What is Feeding Therapy?

Feeding therapy involves working with trained professionals to address eating challenges that may lead to impaired growth and development. The goal is to find strategies that help make feeding and eating less stressful for the child and the family. Parents, caregivers, along with the child and therapists, work together to identify areas of concern, and reasons behind challenging behaviors.

Children with pediatric feeding disorders may have severe oral aversions and refuse to try new foods. It’s important to identify the reasons behind the behavior, instead of focusing on what the child eats or doesn’t eat. This way, parents are able to address the underlying issues that make it hard for the child to meet their nutritional needs. Oral motor skills, sensory processing differences, allergies and intolerances, and past trauma histories can all contribute to pediatric feeding disorders. Feeding challenges can be related to a wide variety of issues. Recognizing the medical, developmental, nutritional and psychosocial aspects of eating supports lasting change.

How Do I Know If My Child Needs Feeding Therapy?

Feeding difficulties are common for normally developing infants and toddlers. It’s a good idea to start looking out for signs of more complicated feeding issues, and have a feeding evaluation done, if these challenges persist. Your child might benefit from feeding therapy if they struggle to meet their nutritional needs in an age appropriate way. Below are issues to look out for as your child progresses in eating:

    • Difficulty with breastfeeding/bottle feedings, or transitioning to solid foods
    • Avoiding whole food groups or textures entirely, or only eating from certain food groups
    • Increased stress and anxiety around meal time, including frequent meltdowns
    • Having a strong aversion to trying new foods
    • Eating less than 20 different foods
    • Frequent coughing, choking, or gaging when eating
    • Failing to meet age appropriate developmental self-feeding skills
    • Faltering weight or impaired growth over a period of time
    • Hoarding or food preoccupation

Ask your pediatrician to refer you to a feeding therapist to address areas of concern.  Challenging feeding behaviors are often related to underlying problems that are easily overlooked.  Some issues include oral motor delays, sensory processing disorders, digestive issues, or past trauma experiences. For that reason, working with a feeding therapist to identify and address the root cause can help you move towards long term progress.

How Do I Find a Pediatric Feeding Therapist who can address my child’s needs?

A professional trained in pediatric feeding disorders, or a group of professionals who address different aspects of feeding, can provide feeding therapy to help your child learn to eat better. Medical, nutritional, psychosocial challenges, or developmental delays that affect feeding skills can lead to food related challenges.  Feeding specialists with different backgrounds can work together and individually address specific aspects of feeding.

Professional roles in feeding therapy

    • Pediatricians identify pediatric feeding disorders and make referrals to specialist who can help with specific feeding issues.  It’s a good idea to have your pediatrician on board with your feeding plan.
    • Registered Dietitian Nutritionists address issues relating to malnutrition, growth concerns, food allergies or intolerances, and nutrient deficiencies. Registered dietitians can also help families foster positive relationship with food and eating.
    • Speech Language Pathologists who are trained in feeding, address oral motor functions including sucking, swallowing, biting and chewing.  If communication skills are affecting meal times, speech therapists can also help address issues in that area as well.
    • Occupational therapists address oral motor strength and coordination involved in feeding and eating, body positioning skills that affect eating.  Occupational therapists can also work with the child to address sensory processing differences.
    • Psychologists and Social Workers address challenging mealtime behaviors that happen when eating is difficult or unpleasant for the child.  Children with complicated histories or trauma experiences, may also have attachment issues that affect eating.
    • Lactation Consultants help new mothers and infants address issues related to milk supply, latching, and the use of a supplemental nursing system (SNS) for adoptive mothers or babies that needs to supplemental nutrition.Feeding disorders are complex. A problem in one aspect of eating usually impacts other areas.  Feeding is a specialty within a specialty, meaning that not all speech therapist, occupational therapists, or dietitians/nutritionist are trained in this type of work.  Finding a professional who is knowledgable in all aspects of feeding is helpful, even if they only specialize in one area.  They should be able to refer you to a specialist who can address your specific concerns that may be out of their scope of practice.

toddler using a fork and spoon to eat at the table

What Are Different Approaches in Feeding Therapy?

Pediatric Feeding Therapy can be done using a more traditional approach, which focuses on behavioral outcomes, or a child led approach that is responsive and sensitive to the child’s needs. It’s important to know what approach works for your family when looking for someone to work with.

Behavioral Approach

Feeding therapy that follows the behavioral approach uses positive reinforcement to encourage children to eat.  Children receive incentives, praise, or rewards when they try new foods.  This approach focuses on changing the child’s behavior. The therapist can work directly with the child in each therapy session, to address areas of concern. Applied Behavioral Analysis (ABA) is a common strategy that uses the behavioral approach to address feeding issues with kids diagnosed with autism spectrum disorder.

Responsive Approach

A responsive approach to feeding therapy focuses on developing positive experiences with food, and helping the parent or caregiver to understand the underlying issues that contribute to the child’s feeding challenges.  This approach builds on a foundation of trust and healthy attachment, so that healing from past trauma experiences can occur.  Progress is generally slower, but results from a responsive approach have been shown to have more lasting effects. Common feeding strategies using the responsive approach include Ellyn Satter’s Division of Responsibility and the SOS Approach to Feeding.

What Can I Expect From Feeding Therapy?

Feeding therapy isn’t a magic pill that will “fix” a child’s feeding issues.  Working with a therapist helps parents and caregivers develop the skills and understanding to support their child in eating.  Parents, empowered with the knowledge and skills needed to help their child, learn to create environments in their home that encourage a positive relationship with food and self motivation to eat.

Children develop felt safely around food when pressure and conflict during mealtime is minimized. This often requires parents to reflect on their own beliefs about food and health. Working with a feeding team allows caregivers to process their concerns, and find appropriate ways to accommodate for their family’s different needs. Parents develop confidence and reassurance, when their child is able to meet his nutritional requirements without being pushed beyond what they are able to handle. A foundation of trust in the feeding relationship supports lasting change that comes with time. Contact us to see if working with a Registered Dietitian would be helpful for you and your child.