Ask the Expert: Feeding Therapy Explained

by Jan Gambino Patient Expert

Infants and children with reflux often face feeding challenges. For the

most part, careful feeding and home care combined with a special diet or

medication reduce or eliminate common feeding problems. A small number

of infants and children have feeding challenges that require medical

treatment and specialized feeding therapy. I have asked Melanie Potock,

SLP, feeding therapist and author of Happy Mealtimes with Happy Kids:

How to Teach Your Child About the Joy of Food to explain feeding


What does a feeding therapist do?

A therapist who specializes in feeding is typically an occupational

therapist (OT) or speech language pathologist (SLP).
Our roles vary

according to the treatment setting - hospital, skilled nursing facility,

homes, etc.
Because I work in children's homes and schools, my job is to

assess how the child's oral motors skills, sensory system,

developmental delays, behavior and/or environmental influences are

impacting his/her ability to eat effectively and efficiently.

I develop a treatment plan in collaboration with thefamily and other

team members to address these needs.

The doctor said my baby needs a feeding evaluation. What should I expect?

In a hospital setting, the evaluation may be a team evaluation.
Members of

the team may include the OT and the SLP and perhaps a child psychologist

and/or developmental pediatrician.
Team members vary from setting to

You doctor may have requested a modified barium swallow (a

"swallow study") or the team may recommend that procedure.
Often confused

with the term "feeding evaluation", a swallow study is actually a video

x-ray of your child's swallow and is a medical test to assess the mechanics

of the swallow that are not necessarily detectable with simple face to face


What are the signs that a baby or toddler with reflux needs a feeding evaluation?

The most typical reasons for referring a child for a feeding evaluation include:

Trouble accepting and swallowing a variety of age appropriate food textures

Refusing to eat certain tastes, temperatures or textures of food; being a

"rigid eater"

Refusing all solids

Refusing all liquids

Coughing, watery eyes, grimacing or other signs of discomfort during


Choking, frequent gagging or vomiting

Difficulty with the mechanics of handling food, biting, chewing and/or

swallowing What happens during a feeding therapy session?

As a speech therapist who specializes in feeding, I am often asked what happens during a typical feeding therapy session.
In my experience, very few sessions are alike because no two children are alike.
I try to design the treatment plan according to the family's needs and their interaction style with their child.
There are some families and children who need and prefer a very structured approach and those who would make more rapid progress if their sessions were play-based, and vice-versa.
Over time, I often observe a shift in the family dynamic and the treatment plan is adjusted accordingly, depending on the skill to be addressed.

Whatever the style, the common denominator is FUN

My baby is less than 6 months old. Is she too young for feeding therapy?

No, not if she is having trouble with any age-appropriate feeding skill.

In fact, most Neonatal Intensive Care Units or NICU's have a specialized

team of therapists to teach developmentally supportive care to the

parents with babies in the intensive care nursery.
Feeding skills begin at

day one.

What advice do you have for parents of infants and children with reflux

and feeding challenges?

Keeping the fun in mealtimes is especially important for a child who has suffered from the pain of reflux.
It doesn't take long for a child who is physically uncomfortable during eating to learn "I need to avoid the pain that comes with food...I NEED TO AVOID FOOD."
Even when medical intervention has stopped the pain, this child will need to establish a new, fun and relaxed relationship with food.
I always encourage parents to start with the fun and slowly introduce the food for the purpose of filling tummies.
Fun first, then food, then eating.
So, if that means building a child's confidence and decreasing his fear by playing "pudding car wash" or "seals in spaghettios", then by all means, get everyone in the family to join in!

An experienced therapist will know how to make steady progress in eating skills.
Therapy that moves to slow is frustrating for everyone - the parents, the child and the therapist.
But, whenever possible, try to start with the joy of being together in the presence of food.
Make food time a part of your child's day to look forward to.
It establishes trust and then you can gently follow the therapist's strategies for challenging your little one.

Each therapy session is designed to help your little darling get closer to her goal, step by step, bite by bite.

For more information about Melanie Potock and her book, Happy Mealtimes with Kids
go to:

Jan Gambino
Meet Our Writer
Jan Gambino

Jan wrote for HealthCentral as a patient expert for Acid Reflux.