Children with pediatric feeding disorder have diverse needs ranging from refusals to eat specific textures to an inability to chew and swallow that necessitates medical interventions such as tube feedings (Berlin, Davies, Lobato, & Silverman, 2009). Many underlying medical or developmental problems may contribute to difficulties with eating. Regardless of a child’s medical status or developmental course, inadequate nutrition or hydration may contribute to learning difficulties in school including, but certainly not limited to:

• reduced concentration
• low energy levels
• poor stamina
• difficulties problem-solving
• poor frustration tolerance

As such, children with feeding disorders may be eligible for accommodations and/or special education instruction and related services. As both a school psychologist and a parent of a child with pediatric feeding disorder, I’ve had an opportunity to think deeply about school-based accommodations and supports for children with feeding needs. Below is an overview of the types of school-based plans that exist, as well as examples of accommodations and supports that may be helpful.

Children primarily receive school-based supports via Section 504 Plans (504 Plans), Individualized Education Programs (IEPs), or Individualized Health Plans (IHPs). Both 504 plans and IEPs provide accommodations for children with disabilities. However, 504 plans are generally limited to accommodations, and do not include specialized instruction or direct teaching from a licensed or certified special educator.

Children who require accommodations and specialized instruction should be referred for a comprehensive evaluation to determine whether they qualify for special education services and an IEP. Some children do not qualify for or need an IEP or a Section 504 plan, but they may otherwise have an IHP developed with the school nurse. If an IHP alone is working for a child, family, and school team, more formalized supports may not be necessary.

Families and educators often wonder what accommodations and/or services might be helpful for a child with a feeding disorder. These determinations are made by teams based on a child’s individual needs. Unfortunately, feeding therapy is not considered a related service provided in schools. However, school districts do provide related therapies such as speech and language therapy and occupational therapy as part of an IEP for educationally relevant tasks that may indirectly support a child’s feeding needs.

For example, occupational therapists may provide fine motor training to support pencil grasp, which may also support a child’s ability to hold and use feeding utensils. Similarly, speech and language therapists may help a child strengthen oral motor skills to support speech articulation, and these exercises may indirectly improve a child’s eating/feeding abilities.

Many families pursue private feeding therapy for school-aged children. Private therapists and school-based therapists should collaborate directly to discuss strategies, accommodations, and/or services that may benefit the child. Below is a non-exhaustive list of accommodations/services that families and school teams may consider when determining appropriate supports for an individual child.

Possible Accommodations/Services for Children with Feeding Disorders Who Eat Orally

• Extra time for eating (for children with reduced endurance for self-feeding)
• Opportunity to bring special foods from home (for children with restricted diets, food allergies, or need for specific textures/consistencies)
• Opportunity to snack during instruction or short breaks from instruction during day for snacking (for children who may not reasonably be able to consume sufficient calories during a designated lunch period)
• Familiar adult to provide supervision during eating (for children who are safe to eat at school per medical team but who may be at some risk for aspiration or choking)
• Verbal or visual cues to chew/swallow
• Verbal or visual cues to help child take appropriate drink/bite-size to prevent choking
• Verbal or visual cues to monitor amount of food in mouth (for children who tend to “pack” food in cheeks or put too much food in mouth)
• Use of behavioral motivators (for children who need positive encouragement to eat)
• Use of specific chairs, utensils/cups/straws or positioners
• Use of fidgets or other sensory supports
• Lunch bunch group (adult supported peer group) to provide modeling and socialization during meals and snacks
• Reduce distractions during mealtimes

Possible Accommodations/Services for Children with Feeding Disorders Who Require Tube Feedings
*Note: Children who require tube feedings at school may also eat orally, in which case any of the above accommodations may apply

• Opportunity to administer tube feeds where the child is most comfortable (i.e. nurse’s office, lunch room, or classroom)
• Designated support staff (nurse or trained assistant) to administer tube feeds, as needed
• Use of specific chairs or positioners during and following tube feeds (for children who need to be in an upright position to manage reflux or other medical issues)
• Monitoring for safety during tube feedings
• Stoma site management by school nurse, as needed
• Emergency plan with school nurse should the tube become dislodged at school

I encourage families to reach out to educators in their child’s school to discuss their specific concerns. School psychologists, school social workers, speech and language therapists, and occupational therapists are particularly well equipped to advocate for children and families with feeding needs. Additionally, families should also know that they can seek out the support of their child’s private therapists or consult with a special education advocate to assist them in securing necessary services.

For more information about Section 504 Plans, Special Education Services/IEPs, and Individualized Health Plans, please check out the following resources from the National Association of School Psychologists (NASP) Section 504 Plans: A Guide For Parents, Special Education: A Basic Guide For Parents, and the National Association for School Nurses. Additionally, Feeding Matters provides a wealth of information that parents can use to inform their advocacy efforts.

References
Berlin, K. S., Davies, W. H. Lobato, D. J., & Silverman, A. H. (2009). A biopsychosocial model of normative and problematic pediatric feeding. Children’s Health Care, 38, 263-282.

Additional Resources
American Speech-Language-Hearing Association (ASHA)
National Association of School Psychologists
School Social Work Association of America
American School Counselor Association
The American Occupational Therapy Association, Inc.
National Association for School Nurses
Center for Parent Information and Resources
The Center for Appropriate Dispute Resolution in Special Education