Published by Kristy Kazian, MS, CCC-SLP on Sep 20, 2018

Six Best Practices to Provide Safe Feeding Therapy While Reducing Your Liability

Feeding therapy can be scary not only to a new, inexperienced feeding therapist but even to those of us with years of experience. Thanks to advances in modern technology, babies are being born earlier than ever before. While scientifically amazing, we are seeing feeding and eating challenges as well as other complications including physical and cognitive delays and breathing difficulties. Additionally, we are seeing an increase of children develop food allergies including some so severe they are causing anaphylactic reactions. Other therapists and family members ask me, when they find out what kind of work I do, “aren’t you afraid of a lawsuit if a child chokes during one of your sessions?” My response is simple- my passion for helping infants and children with feeding disorders outweighs my fear of a lawsuit. By following best practices for the “safest” feeding therapy, I decrease any feelings of fear.

1. Don’t Do It Without Training– Too often we hear about a therapist who had no training but tried feeding therapy anyway. The inexperience and lack of training can cause regression in the child’s progress by increasing food aversions, fear and gagging. Most Feeding Therapists receive little training in undergraduate or graduate school and therefore much of the training comes through continuing education focused on feeding. My suggestion is to take those courses and shadow a mentor for 6 – 12 months to gain your confidence and increase your knowledge.

2. Build Strong Relationships– Your clients expect good quality care and trust in their therapist. Getting to know your clients, their family members, their culture and their family traditions, so that you can respect their culture and traditions, will help you build a better relationship creating more trust and a better bond. Include the caregivers and siblings in your sessions when possible, providing a family-centered therapy approach is key to success. Feeding, eating, mealtimes and even the types of food our clients eat, vary from family to family based on culture and traditions. Knowing your clients and their families, providing open, honest and regular communication rooted in respect and kindness, builds the necessary trusting relationship for success.

3. Be an Active Team Member– Being an advocate for your client starts by having a prescription from your client’s primary care physician to provide your services. Get informed consent from you client’s caregiver to be able to communicate with other healthcare professionals. Complete a thorough review of the child’s medical history and any recent medical assessments. If the client has not had a recent assessment from his/her primary care physician, recommend that they complete one. Engage with a phone call to your client’s pediatrician and/or medical specialists, letting them know who you are, what you are doing and that you are available for questions or concerns regarding your client’s feeding skills. If necessary, accompany your client to a doctor’s appointment(s) to engage with your client’s healthcare team. Ask to co-treat with other therapists (PT/OT), especially if the client is working on skills that crossover, such as positioning and self-feeding.

4. Safety First– Best practice is to maintain CPR/First Aid certification when doing feeding therapy. Consider requiring the family to have an antihistamine available like Benadryl or an Epi-pen, if prescribed, during all sessions. When working with infants and toddlers who may not have been exposed to wide variety of foods, allergic reactions can occur at any time. Even if the caregiver reports the child has no known allergies and has never had a reaction in the past, you need to be prepared. Know the signs of an allergic reaction and take necessary action as needed.

5. Documentation Matters– Keep accurate and precise documentation. Getting a detailed birth and medical history will help you to develop the best treatment plan and provide individualized therapy. Writing detailed reports/notes that you can share with other healthcare team members will help strengthen the entire team. Provide specific written instructions when recommending a daily home care program for families to work on outside of therapy. Providing them your contact information so they can ask questions in between your sessions will give them the confidence to follow the plan, ask questions as they arise, and reduce chances of feeding them the wrong types of food.

6. Protect Yourself– Stay current with your professional requirements. Having Professional Liability Insurance and a current active license are mandatory. Maintain your first aid and CPR certifications and never let them lapse. Focus on a full understanding of HIPAA regulations and follow mandated privacy practices. To further reduce risk, consider creating an LLC (Limited Liability Corporation), as it is not expensive and may help protect you personally in case of a lawsuit.

The best way to reduce your liability as a therapist is to do the training and mentee process to gain experience and confidence. Having confidence in yourself and knowing your limitations will help you provide the best feeding therapy possible.

Kristy Kazian, MS, CCC-SLP

Kristy Kazian, SLP, LLC