The power of assessment: How validated diagnostic tools fuel feeding therapy
Published by Feeding Matters on Dec 17, 2024
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.
- In the past, feeding disorders were viewed through the lens of a single professional discipline, which failed to support feeding’s complex and multifactorial process.
- 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