What does it mean when families describe to us that their child has eating difficulties?
It means that there is puzzle for the adults in that child’s life to piece together. We must
become private investigators. We must take the entire child and the environment into account.
Data collection can be essential. The family is the center of the investigation, and a
collaborative team of medical and developmental professionals must support them during what
seems to be a long process. Unfortunately, there is no quick fix to a pediatric feeding and/or
So, what are these adults, both parents and professionals looking at?
They are looking at the children’s history very carefully including pregnancy, birth, medical, all
developmental milestones and feeding skill progression from birth. They are looking for
contributing factors. Not actual causes. Why? Because there is never one isolated “cause” of a feeding disturbance in children. This is why PFDs (Pediatric Feeding Disorders) are so complex.
As a skilled feeding-swallowing therapist for over 25 years, I have learned to observe and make
professional referrals based on the data I collect from thorough histories, meals with the child
and reports from all caregivers who are involved. These are the major contributing domains
that I examine when I do a feeding and swallowing assessment with a family. However, there
can be other subcategories evaluated over time and during the treatment process.
Complete pregnancy, birth and post birth medical & feeding histories
Feeding and swallowing skill acquisition timeline
Look and listen to he child’s perspective on eating / drinking at meals and snacks (often they can show you with behavioral patterns or tell you what the problems are)
Health-related factors (allergies, breathing, snoring, constipation, gastroesophageal reflux, colic, surgeries, illnesses, all diagnoses, syndromes, neurological disorders)
Nutritional status (weight, growth trends, growth chart)
Appetite levels and eating patterns
Structure and function of the body (oral motor webbing, oral-facial structures, agility, stamina, consistency, breathing, digestion, motor skills, general body stability)
Seating, posture at feedings, snacks and meals
Comprehension and communication skills
Oral motor skills
Pharyngeal swallowing abilities
Sensory processing skills (all 5 senses plus common preferences or aversions)
Child’s food & liquid variety acceptance patterns
Food & liquid rejections or reactions
Learning style and cognition
Eating experience (feeding history)
Home eating environments
Family feeding goals
Family food culture
Family relationship with food
Family’s perception of the child’s eating patterns
Food availability and consistency of feeding schedule
Child’s attention to food and motivation to eat
Now you can see how data can help to obtain the contributing factors so that an effective
treatment plan can be set forth. The Family is at the center of this because they know the child
best. They are at every meal and snack with the child. They often get mixed messages from
well-meaning professionals about what to do. They alter their reactions based upon the child’s
eating or attention patterns. This means that the family’s description of the child’s histories,
eating abilities and opinions are essential to obtaining this complex array of puzzle pieces.
Written documentation is needed to identify patterns and barriers in eating. This is how we
can formulate a team-based, functional and effective treatment plan.
The members of the team that can help the family the most includes any other caregivers or
teachers involved with the child. The professionals involved show include a registered dietitian
to ensure adequate current nutrition and hydration, then advance the child’s nutritional status
throughout treatment. Feeding and swallowing therapists or other team members cannot
assess a child’s nutritional status. A skilled developmentalist who can conduct a complete
developmental assessment. A speech-language pathologist with knowledge in feeding, oral
motor and swallowing development. An occupational therapist with knowledge of feeding and
sensory processing can lead this treatment process. A medical support team may include but
not limited to the child’s primary care physician, a pediatric gastroenterologist, allergist,
endocrinologist, otolaryngologist, pulmonologist, chiropractor, nurse, lactation consultant, child
psychologist, behaviorist, neurologist or aerodigestive team. Referrals for additional medical
and neurological testing depends exclusively upon what factors the family and the team
discovers. It is important to note that not every child will need all of these assessments.
However, if the treatment is not effective then the team needs to “Circle Back” and look again.
Children do very well with wrap-around feeding and swallowing services. This means that
supporting the child with eating problems is a steady process that cannot be rushed. However,
based upon the detailed ongoing feeding and swallowing an assessment, there are immediate
strategies can be set in place that helps the family feed their child and reduce stress. Such
strategies include home food access support via WIC, SNAP or other food financial support.
Scheduled kitchen routines for meals and snacks, graze reduction and food texture variety
rotation. Formal feeding therapy can consist of nutritional counseling, oral motor, dysphagia
therapy speech-language therapy, occupational therapy, seating assessment and emotional
support. For more information and resources see this wonderful resource
Cheryl Pelletier, M.S., CCC Speech-language Pathologist Feeding & Swallowing Specialist, Founder of Gnosh, Inc Private Practice Services on Cape Cod, MA & Chewing-Swallowing. Products can be reached at cheryl@GnoshFeeding.com, www.SideBiter.com or phone 508-720-CHEW (2439).