Child & Family Development Child & Family Development

June 28, 2023

Feeding Therapy: Who to Refer and What to Expect

Speech-Language Pathologists and Feeding Therapy: Who to Refer and What to Expect

By: Ashley Godwin, MSP, CCC-SLP

When is it best to refer a child to a speech-language pathologist for feeding therapy? A good first step would be to understand the difference between a picky-eater and a problem eater. A picky-eater accepts approximately 30+ foods in their food repertoire, eats 1 or more foods from most all food texture groups or nutrition groups, and tolerates new foods on their plate and usually can touch or taste it. These children are sometimes reported as a ‘picky eater’ at well-child visits and they typically eat with family, but frequently eat different foods than the family. A problem eater accepts less than 20 foods in their food repertoire and they often have a phobic reaction to foods such as gagging, tantrums, shuttering at the sight of foods, or throwing up. They may refuse entire categories of food textures or nutrition groups, drop foods entirely from their diet and never return to that food (also known as a food jag), and they are persistently reported as a ‘picky eater’ across multiple well-check visits. Problem eaters usually eat different foods than the family and often eat alone. A problem eater often has a an underlying medical condition, a sensory related issue causing mealtime to be difficult, oral motor difficulties making it hard to chew and swallow a variety of textures, or a diagnosis such as autism spectrum disorder. A speech-language pathologist can work problem eaters to help children and their families overcome feeding problems and expand their diet in a safe and natural way.

During an evaluation, the speech-language pathologist will often ask the family a variety of questions to try to get a better picture of what is happening at home, what behaviors are observed at mealtime, and what the child’s diet consists of. They will also ask questions to help rule out or identify any sensory and/or medical problems. Before beginning therapy (or along with the start of feeding therapy), the speech-language pathologist may refer to other medical professionals such as occupational therapists, dietitians, nutritionists, pediatric gastroenterologists, ENTs, etc. to further evaluate the child and treat any other areas  that may be contributing to difficulties with eating.

Food chaining is often a type of treatment that therapists use. It is important to think about the texture, flavor, temperature, and consistency of foods that the child will eat. The therapist will start with these foods and slowly expand to similar foods based on the factors listed above. Patience is key in all aspects of feeding therapy because the therapist is trying to gain the trust of the child in order to make progress towards their feeding goals. The therapist offers choices, talks about the foods, plays with the foods, and uses fun toys and rewards to make feeding fun.

Speech-language pathologists can also help parents with breast and bottle-feeding techniques and positioning, help transition babies from formula to early foods as early as 4-6 months of age, and transition children on feeding tubes to table foods. They work with a variety of populations on improving oral motor strength and function so that they can safely tolerate a variety of textures. A huge part of mealtime success is teaching the family about feeding. To help with this, the speech-language pathologist will work very closely with the family throughout the whole process so that everyone is learning the strategies used in therapy so that they can generalize them into the home environment.

One of the main goals of feeding therapy is for the child and the family to feel comfortable around food and for mealtime to be a pleasurable experience so that ultimately the child can maintain a healthy diet for their age. Speech-language pathologists and other medical professionals can work together to help children achieve this goal.

Resources and References

Kay A. Toomey, Ph.D. ©2012


©Susan Roberts, 2010

Cross Country Education