Three Practical Tips on Getting Started as a Feeding Therapist

Embarking on a journey as a pediatric feeding therapist can be both exciting and daunting. With the right tools and mindset, you can make a significant impact on the lives of children and their families. Here are three practical tips to help you get started as a feeding therapist.

1. Know Your Scope of Practice in Feeding

As an occupational therapy practitioner interested in becoming a feeding therapist, understanding your scope of practice is crucial. Sometimes other professionals, therapists that work in other settings or even pediatricians may not know what occupational therapy practitioners can do in feeding, and that’s ok! But we need to be prepared to answer questions for ourselves and others if we are going to keep this potential roadblock away from affecting our confidence. Here is on of my favorite resources to explain or education on the scope of practice in feeding for OTs and OTAs.

The Occupational Therapy Practice Framework 4th edition (OTPF-4) provides a comprehensive guide to our profession. According to the OTPF, feeding, eating, and swallowing are integral components of two of the eight primary occupations that define our field: Activities of Daily Living (ADLs) .

Eating and Swallowing: Eating can be understood as everything that happens within the oral cavity to accept foods and liquids into the mouth and prepare them for swallowing. This includes the performance skills such as sensory and motor components of coordinating movements in our lips, tongue and cheeks to lick, chew, suck, etc. Swallowing is the coordination of bringing prepared foods or liquids as they exit the mouth safely to the stomach.

Feeding: Feeding encompasses all the tasks that make up bringing foods from our plate to out mouth or liquids from our cup to our mouth. This includes things like scooping foods onto a spoon or fork, or raising a cup to your lips for example.

Understanding how the work we do in feeding therapy is clearly covered in the OTPF-4 helps you know your role and responsibilities as an OT practitioner in feeding therapy. It is essential to stay within your scope, adhere to ethical guidelines, and participate where we are needed to support our clients in their occupational needs, which sometimes means helping others understand what we do!

Check out the OTFF-4 at:

Occupational Therapy Practice Framework: Domain and Process—Fourth Edition

The American Journal of Occupational Therapy, 2020, Vol. 74(Supplement_2), 7412410010p1–7412410010p87. https://doi.org/10.5014/ajot.2020.74S2001

2. Use the Pediatric Feeding Framework

The Pediatric Feeding Framework is an invaluable tool for ensuring your evaluations and interventions are comprehensive and effective. This framework helps organize your approach, ensuring that you consider all relevant factors in a child’s feeding development both in evaluation and interventions for feeding therapy. It is easy to make missteps in feeding therapy when we are only considering part of the picture and the Pediatric Feeding Framework helps us avoid that by encouraging a comprehensive take on feeding! Here are all the sections that are ideally represented when providing holistic feeding support:

• Sensory: What are the child’s sensory responses to different food smells, textures, temperatures, and tastes. What are their broader sensory processing needs? (Often the sensory patterns we see in the whole body are replicated in the mouth).

• Behavior: What foods does the child eat? How do they interact with different eating and drinking opportunities in their routine? How do their parents respond to their child’s behaviors related to eating, drinking and swallowing? Is the behavior explained by oral motor skill differences? Has the child ever experienced adverse oral experiences that explain behaviors (NICU stay, NG tube, severe allergies, forced dental hygiene, etc)?

• Culture: Consider the child’s daily routines and how they impact feeding. Do they eat at the table, on the couch, at the bar? Do they eat alone or with others? Do they use utensils to eat? What type of cup or plate do they use at meals? How often do they eat / drink during the day / night? Are they able to participate in the cultural routines of their family, home or school?

• Posture: Is the child able to roll, sit unsupported, stand, walk, run, jump? Do they have head / neck control and symmetry? Do they lean, prop or complain of fatigue when holding a sitting or standing position? What type of chair do they sit in at the table? Are their feet, hips and shoulders supported well? (Feeding skills rely on postural control).

• Safety: Assess the child’s ability to eat, drink, and swallow safely. This includes checking for red flags of choking and aspiration. Are they chewing foods before they swallow? Do they swallow quietly? Do they cough or clear during or after eating / drinking? Do they loose liquids from the the edge of their mouth? Are they being presented with foods and liquids in a manner that is safe compared to their abilities? What is their medical history and how might this impact feeding?

• Oral Motor : Assess the tone, range of motion, strength, coordination, and endurance of the facial and oral muscles.

  • PASSIVE evaluation / intervention: How far do the lips, cheeks and tongue stretch when you move them passively? Is there high or low tone in the face and mouth? Are there any tethered tissues (tongue, lip or cheek ties) that are restricting movement? What do the muscles of their face and mouth feel like? Are they symmetrical from left to right and top to bottom? Are there any other structural differences impacting feeding (for example: high palate, overbite, etc)?

  • ACTIVE evaluation / intervention: How far do the lips, cheeks and tongue go when the child moves them actively? Are they able to coordinate smooth movements? Can they isolate just one part of their face- for example move their tongue without moving their jaw? How much strength and endurance do they demonstrate in each muscle group? Are there any retained oral reflexes impacting movement patterns (for example: suckle foods instead of chew)? Are there any compensatory movement patterns when movements are attempted (for example: bite on the tip of a straw instead of seal with lips)?

  • FUNCTIONAL evaluation / intervention: Watch how the child eats, drinks. chews, swallows, coordinates breathing, spitting, blowing etc. How many times do they chew their food before they swallow? What pattern do they use to chew foods? Where do they place the food in their mouth? Can they coordinate moving their tongue to control a bolus? How do they drink from a cup? straw? Do they seal their lips when drinking? How many sips can they drink before coordinating a breath? Are they able to breath through their nose or mouth? Do they have wet breath sounds when they swallow?

Download a copy of the Pediatric Feeding Framework here! https://circleeducationpeds.com/

3. Focus on What You Do Know

As a new feeding therapist, it’s easy to feel overwhelmed by the complexities of feeding therapy. Instead, focus on applying the foundational skills you already possess as an OT practitioner. There are tons of skills that every OT or OTA was exposed to in our educational curriculums that easily apply to feeding and will help you avail overwhelm! Think through what you do know and how it could potentially apply to feeding and then build on that foundation!

Do you remember the following skills from OT or OTA school?

• Manual Muscle Testing (MMT). Could you us the concepts of MMT to assess the strength of the oral muscles? Understanding how musch muscle strength a child has in various parts of their face can guide your interventions to improve specific deficits.

• Passive and Active Range of Motion (ROM). Could you apply PROM, AROM, and AAROM principles to evaluate and enhance the movement of the cheeks, lips, and tongue when eating / drinking? Evaluating range of motion can be helpful in identifying key deficits. Exercises that target deficits in range of motion can improve a child’s ability to manipulate food and liquids in their mouth effectively.

• Home Exercise Plans (HEP). Could you design HEPs that include targeted exercises to promote strength, endurance, and coordination of oral motor exercises, sensory activities, and mealtime routines. Consistency in practicing exercises that target key deficits at home can significantly impact a child’s progress.

• Activity Analysis. Could you use activity analysis to break down the tasks involved in chewing, drinking, swallowing, etc? Once broken down into a list of performance skills you can identify what the key deficits are and then center intervention around the client specific reasons that this specific client is needing support. This helps identify the specific areas where the child struggles and allows you to tailor your interventions accordingly. For example, analyzing the steps involved in drinking from a cup can help you create targeted exercises to improve lip closure and tongue movement.

  By leveraging these basic skills, you can build confidence in your practice and provide effective interventions for your clients. It gives you a starting place right out of the gate as a new feeding therapist and helps you remember that you know more than you realize and have more to give than you might be thinking of for the little clients who need you most.

Becoming a successful pediatric feeding therapist involves understanding your scope of practice, utilizing comprehensive frameworks like the Pediatric Feeding Framework, and applying your foundational OT skills to feeding therapy. By focusing on what you know and continuously seeking to expand your knowledge, you can make a meaningful difference in the lives of children and their families.

Happy Eating!