What is feeding therapy? Does your child or toddler need therapy, and if so, how do you get a feeding evaluation for them? Get answers from a feeding specialist!
For well over a decade, a big part of my job as an occupational therapist was doing feeding therapy with toddlers and kids, from mostly in people’s homes through early intervention, but also in a private school setting, too.
And, over the last 5 years, there have been more emails than I can count from parents asking if their kids that were struggling with picky eating or transitioning off baby food actually need more help.
In many cases, feeding therapy is one of the best ways to get help from a feeding specialist. While some of you have heard of feeding therapy and are considering it, I know for others it is a very new concept and may be something brand new to you.
Either way, by the end of this post you will know exactly what feeding therapy is, who it’s for, and how to get help. Plus, a bunch of other important tips, too!
What is Feeding Therapy?
Basically, in its simplest terms, feeding therapy helps children learn how to eat or how to eat better. Feeding therapists provide feeding therapy and are usually occupational therapists (like myself) or speech-language pathologists (SLP).
Some dietitian/nutritionists provide direct treatment, but more often provide support with additional services for some children to manage any weight or growth concerns when it is necessary.
No matter what their background, it is important to note that “feeding” is a specialty within a specialty. Not all OT’s and SLP’S are trained in pediatric practice, and not all pediatric therapists have advanced feeding therapy education and practice either.
Feeding therapy often happens on a weekly basis, but can be every other week or once a month during a scheduled block of time, usually 30-60 minutes long. Feeding therapy sessions can be individualized or in group settings, each with their own benefit and goals that we will discuss below.
Most often, this time is spent teaching your child how to eat new foods (if they have a very limited diet) or how to eat (if they don’t know how to chew or manage food in their mouth).
But, depending on the child’s underlying challenges, you may see your child participating in sensory integration activities or completing exercises to strengthen oral motor skills and the muscles they need for eating.
Exercises will likely be things like blowing bubbles, making silly faces, or using whistles.
Before you get to weekly appointments, an evaluation is completed first, which usually consists of the occupational or speech therapist observing the child eat and interviewing the parent. Not very invasive at all.
A combination of standardized testing and skilled observation will help build goals for your child based on what is considered typical and what skills your child might be lacking.
After the eval, a team of professionals or the therapist that completed the eval makes a recommendation for how often feeding therapy takes place and what the treatment plan will be.
At this time, goals are written that guide the direction of therapy. The goals are usually specific and include the parents’ concerns.
For instance, a feeding therapy goal might be: Suzie will drink from an open cup independently 75% of the time, or Logan will eat and swallow three new foods independently within 30 days.
Sometimes, feeding therapy is done one-on-one with a child and therapist. Other times, it’s with a group of children that all have similar goals because a group dynamic can be very motivating for kids.
But, feeding therapy may also be done with the parents, which is definitely the case in an early intervention setting, we’ll talk more about that in a minute.
Who is Feeding Therapy for?
While I gave you a general idea in the section above, I want to get really specific because I know a lot of you are here reading because you want to know if YOUR child needs feeding therapy.
Generally speaking, feeding therapy is extremely helpful and strongly recommended if your child is having difficulty actually eating. This is most common with children that have special needs or medical challenges that may make it physically difficult for them.
Pediatrician’s usually suggest feeding therapy early on in these instances, based on the child’s ability and the child’s individual needs, but there are two more common situations that are often overlooked…
Is Feeding Therapy for Picky Eaters?
Well, for me to answer that question you need to know that not all picky eaters are created equal.
It’s a blanket term that we use to describe any child that basically has food preferences or maybe doesn’t like vegetables, but also includes kids that gag or even throw up at the sight of new food or new textures, and only have 5 foods that they eat.
That’s quite a range! Obviously, feeding therapy isn’t necessary for all of them.
Feeding therapy is recommended for more extreme picky eaters that have a very limited diet and stress around trying new foods. Head over to When Won’t Eat and Extreme Picky Eating Red Flags to understand more.
You can also take our picky eating test to be sure where your child falls in this range.
Is Feeding Therapy for Toddlers?
Depending on the challenges a child is facing, infants can actually be in feeding therapy, so, just to be clear, age doesn’t matter.
But, if you’re asking this question, it may be because your toddler is behind on some feeding milestones, and you’re wondering how long you should wait to see if it improves on its own.
For example, maybe your 14 month old is still only eating baby food and you’re not sure if they know how to chew in order to eat solid foods. Or, maybe they cough every time they drink from anything other than a bottle feeding. Another common concern is a sensitive gag reflex.
In any of these cases, reaching out for an eval is a good thing. Your child may or may not end up qualifying for therapy, but at least you will know if they need more help.
And, with any evaluation you will get some suggestions for activities to try at home during mealtime, which may be all you need! To read about more possible feeding challenges check out Feeding Red Flags.
Also, keep in mind that picky eating often starts for children when they are toddlers, and that it is a normal phase. If you feel like it is getting out of control or is beyond any limits of normal, then this would be another instance that a toddler may need feeding therapy.
If picky eating continues and worsens, and your child becomes an “extreme picky eater,” they may qualify for a feeding diagnosis called Pediatric Feeding Disorder (PFD).
This is a relatively new diagnosis that has offered a more sensory-based treatment approach to advanced picky eating.
How to Get Feeding Therapy
At this point, you should have a pretty good idea if feeding therapy is something you should consider or not. Let’s look at your options.
First things first, it’s always a good idea to talk to your pediatrician. They should know the best options in your area. BUT, and this is really a big BUT, if you explain your concerns and don’t get an answer that sits well with you, don’t hesitate to get a second or even third opinion.
Sometimes feeding issues may seem like typical development on the surface, especially to a doctor that is getting a quick run down, which is why I want you to listen to your gut. As an OT, pediatric feeding therapist, and mom, I cannot express enough how important early intervention can be.
As soon as your gut tells you that something might be wrong, it is completely okay (and recommended!) to pursue opinions and expertise on your own, despite hearing that “nothing is wrong” from your doctor.
It’s also important to know that in many cases you don’t need a referral or recommendation from a doctor to proceed with feeding therapy. However, whenever possible it’s best to have your child’s doctor on the same page as you.
If your doctor doesn’t give you any feeding therapy suggestions, you have a couple of options you can explore on your own:
- Clinic or hospital – Children’s hospitals and many of their satellites offer feeding therapy.
- Private clinic – These may be smaller, but may be in a better location. Some privately owned clinics specialize in specific types of treatment that might appeal to you. (See the next section)
- Early intervention – For children under 3, and in some cases under 5, for children that live in the USA. This therapy takes place in your home.
- School – This is much more rare, but if your child is in a school for special needs, feeding therapy will be covered at school. In the majority of typical public schools this will not be an option.
With the first two options, it’s very important that you check with your health insurance provider about what is covered before you make any appointments. Once you know what will be covered and to find locations near you, just do a simple Google search: “feeding therapy in ‘your city””
Early Intervention is free or mostly free. I have a whole post completely dedicated to early intervention, check it out for how to get in touch with your specific state. I was an early intervention therapist for many years, it’s very near and dear to my heart!
Lastly, if your child is in an approved private school for children with special needs and you think your child would benefit from feeding therapy, ask the team about it!
What to Expect with Feeding Approaches
As you can imagine, there are different approaches to feeding therapy, some of which you may be comfortable with and some that you may not be. Whether you are calling clinics or have early intervention in your home it is okay to ask what type of approach they are using to help your child.
There are dozens of specific, different approaches and a variety of techniques that would be much too cumbersome for me to cover in this post, but most of them can be summed up into two different categories:
1.Behavioral – The traditional method of feeding therapy that uses rewards to gain new foods eaten. For example, your child may be given a sticker, toy, or electronic device for successfully taking a bite of a new food.
To get another sticker, toy, or more time with the electronic device, they need to take another bite. Over time, these rewards should be phased out, although that isn’t always the case.
2. Child directed – This is a more modern approach and is positive in nature. Parents are more involved with this type of treatment and there is a focus on addressing the underlying cause of the problem (i.e. sensory, medical, etc.).
While this approach can take longer to see results initially, there is research that supports the effects are longer lasting. The SOS approach to feeding and Ellyn Satter’s work fall under this category. You can read more about Satter’s technique in my favorite Picky Eating Strategy.
I will be completely honest in saying that I use and support the child directed approach, but I respect parents and other therapists that choose to go the behavioral route.
If it’s important to you that your child’s feeding therapy does or does not include one of the above approaches, make sure you ask when you schedule an appointment what approach they use and the experience level of the therapists.
If the clinic or therapist can’t accommodate you, then it will be best to call other facilities until you find a good fit.
Are There Other Options for Help?
If I haven’t been direct enough yet, I think feeding therapy can be great for you and your child. But, I know there are many reasons it sometimes isn’t possible, whether it’s due to financial constraints, location challenges, or simply not a lot of therapists being available.
If that is the case, or if you want to also be able to help your child at home day in and day out then grab a seat in our free 1 hour workshop:
You’ll learn my 3 most basic strategies that are totally essential to making eating progress with your child, and you’ll learn the entire plan I teach inside of my picky eating program, Mealtime Works.
And, if after reading this you are concerned about possible sensory issues with your child, either related to their eating or outside of it then you’ll want to stop over to sensory integration therapy to learn if it would help your child.
More on Feeding Therapy and Picky Eating
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