Is your baby or child struggling with feeding? Pretty sure you need feeding therapy but not sure where to start? As feeding specialists, this is how we recommend going about it if you’re looking for a feeding therapy evaluation for your kiddo. Once you have an idea of who and what you are looking for, take a look at the PRO directory over at Solid Starts. This growing directory includes feeding therapists, dietitians, physicians, and other licensed medical professionals who have completed the Solid Starts PRO course and align with our feeding philosophy.
1. Write down your concerns about your baby or toddler’s eating. Be as specific as possible about your concerns. Possibilities include:
Weight/growth
Tantrums at the table or around certain foods
Picky eating
Throwing food
Refusing to eat
Preferring one or two types of foods
Hating certain food groups, food textures, flavors or colors
Eating too much
Not eating enough
Battles/arguments at every meal
Limited repertoire
2. Write down what you’ve done so far to support your child or to try to fix the problem. Again be as specific as possible.
3. Talk to your child’s pediatrician or family medicine physician. Bring your list of concerns and ask what you can do. Ask for copies of their growth chart and ask your doctor to walk you through how your child is growing. We recommend this, not because growth is a great indicator of whether or not a child needs feeding therapy, but because it can be helpful to both you and a potential feeding specialist to know how severe the issue is and what to focus on first.
4. If your doctor does not seem concerned and/or does not offer you a referral to a feeding therapist, ask for one! You have every right to tell your child’s physician that you want and need more help with this. Make it clear that you’d like a referral for a feeding therapy evaluation from a licensed pediatric Occupational Therapist or a Speech Language Pathologist. Some pediatric physical therapists also provide feeding services, but most of the time you will be working with an OT or SLP.
5. Ask your baby’s physician for recommendations on who to see/where to go. Often the physician will have a few local resources that he or she uses which can be an excellent starting point.
6. If your child’s physician has no recommendations or if you would like other options, you can do your own research to find local support. We suggest you start with a google search to find your local children’s hospital, early intervention services, as well as any private pediatric OT or SLP clinics in your area. Contact each of these with a brief description of what you need (a feeding therapy evaluation and possibly intervention for your baby or toddler to help with [x, y, z] issue.)
7. Interview each clinic or therapist. Ask questions and search for the right fit for you and your child. In particular, you want to make sure you find someone who:
Has pediatric feeding experience
Has advanced practice and training in the area of feeding issues or works closely with a mentor
Uses a variety of approaches in their feeding therapy (not just ONE approach)
What are the different feeding therapy approaches?
There are a few different tools, certifications, theories, and approaches that feeding therapists may be trained in. This list is NOT comprehensive so if a therapist names off a different approach or tool from what we list here, we recommend asking them to tell you more about it. Also, some “approaches” have names/titles and sound very legitimate, while others are based more broadly on a topic/aspect of eating or mealtime.
Responsive feeding
Relationship-based feeding
DIR-Floortime
Sensory integration or sensory strategy based services
Oral motor therapy
SOS (Sequential Oral Sensory) approach
Graded desensitization
ABA (Applied Behavioral Analysis)
Get Permission approach
Food chaining
Beckman stretching/exercises
Orofacial Myofunctional Therapy
Environmental adaptation
Dysphagia/swallowing focused work
Cognitive Behavioral approach
“Feeding, eating, swallowing, and mealtime are highly complex activities and engage multiple systems, muscle groups, and relational elements.”
We bring this up because each child's feeding challenges can be met with a variety of approaches, but ideally, there is a good fit between child and therapist/approach. For example, if you have a child who is dealing with sensory based feeding challenges (ie: sensitivity to touching/feeling textures), it would be best to work with a therapist who is trained in sensory integrative techniques. OR if your child has underlying dysphagia (or swallowing issues), working with a therapist with swallowing experience would be best. We don't expect YOU as a parent to know what type of therapy approach best suits your child needs, but we hope you can use this information to discuss your child's unique feeding needs with the therapists you meet to determine if it's a good fit. Ideally you want to find a therapist who is trained in and understand a variety of approaches- not just one (because feeding, eating, swallowing, and mealtime are highly complex activities and engage multiple systems, muscle groups, and relational elements.)
And remember, never feel like you can't change therapists/approaches if things don't seem to jive.