Paula Rabaey, PhD, MPH, OTR/L, has seen firsthand how research can improve patients’ lives worldwide over her 30 years in occupational therapy (OT). Dr. Rabaey, an associate professor at the University of Minnesota, has continued working with children throughout her academic career to maintain a direct connection to those who may benefit from her research.

Since her first occupational therapy position, when she was introduced to the role of OT in feeding children with cerebral palsy and other neurological developmental delays, mealtime participation as a major childhood occupation has been Dr. Rabaey’s passion. Working with families in her area and on her volunteer trips abroad has given Dr. Rabaey a direct connection to families’ feeding therapy needs. She also can see how educational experiences and academic research can profoundly impact service delivery.

How education and research in occupational therapy improves feeding therapy methods

An early example of how education informed her practice was evident after attending a multi-day continuing education course focused on strategies to foster feeding skill development. “The course was life-changing because it made me think about the multiple steps to eating, from getting the food on your plate to getting it to your mouth,” says Dr. Rabaey.

One child born with a cleft palate and later diagnosed with autism spectrum disorder stands out in particular. At age two, the girl’s feeding difficulties were so profound that she would scream at the sight of her high chair. All of her medical feeding needs had been addressed, but she still refused to eat.

By the time I met with her, numerous therapies had failed to help, and the little girl was getting all of her nutrition from a gastrostomy-tube. Her family was wary of therapy but desperate for a solution that could offer a more typical eating experience.

Dr. Rabaey worked with the entire family using the skills she learned from her feeding coursework. For nearly a year, they worked through the toddler’s tactile aversions and slowly introduced food and witnessed remarkable progress. “By the time I discharged her, she was eating pretty much everything by mouth. She started attending school and was thriving,” Dr. Rabaey said.

It was an important early lesson on the power of working with the whole family while advocating for the child’s unique needs.

Researching abroad to benefit children with pediatric feeding disorder worldwide

Much of Dr. Rabaey’s research comes from her OT work abroad with SPOON. She’s dedicated to using a mixed methods approach of qualitative and quantitative research methodologies to understand the complexity of pediatric feeding disorder and its impact on children and families.

With SPOON, she volunteers as a feeding technical expert and helped develop an assessment tool for caregiver feeding practices in orphanages. The tool offers solutions for positioning, cup and spoon use, modification of food textures and responsive feeding practices for caregivers who feed children with disabilities. She continues researching the tool’s efficacy and usability and has presented the work in Mongolia, Kazakhstan, China and Russia.

Dr. Rabaey also has helped develop a training of trainers (TOT) curriculum for community health workers working with families with a child with a disability in Zambia and is assisting SPOON with piloting a unique and low-cost feeding chair for use in low and middle-income countries. This work has informed how she teaches her students to practice with multicultural families in the U.S. today. There are so many cultural elements to eating; “You have to be empathetic to consider every family’s way of doing things,” she says.

How research informs our work at Feeding Matters

As the research pillar at Feeding Matters, Dr. Rabaey leads our research initiatives as well as how research informs our evidence-based practice recommendations. Research was key to establishing an International Classification of Diseases (ICD-10) code for PFD. The code was made official in October 2021 after the council published a consensus paper, advocated for a diagnostic code within the ICD and disseminated the information to the healthcare community.

Since then, Dr. Rabaey collaborated with Kate Barlow, OTD, OTR/L, IMH-E on a mixed-method study through a Feeding Matters grant to identify what assessment tools therapists are using to diagnose PFD. “You don’t pull out a standardized kit from the shelf to evaluate feeding,” she says.

That research was published in 2023, showing that OTs and speech pathologists use a mix of ways to evaluate PFD, and not many of the assessments are standardized. The tools don’t necessarily fit the four domains of pediatric feeding disorder: medical, nutrition, feeding skill and psychosocial. “What’s clear is we need to have a broader, more formalized way to assess the complexity of PFD,” says Dr. Rabaey.

While there’s more work to be done to improve feeding therapy practices through research, Dr. Rabaey is proud to see how far feeding therapy has come since she began as an OT.

“There is a great need for evidence and evidence-based practice. While it’s slow going, I think we’re making important strides.”

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Paula Rabaey is the research pillar at Feeding Matters and a new fellow for AOTA. She’s on the Medical Advisory Board and a feeding technical expert for Spoon Foundation. Many of her numerous academic publications focus on her international research.