of a problem.

  2. Stressful feeding experiences: Feeding should not be super challenging or miserable. If you dread mealtime, this is an indication of an issue.

  3. Sleepy during feedings: Especially in infants, sleepiness can signal feeding difficulties.

  4. Transition struggles: Difficulty moving from liquids to solids or new textures.

  5. Slow progress: Inability to increase food volume as the child grows.


How clinicians can raise caregivers’ awareness of feeding challenges

As with any disorder, early diagnosis leads to more positive outcomes. For those who present some early signs of PFD, identifying and addressing red flags early can even prevent a child from developing pediatric feeding disorder.

Solid foods are not one thing. A range of foods requires different skills. One way to identify more children earlier is for primary care providers to ask caregivers more direct questions about feeding instead of simply asking if a child is eating solids.

More specific questions about feeding could include the following:

male doctor smiling at child with child's caregiver standing beside him
  • What types of textures is the child eating?

  • What foods does the child eat?

  • How much can the child eat?

  • Is the amount the child eats steadily increasing?

  • How long do meal times last?

  • How much refusal occurs?

  • Is feeding a struggle?

The Feeding Matters screening questionnaire includes some of these questions to identify children who may have PFD. Asking detailed questions about early feeding habits could prevent some children from developing PFD in the first place.


Raising clinical awareness of PFD

While the past few years have brought significantly more awareness of PFD, it’s still not unusual to encounter pediatric clinicians unaware of the diagnosis.

Widespread advocacy and education are needed within and beyond the healthcare community. Pediatricians, speech-language pathologists, nurses and even early childhood professionals must have the knowledge and tools to recognize and address feeding difficulties early.


What clinicians can do to better support feeding

  1. Ask detailed questions: Inquire about specific food types and textures offered.

  2. Provide guidance: Offer nuanced advice on feeding progression and when to introduce new textures.

  3. Educate caregivers: Share knowledge about developmental milestones and readiness for new foods.

  4. Monitor closely: Pay attention to children with feeding struggles instead of encouraging a “wait and see” approach.

  5. Encourage early intervention: Identify and address feeding difficulties as early as possible to prevent escalation.

family of four smiling, with each parent giving a child a piggyback ride

Finally, clinicians must emphasize how important it is for caregivers to trust their guts. When feeding seems like it isn’t going well, it probably isn’t. That warrants discussion and perhaps intervention to adjust the child’s feeding practice.

The more we as researchers and clinicians do to understand feeding and support children and families during the transition from liquids to solids, the more children will have the opportunity for healthy, positive feeding experiences. This could reduce the prevalence of PFD and promote better outcomes for children and families.

Amy Delaney, PhD, CCC-SLP is an assistant professor at Marquette University and director of the Neurodevelopmental Feeding and Swallowing Lab. She is the education pillar chair for Feeding Matters’ PFD Alliance Executive Council. She co-authored the consensus paper creating pediatric feeding disorder (PFD) as a stand-alone diagnosis and the Infant and Child Feeding Questionnaire, an online survey developed by Feeding Matters, to identify red flags for PFD.

Dysphagia and PFD: Understanding and treating swallowing challenges in children

Published by Pamela Dodrill, PhD, CCC-SLP on Aug 06, 2024

Considering the complexities of swallowing, it’s a wonder most babies are born knowing how to feed. Those who struggle with feeding may be diagnosed with dysphagia, which is the medical term for difficulty swallowing.

Babies generally receive hydration and nutrition from the breast or bottle. They need to coordinate sucking, swallowing and breathing throughout the feed, which typically takes 20 to 30 minutes. Safe feeding requires precise coordination of swallowing and breathing and as any parent whose baby develops a cold knows, any complication can make it more difficult.

For the vast majority of people, eating is a basic instinct. When a child is born prematurely or with medical complications, this may interrupt these instincts. It’s a red flag that something is wrong if a child doesn’t enjoy eating or isn’t growing as expected.

According to the March of Dimes, 10% of children in the United States are born prematurely. Many preterm babies experience early difficulties coordinating swallowing and breathing. Some full-term babies experience swallowing problems also, for a variety of reasons. Some babies overcome swallowing challenges as they mature, while others need clinical support for dysphagia to be able to swallow normally.

clipboard with the word "Dysphagia"

Dysphagia, PFD and ARFID

Many children with dysphagia are also diagnosed with pediatric feeding disorder (PFD). PFD is defined as impaired oral intake that is not age-appropriate and is associated with medical, nutritional, feeding skill and/or psychosocial dysfunction. Reliance on enteral feeds or oral supplements to sustain nutrition and/or hydration, need for modified feeding position or equipment, use of texture modification of liquid or food and/or need for modified feeding strategies are all indicative of PFD.

In some cases, a medical condition or mechanical issue, such as dysphagia, causes PFD. In other cases, the medical and mechanical issues are resolved, but the child continues to display PFD. Some children may also go on to display avoidant/restrictive food intake disorder (ARFID).

Treating dysphagia in children

Many newborns outgrow dysphagia within a few weeks of birth. In those cases, the goal is to help keep babies safe, hydrated, and nourished with modifications such as positioning changes during breastfeeds, varying bottle nipple flow or thickening liquids.

When dysphagia persists beyond the early weeks, children need additional evaluation to determine the cause and address any mechanical feeding issues.

Feeding therapy is based on an individualized treatment plan. This may include:

  • Diet modifications: Modifying food and liquid textures to ensure they are safe and manageable. This may include pureeing foods or thickening liquids.
  • Nutritional support: Ensuring the child receives adequate nutrition and considering alternative feeding methods if necessary, such as enteral feeding.
  • Skill development: Teaching strategies to enhance oral motor skills, such as chewing and swallowing, through exercises and activities.
  • Family mealtime interventions: Techniques to support mealtime routines, engagement and enjoyment with a focus on family education and support.

Frequently asked questions about pediatric dysphagia

Q: What is dysphagia and how is it different from other feeding issues?

Dysphagia describes difficulty swallowing, which can be due to anatomical, neurological or developmental issues. It refers to swallowing mechanics rather than a sensory or psychological food aversion.

Look for the following indicators of pediatric dysphagia:

  • Breathing difficulties during feeding: Changes in breathing patterns, such as working hard to breathe or appearing out of breath, can signal dysphagia.
  • Wet or congested sounds: If a child sounds wet or congested during feeds, it may indicate that food or liquid is entering the airway or staying in the throat and increasing the risk of entering the airway.
  • Coughing, gagging or choking: Frequent coughing or gagging. The child shouldn’t hold their breath during a choke.

Growth concerns, prolonged feeding times and unusually stressful mealtimes can also be indicators of dysphagia.

Q: What causes dysphagia in children?

Dysphagia in children can occur due to prematurity or medical conditions. Sometimes, the exact cause may not be easily identifiable.

The following are some other causes of pediatric dysphagia:

  • Neurological disorders, such as cerebral palsy and muscular dystrophy
  • Structural abnormalities, such as cleft palate or esophageal atresia
  • Genetic conditions, such as Down syndrome
  • Developmental delays

Q: When is dysphagia diagnosed?

Swallowing difficulties can occur at any age. Some infants, such as those born prematurely and in the NICU have swallowing problems from birth. Others are diagnosed within a couple of weeks of going home.

Three months is another age when dysphagia can become apparent. By three months of age, reflexive sucking starts to diminish, and problems coordinating sucking, swallowing and breathing may become more apparent.

Dysphagia may appear in older children who are better able to communicate and signs of struggle may be easier to observe. or it can develop after an illness or incident that causes swallowing issues.

Q: How can parents differentiate between typical feeding challenges and something more concerning, like dysphagia?

Occasional feeding challenges are normal, but persistent issues that affect breathing, growth or overall enjoyment of mealtimes should prompt a professional evaluation.

Q: How is dysphagia diagnosed in children?

The comprehensive evaluation may involve a pediatrician, speech-language pathologist/ occupational therapist, and sometimes a gastroenterologist or otolaryngologist. 

Diagnostic tools may include:

  • Physical exam
  • Clinical swallowing assessments
  • Videofluoroscopic swallow studies (VFSS),
  • Fiberoptic endoscopic evaluation of swallowing (FEES)

Q: Once a child is diagnosed with dysphagia, what does the treatment process typically involve?

Treatment usually starts with determining strategies to ensure safe feeding, such as modifying the textures or consistencies of foods and liquids or adjusting feeding techniques. It may involve teaching older children specific skills to orally prepare and swallow food safely. The approach is tailored to the child’s specific needs and abilities.

Q: Can dysphagia in children improve over time?

Yes, with appropriate intervention and therapy, many children with dysphagia can see improvements in their swallowing function. The extent of improvement depends on the underlying cause and the child’s condition. Early intervention is key to better outcomes.

Q:  What are some of the most exciting developments in pediatric dysphagia research and management?

We continue to uncover evidence that early intervention and prevention strategies can significantly reduce the severity of the condition. Many families are better able to access care through the use of telehealth services as well. Ongoing research into precise diagnostic tools and effective therapies continues to advance the field.

Pamela Dodrill, PhD, CCC-SLP, is a clinical specialist on the neonatal intensive care unit feeding team at Brigham and Women’s Hospital in Boston and a member of the consensus group that developed the new pediatric feeding disorder codes. She is an affiliate of ASHA Special Interest Group 13, Swallowing and Swallowing Disorders (Dysphagia).

The anatomy of a swallow: The complex process that can challenge children with PFD

Published by Georgia A. Malandraki, PhD, CCC-SLP, BCS-S, F-ASHA on Jun 12, 2024

The process of swallowing that most people take for granted is a remarkably intricate series of sensory and motor events. Developing effective treatments to support children with pediatric feeding disorder (PFD), who struggle with swallowing, requires understanding the specific physiological deficits in each child, rather than relying on generalized approaches.

Far from being a simple reflex, it involves coordinated, complex actions by muscles, nerves and sensory organs. When one step of this process is not automated, swallowing is difficult, uncomfortable and even dangerous.

The more researchers and clinicians understand the swallowing process, the better clinicians can support children with PFD.

Four Stages

Initially thought to be a simple reflex, swallowing is now understood to be a complex process involving both automatic and voluntary neural control. In early fetal development, swallowing is reflexive, but as infants grow, the process becomes a learned behavior and eventually a patterned response.

Swallowing can be divided into several stages, each involving distinct anatomical landmarks and physiological processes:

  1. Pre-oral stage: This stage occurs before food or liquid enters your child’s mouth. When seeing and smelling food, your child makes a cognitive decision about whether or not to eat it. This simply means opening the mouth to accept the offering or reaching for food.
  2. Oral stage: Once food enters the mouth, your child processes sensory inputs such as taste, texture and temperature. The child manipulates the food by chewing and mixing it with saliva, preparing to swallow. This stage is primarily controlled by the brain, allowing voluntary actions like chewing and spitting.
  3. Pharyngeal stage: When the food reaches the back of the tongue, a reflex triggers the pharyngeal swallow. This stage is more automatic and involves quickly moving food through the throat into the esophagus while protecting the airway.
  4. Esophageal stage: The food passes through the esophagus to the stomach. This stage involves automatic sensory and motor processes within the esophagus.

Understanding the swallow in pediatrics

A child swallowing water through the straw of a blue water bottle.

Understanding swallowing in children presents unique challenges. While adult swallowing has been studied extensively, pediatric research is limited due to ethical and practical constraints. However, the fundamental principles are similar, with the process becoming more complex around five to six months of age when infants start consuming solid foods.

The first swallow movements in utero occur around 12 to 15 weeks of gestation. At this stage, we believe it’s completely reflexive. Once a baby is born and it becomes more complex and less automatic, part of the process becomes a learned, patterned response. This is likely around five or six months when infants start sitting and consuming solid food.

Diagnosis and treatment of swallowing disorders

Because swallowing is so complicated, there’s no cookie-cutter approach to treating a swallowing disorder. The first step to help a child with PFD is diagnosing the cause of the disorder. This evaluation ideally should involve a multidisciplinary team of experts, such as neurology, ENT and speech-language pathologists. If that’s not possible, the evaluating clinician should at least understand the anatomy, physiology and neurophysiology of swallowing.

Key diagnostic tools for evaluating swallowing include:

  1. Cranial nerve assessment: Cranial nerves are the nerves that innervate the muscles and the sensory components of the head and neck, including during swallowing. An assessment of these nerves is done by a specialist who can evaluate the motor and sensory components of the head and neck. This goal is to gather detailed information about muscle function and sensory perception –– such as strength, range of motion, reflexes, abnormal movements and sensory components.
  2. assessments: Endoscopy and video fluoroscopy are common techniques for assessing swallowing, though they have limitations, such as radiation exposure in children.
  3. Manometry or electromyography: These tools measure pressure and muscle activity, offering insights into the strength and function of swallowing muscles.

Challenges and future goals for supporting children with swallowing disorders

Despite it’s complexity, there are few standardized treatments, especially for children. This stems from a limited understanding of the underlying mechanisms of swallowing disorders.

Without knowing the mechanism causing a swallowing disorder, clinicians and parents are left to compensate to overcome children’s challenges by thickening liquids and adjusting nipple sizes or flow rates. This helps feed the struggling infant, but it doesn’t treat the disorder.

By understanding the anatomy and physiology of swallowing, as well as the challenges in diagnosing and treating disorders, clinicians can better support children with PFD and their families.

Georgia Malandraki, PhD is a professor of speech, language, & hearing sciences at Purdue University.

7 tips for SLPs to improve support for children with PFD and their families

Published by Stephanie Cohen, M.A., CCC-SLP, CLC on May 15, 2024

The perspective on feeding therapy from a speech-language pathologist

When a child struggles with eating or eats differently than parents expect, it impacts the entire family. That’s because eating is about so much more than the variety and quantity of foods we consume. It’s about giving and receiving love, celebration, enjoyment, connection, learning, socialization, sensory experiences, fine motor skills and communication.

As clinicians who learn the technical aspects of eating, we sometimes view feeding through a medical lens. To better help families struggling with pediatric feeding disorder (PFD) though, we need to widen our perspective and consider a child’s eating in the context of their family and environment.

Of course, safety and nutrition are of primary importance. But to best serve families, we can’t evaluate and support feeding skills without also understanding how specific feeding challenges impact each family.

A photo of a baby laying on their back in the NICU, with their face away from the camera.

I recently worked with a client who was born prematurely at 24 weeks gestation. Prior to her birth, her mother spent four weeks in the hospital on bed rest. For this family, the stress and trauma related to their baby’s health began before she was even born.

After she was born, this little girl spent five months in the NICU and required surgeries, intubation, an NG tube and ultimately, a g-tube. The need for multiple medical interventions meant early experiences around feeding and bonding didn’t happen as expected for this family.

By the time I met them through Early Intervention (EI), feeding still felt very medicalized to her parents. Her parents adhered to a strict tube feeding schedule (as they were directed to do by her medical team) and desperately tried to find a formula that didn’t cause her to throw up after each feeding. There were few opportunities to learn her hunger cues, cuddle together while she ate or share love around mealtimes. Her parents felt powerless, confused and frustrated.

We began with conversations about what her family wanted their mealtimes to feel like. This helped them shift their lens to think about how to help their daughter feel comfortable and ready to learn. We talked about what she might enjoy. Of course, we continued to consider her complex medical needs, but together, we were also able to shift our focus to helping her feel safe, building trust between her and her parents, supporting her internal motivation to explore and learn and letting her explore at her own pace. Once she felt better, she became a very curious baby at mealtimes!

Her parents took time to learn that the goal of mealtime doesn’t have to be the specific number of ounces or calories. Instead, they began the journey to help their daughter discover what was right for her body. They were encouraged by small indicators of change, such as getting messy while exploring food and putting a spoon into her mouth independently.

Their focus became celebrating each learning experience.

Not every client I work with is so complex, but my approach to feeding therapy always remains the same: family-centered, responsive feeding.

Below are seven important tips for clinicians supporting children and families to keep in mind:

Eating develops in the context of relationships.
If you’ve spent time talking with families about how mealtimes feel and how hard they work to help their child eat, you know that the feeding experience is dependent on the participation and capacities of both a child and their caregiver(s).

In their book Pre-Feeding Skills, Suzanne Evans Morris and Marsha Dunn Klein describe this caregiver-child interaction at mealtimes as a dance. Families move, interact, and learn in response to each other. Considering that infants eat 8-12 times per day and toddlers eat 5-8 times per day, this makes eating the activity that families spend the most time doing together.

Relationships matter in feeding therapy, and supporting parents’ and children’s communication around mealtimes is key to facilitating trust.

Understanding a child’s communication is a gamechanger in feeding therapy.
PFD can co-occur with over 300 different diagnoses. That means many children with PFD also experience speech, language and hearing challenges that can further complicate feeding. When a child has difficulty clearly communicating with their caregiver, that caregiver may misinterpret mealtime behavior. Behavior is communication. Let’s work with parents to better understand what their children are telling us about how they feel about their experience. Are they communicating that something is not working? Do they need us to make a modification in order to help them feel more comfortable and ready for learning? When we seek to understand a child’s communication, we can also support parents in knowing how to respond appropriately.

Eating means more than consuming calories.
Central to supporting families of children with PFD is the realization that eating is much more than the physical act of consuming food. Love, connection, socialization, internal motivation, communication, sensory experiences and skill development are all important parts of eating.

As clinicians, we can inadvertently add to the stress and anxiety parents feel when we focus solely on quantity and volume goals.

The truth is that success is not always measured by the number of calories consumed. Instead, we can celebrate a child feeling comfortable enough to explore a new food or a caregiver who helps a child participate in family mealtimes in the way that’s right for them.

Acknowledge that it’s not our job to get a child to eat.
Although we need to carefully monitor a child’s nutritional status with the help of a child’s medical team, focusing on “getting” them to eat shouldn’t be the goal of feeding therapy. Instead, it’s our job to collaborate with caregivers and support a child’s autonomy, internal motivation and ability to learn. We can offer opportunities and then let a child show us what works for them at that moment.

Make asking about feeding part of your evaluation routine.
It would be an incredible service to so many families if we regularly asked about mealtime routines even when we meet a family with other primary concerns related to communication or other diagnoses that impact development. Because we know how prevalent pediatric feeding disorder is, we can facilitate earlier access to feeding support in early intervention and beyond.

When in doubt, check it out.
It’s not unusual to hear from families that another provider told them their child will grow out of a feeding concern. Parents know their children best. If a parent feels there is a problem, then there’s an issue to address –– even if it’s minor. Let’s give parents access to information and resources when they need it most. We know that for the children who are struggling, ignoring the issue can have a negative impact on family routines, interactions, and ultimately family life as a whole.

Families do best with a team approach to PFD
Many caregivers worry about whether their child with PFD is eating what they need in order to grow. Some parents may overestimate their child’s needs and underestimate their child’s intake.When we collaborate with pediatricians, registered dietitians and other professionals, we can gather specific data that helps us understand whether a child is consuming what they need to grow and thrive. This information helps us make informed decisions and often helps lower stress for parents, ultimately helping them feel more comfortable letting their child learn at their own pace. We can also collaborate with other professionals to help us explore the impact of medical conditions on eating and the psychosocial factors associated with family feeding experiences.

Feeding success looks different for every child, but with the right support, we can empower parents to be their child’s best teacher by supporting emotional connection and individualized earning.




Stephanie Cohen is an experienced SLP and private practice owner in the Chicagoland area and co-founder and co-director of the Chicago Feeding Group, a nonprofit supporting children with pediatric feeding disorder and their families and providing responsive feeding-focused education for both families and professionals. Find her at www.learntotalkwithme.com.

Building a care team for PFD

Published by Erin Ross, PhD, CCC-SLP, CLC on Feb 26, 2024

In Washington state, every child supported by early intervention (EI) for pediatric feeding disorder (PFD) is treated by a team that includes a nurse, dietitian and a speech and language pathologist (SLP) or an occupational therapist (OT). The clinicians work together to coordinate care and discuss each child’s needs. It’s a model of care that works –– but is also extremely rare.

Many states are moving in the opposite direction for EI –– providing children ages 0-3 with services from a single provider. This may be a physical therapist (PT), OT or an SLP. That clinician is expected to cover every area of the child’s developmental therapy. Even with the best intentions, clinicians will fall short of providing the comprehensive care required for PFD.

Outside of feeding clinics and children’s hospitals, many children with PFD are treated by a patchwork of clinicians who don’t easily coordinate care. Those who seek a spot in a feeding clinic face long waiting lists and typically experience severe symptoms of PFD.

Finding support for four domains of PFD

Care for the Four Domains of PFD

Pediatric feeding disorder affects four domains of feeding:

  1. Feeding skill: Actual feeding skills, such as chewing and swallowing and managing the sensory aspects of eating
  2. Medical: The body’s physical ability to digest food
  3. Psychosocial: Learned ability to eat without distress
  4. Nutrition: Willingness to eat a variety of foods with high nutritional value

Feeding Matters’ Coordinated Care Model examines the complexities of PFD through these four key domains that significantly impact a child’s lifelong well-being. Because PFD is so multidimensional, children need support to cover each domain. This requires a multi-disciplinary care team.

PFD can be well-regulated and treated through collaborative care and the proper support system. But for many parents, the job of cobbling together a PFD care team falls upon them.

Designing the all-star PFD care team

Symptoms of PFD vary for every child. Some common ones include a lack of interest or refusal at mealtimes, extreme picky eating and slow weight gain. If this sounds familiar, know that it’s not okay if mealtimes are a constant struggle. Unfortunately, some providers may discount these behaviors. A good rule when working with any clinician is that if you are worried, this means there’s a problem.

If you are building a care team for your child with pediatric feeding disorder, seek support from clinicians who can cover the four domains of feeding. Consider finding support from pediatric clinicians who work on telehealth if you live in an area with limited options.

Medical domain
This provider has expertise in your child’s overall medical health, such as a pediatrician, nurse practitioner or physician assistant. Their job is to identify when feeding needs additional assessment. If your child shows signs of PFD, you’ll need a provider who understands the disorder and the four domains that make up the coordinated care model.

Feeding skill domain
An OT or SLP with expertise in teaching the skill of feeding is an important member of your PFD care team. They’ll focus on the development and coordination of the sensory and movement skills that eating requires.

There’s overlap in the feeding skills and OT and an SLP can support, so be sure to describe your child’s challenges with the clinician. Ideally, you can work with both as they each bring expertise. Look for an OT and/or SLP with expertise in sensory and oral motor skills.

Psychosocial domain
Mental health providers, such as a psychologist or a licensed social worker, can help assess and treat the learned avoidance behaviors typically seen with a pediatric feeding disorder. For the child, this means managing mealtime behaviors and learned responses. This also includes modifying caregivers’ responses to the child’s behavior to promote a positive and successful feeding interaction.

Nutrition domain
It’s important to distinguish a registered dietitian (RD) from a nutritionist. In most states, individuals call themselves a nutritionist with no formal education or medical licensure association. Look for an RD with pediatric experience. Many RDs work over telehealth.

Finally and most importantly, you, as the parent, are a key member of the multidisciplinary team. You know your child best. It’s important you feel the team is listening to you and not just talking at you.

Tips for coordinating your child’s care

Ideally, your child’s care team will communicate on their own. When this doesn’t happen, serving as a middleman for provider communication is challenging. Ask your child’s clinicians to follow up with one another rather than passing messages and forms through you.

Tell the practitioner that you would really appreciate it if they would contact the other clinician. When your child is able to go to a multi-disciplinary team under one roof, that’s how they would function. Even when that’s not the case, you can still set that as the expectation for your child’s care team.

Most importantly, trust your gut. Many people are raised to think physicians are going to direct care. This is often true, but if you feel a provider is missing something or you want a second opinion, you are your child’s advocate.

If you think feeding is a problem, it’s a problem.

To find a licensed professional in your area, visit the Feeding Matters Provider Directory.


Dr. Erin Ross is a practicing SLP and the owner of Feeding Fundamentals, an organization that provides evidence-based professional training to advance the practice of infant feeding. She is a long-time member of the Feeding Matters Founding Medical Professional Council.

Getting the most out of feeding therapy for PFD: A step-by-step guide to finding the right pediatric feeding therapist

Published by Nicole Williams, OTD-OTR-L, at Desert Valley Pediatric Therapy in Arizona on Feb 15, 2024

When your child needs feeding therapy for pediatric feeding disorder (PFD), navigating the system to access treatment can be challenging. If your pediatrician recommends feeding therapy, the following are some tips for how to find the right match.

Understand the role of feeding therapists

Feeding therapy requires additional training that neither pediatric speech and language pathologists (SLP) nor occupational therapists (OT) typically learn in graduate school. Look for a clinician who has obtained this additional training and has been mentored by another experienced feeding therapist.

therapist and child sitting across from each other smiling and interacting

Both SLPs and OTs can be qualified to provide feeding therapy. There are times when one discipline is better equipped to support your child than the other.

SLPs have extensive knowledge of swallowing, chewing and the oral motor part of feeding therapy. If your main concern for your child is choking or chewing, speech therapists are best equipped to help.

An OT is an expert in sensory issues and texture aversions. If the feeling of food in your child’s mouth, combining foods or picky eating are the issues, look for support from an OT.

Even in the initial feeding therapy evaluation, you might want to request one specialty over the other. If you’re unsure, let the intake team know your feeding concerns. They should be able to match you with the right therapist.

Check your insurance benefits

In many cases when a child needs feeding therapy, the referring physician will not indicate whether the therapist should be an SLP or an OT. In some cases, though, your insurance will specify coverage for one or the other. It’s a good idea to understand your benefits before requesting a therapy intake evaluation.

Set expectations from the start

To get the most out of feeding therapy, share your goals from the start. Even during the initial evaluation, it’s important that you and your child’s therapist have aligned goals. For example, if your child responds to a specific approach or personality, be sure to share that. In many cases, therapists can adjust to match your child’s needs. Part of the therapeutic use of self is learning to gauge and meet children where they are.

Feeding therapists have to be flexible. This means goals should be fluid from the start. If your child isn’t reaching their therapy goals, it’s time to adjust them. If your child has a setback, like a hospitalization, you may need to change your goals entirely.

Find out how to be a partner at home

As feeding therapists, we only have one hour a week to work with a child. That’s why we typically ask parents to join us during sessions so you can continue the therapy at home. As much as parents need breaks built into the schedule, therapy is not the ideal time.

hands of adult and child, touching foods to explore textures together Expect collaboration

From the start, feeding therapy is collaborative. During the initial evaluation, you’ll set goals and therapy expectations together with the therapist. You should also expect your therapist to work closely with any other clinicians who support your child.

Know that feeding therapy is not linear

Unlike the progress you might see in speech therapy, for example, feeding therapy tends to progress at a slower pace. Overall, you’ll want to see an upward trajectory of progress in feeding therapy, but it’s normal for your child to have ups and downs. What you don’t want to see is a plateau over time.

Don’t be surprised if it takes time to see progress in feeding therapy. Some kids are slow to build rapport and feel comfortable with a therapist. If your therapist is answering your questions, being collaborative and is confident in their approach, be patient.

Don’t be afraid to pivot if it’s not working out

If you’re not seeing positive progress over time or if your child’s feeding therapist isn’t a good fit, be sure to raise these concerns. In many cases, the feeding therapist can make improvements.

If results don’t improve, your child may need support from another therapist. Try switching therapists to see how your child responds. If that doesn’t help, your child may need support from another discipline entirely –– such as a gastroenterologist or a psychologist.

Consider the following questions and answers for a potential feeding therapist:

Q: How long have you been seeing and treating children with pediatric feeding disorder?
A: Look for someone with at least a few years of experience.

Q: Are you familiar with the Pediatric Feeding Disorder Consensus Definition and Conceptual Framework article published in the Journal of Pediatric Gastroenterology and Nutrition?
A: If not, look for someone willing to read the article.

baby being spoon-fed

Q: Do you have specific education and training regarding pediatric feeding disorder?
A: Look for someone who has additional training to understand the issues.

When therapists finish school, they usually don’t just jump into feeding therapy. Feeding is a specialty within speech therapy and occupational therapy that requires additional training and guidance under an experienced feeding therapist.

Q: Have you seen a child who’s had a similar experience?

A: Finding a therapist familiar with your child’s specific feeding challenges is important. Don’t be afraid to ask this specifically to be sure you’re comfortable with the answer.

Q: Describe your overall approach to pediatric feeding disorder.

A: Look for someone who understands the medical, nutrition, feeding skill and psychosocial domains and is willing to collaborate with a multidisciplinary team.

Q: How do you determine if a child is growing well?
A: Look for someone who follows your child’s growth pattern, not just a standard growth chart.

Q: How do you share the results of diagnostic testing, treatment goals, and other information with me and other providers treating my child?
A: Look for a practitioner who partners with professionals in other disciplines and keeps open lines of communication with them as well as with you. Make sure they are willing to provide you with copies of reports and take the time to go over reports with you.