From Guessing to Growth: How a Clear Framework Transformed My Practice

What would you say to someone who feels really stuck or unsure right now? Like a clinician who's just, oh my gosh, I've taken all the courses, or I just feel so lost when it comes to feed feeding.

One, you're not alone. We've all been there. We have all struggled with imposter syndrome, especially with pediatric feeding. We've all questioned ourselves and our ability to— there are systems in place where you can get the support you need, whether that's through Feed the Peds or through the Pediatric Feeding Hub. There's a seat for you at the table. Whatever table you want that to be, like there's a seat for you here and it'd be fun to get to walk alongside you.

Hi and welcome back to the Untethered Podcast. Today we have Courtney Lewis joining us. Courtney is a pediatric occupational therapist, pediatric feeding specialist, and owner of Nosh Pediatric Feeding Therapy, where her heart is to transform mealtime struggles into a joyful family experience. With over a decade of experience across pediatric home health clinics, hospitals, schools, and virtual platforms, she supports infants routines with pediatric feeding disorders, sensory-based feeding challenges, and oral motor difficulties using a holistic, sensory-informed, play-based approach that fits real family life. As a Feed the Peets graduate and mentor in the Pediatric Feeding Hub, Courtney is passionate about walking alongside clinicians as they build clinical confidence and better serve in their own communities.

Welcome to the Untethered Podcast. I am your host, Hallie Bulkin. I'm a certified myofunctional therapist, feeding specialist, podcaster, business owner, and mentor. This podcast is all about getting your questions answered and collaborating with colleagues to bring you the most up-to-date information in the orofacial myofunctional therapy, airway, tethered oral tissue, and pediatric feeding therapy space. If you're new here, I challenge you to keep an open mind and join my mission to spread this message far and wide. If you've been around since June 2019, thanks for being a loyal listener. As we jump into today's episode, remember to listen with correct oral rest posture— tongue up, Lips closed, teeth apart.

Breathe through your nose.

Let's get started.

Courtney, welcome to the podcast.

Thanks for having me. I'm so excited to be here.

I'm excited for you to be here because I feel like if anyone's ever felt unsure or underprepared in feeding therapy, this is for you. Courtney is a feeding therapist, Feed the Peeps grad, mentor inside the Pediatric Feeding Hub. We're going to talk about all the things. But Courtney, I would love for you to share with everybody how, like, how did you get into pediatric feeding?

Yeah, so I knew I wanted to do pediatric occupational therapy when I went into grad school, but I never envisioned doing pediatric feeding therapy. And I feel like it's one of those things where it just found me. And I feel like every setting I've worked in has led me to where I am today as a clinician and as a pediatric feeding therapist. And so it's been a long and winding road of a journey, but it's been It's been a sweet journey. And yes, they're, you said, underprepared and unsure. And I feel like that is, there's so many clinicians, especially in the feeding world, because as you've chatted with therapist after therapist, we just don't get the training we need as especially pediatric feeding therapy. And so yeah, that's, it chose me is what I feel like happened.

Yeah, I love that. And I feel like this is how so many clinicians start without enough or any training, right? Like you said, we don't get this in grad school, and I think I can count on less than two hands how many grad schools are teaching it now. I got really excited because I actually was asked to come in and speak as an expert in the space at one of my old— in my old grad program. So I think they're finally bringing pediatric feeding in, and so I'll be like a guest lecturer on a panel or something for one class. But I was like, oh my gosh, it's about time you guys finally are bringing a class in. And Funny enough, the person teaching it is a Feed the Peeps grad and was also— we worked with their child. And now I'm like, oh, it's all coming full circle. More of this, please.

Yeah.

Hopefully this conversation will be different a year from now, but I don't know, because I said that back in 2019 and it's now 2026. So here we are. When did you realize— obviously not getting education in grad school is one thing, but like, when did you realize that you really needed more support or training in this space?

Yeah, so as I was preparing for this podcast, I reflected on different seasons, and I couldn't remember where I had this thought process, but as a new grad, I remember I practiced with the mindset of occupational therapy, our job was to get food to the mouth, and speech therapy, their job was to get food from the mouth to the stomach. And so that was the lane I did feeding therapy in. I could get the food to the mouth, but once it was in the mouth, that, that wasn't my responsibility. And it wasn't until we moved to California where I was at a clinic where OT did all the feeding. We did outside and inside the mouth. And so that was super eye-opening for me. And I think that was the catalyst for, I enjoy this and I love learning about this. And I want to learn more. And so we moved back to Texas in 2023, and I knew I wanted to start a pediatric feeding therapy practice, and I knew I wanted something that really met families where they were, where the families that were told, "Just wait and see, they'll grow out of it," or, "It's okay, they'll be fine." I wanted a space where families felt seen and they felt heard and they felt understood. And so the, for the first year I was off the radar. I wasn't publicly announcing to the world that, hey, I have my own business because I just didn't have the confidence. I had worked with feeding clients throughout my whole career, but I, to me, I wanted to be like the perfect feeding therapist. I wanted to make sure I had the foundation and I had the knowledge and I wasn't there yet. And so at the end of 2023, I had a family that was referred to me from a friend and she was 1. She was only breastfeeding. Mom had tried at 4 months, 5 months, 6 months and could not get her to transition and mom's supply was weaning and we were on a time crunch and I saw this family for maybe 10 weeks and by the end when we discharged, she was eating what family was eating. She, it was beautiful and it, that gave me the confidence of I can do this. I have some knowledge, I have some understanding and that then led me to 2024. When I was like, I'm doing this, but I'm gonna take every feeding class to make sure that I have the understanding and I have the foundation. And that's where Be The Peeds came in because I had taken SOS, I had taken Beckman, I had taken other approaches. And so I knew how to do those approaches, but I still felt like I was missing the foundational, the piece, the understanding of what pediatric feeding therapy was. And I definitely was missing the confidence of, can I walk into an evaluation and parents tell me, what's going on, and I know this is what we're gonna do to get there. And I didn't until I took Feed the Peeds.

I love to hear that. Um, but I think it's so tricky because so many people are in your shoes, whether they work for themselves or they work for somebody else. It's— you go, you take the courses, you're like, uh, what's wrong with me? Why don't I get this? And that was my experience. I took courses and I was like, okay, I got this. And then I would be like, no, I got an idea of what to do with this couple kids on my caseload for the next couple sessions, and but then what? And what about the rest of the kids? And I just felt kept like you. I felt like I kept walking away without a really good foundational understanding of, hold on, what am I even working towards? What is, what does typical feeding look like? Like, how far off are we from that? What should they be doing that they're not? Like, how do I determine, okay, the child's not eating, but I don't really understand the why. I don't understand anatomically, is there something going on? I don't understand if there's something more. Is it physical? Is it, are there other medical diagnoses at play that are adding to the complexity? I really was not sure of, like you said, the foundations of the And also, how do I integrate all of this once I do figure it out? And so that's where my brain was like, okay, we have got to change how this is taught. And I think that's the one thing that I will admittedly say I'm very good at, is I can take information and put it into a teachable fashion that works for so many others because I have that neurodivergent brain, that ADHD brain.

That's—

this is how I best learn. So I'm literally doing this for myself. So why— this is how I need it. Let me see if this helps others. Oh, and I realized, oh wow, this does help. A lot of other people to learn it similarly. And honestly had no idea coming into it that it would be that helpful to everybody else. But I was, oh, I guess I have a skill. Okay, let me share this with others because hi, these kids need help and we are all struggling as professionals. Let's get over that hurdle. So I love hearing that. There was a lot of uncertainty. I know for me it felt like I was guessing a lot early on and I had some hard cases that just felt like they weren't progressing and I really needed support and mentorship and I couldn't even find that. And so that, that's another piece. If we can create support around these topics and around cases so that we can better help our patients, in my mind I was like, everybody's gonna wanna help, it's for the kids. And then nobody would even take my money to support me. And I was like, I'm so confused. Like, why is this the way it is? Yeah.

And I remember up until Feed the Peds, I feel like every feeding evaluation I did was chaotic. Because I didn't have a structure. I didn't have, this is the system you follow because there is no standardized assessment. There is no streamlined process for evaluating whatever age child for feeding therapy. And I remember being like, did I do oral motor? Did I do sensory? Did I do positioning? Did I ask about family environment? And I took your Feed the Peds Screener. First, and I remember taking that and feeling like, this is what I've been missing. This is, you presented it and created it in such a way where it was so cohesive and so fluid and it was so easy to take and implement and then carry that over into then Feed the Peds. And your intake forms and evaluations, I think, are the thing I use the most every day because it, to me, a feeding eval finally made sense. And I have taken it and adapted it to then fit my practice, but I've done it in such a way where my intake form builds upon each other and parents can even connect the dots while they're doing the intake form because they see how everything plays an integral part in feeding. And then the very thing, the very last thing I ask about is your child's feeding development because it's all layered. It's all, it all impacts. Our feeding abilities. And so taking that from the intake form and then being able to do it in an evaluation and knowing I'm going top down, I'm not having to guess, I'm not having to question, did I remember to do this? And so that to me is the confidence piece. And then having a framework to be able to go in and assess and evaluate. And like you said, not question, not guess. Do I know how to help this family? Has been such a game changer for me as a pediatric feeding therapist.

I love that. So I feel like so many clinicians, like we were talking about, get stuck in that struggle phase and they're just in that spot of that uncertainty, feeling like they're guessing, the cases feel hard, why is this not progressing? And then I love hearing you went through Feed the Feeds and there was this shift to feeling more confident. And we always tell everyone, we're like, it's the clinical reasoning side of things too. We are trying to create critical thinkers and help you look through a clinical lens so that you understand like why this is happening. If we can figure out the root, can, can we figure that out? And how do we work on this case and ultimately towards the parent's goals, right? What are the parent's goals for the child? Knowing what to do and why. I think that why is missing. I will ask people, what are you doing? Okay. They'll tell me, I'll be like, why are you doing that? Oh, cuz that's what I learned in this course. Not our course, but any given course, right?

Yeah.

Okay. So you don't know why you're doing what you're doing. Got it. Great. What skill are you working towards? I don't know, we're just trying to get them to eat solid foods, or we're trying to— I'm like, okay, what kind of solid food? It's like when you start to probe a little and people start to think, they don't actually have a reason most of the time as to why they're doing what they're doing. They're like, oh, I just saw— and honestly, that was me as a new clinician back in 2009. I get it, I've been there, I pass no judgment. But that was also after I took certain courses, I came out, I was like, okay, great, I got more exercises and strategies and tools in my toolbox, and I'm gonna try all the things and all the kids. And as I'm going through the motions, I'm like, Wait, why am I doing this? Is this actually helping? I don't know. I don't have good data to show that this is actually making a difference. And that's when I was like, okay, I'm sure that there's a rhyme and a reason to this, but nobody's teaching the why behind it. Can we figure that out now? And yeah, so just knowing what to do and why, I feel like that makes such an impact on your sessions and then the patient's outcomes.

Absolutely, absolutely. And also understanding not every approach is for every family. And being mindful of the family's capacity. Does the family have the capacity to do the exercises you're asking them? Does the family have the capacity to do whatever intervention you're suggesting? Because if they don't, you're not gonna get the outcome you're wanting. And so being able to then, I'm gonna use an OT word, grade the activity, to grade all the different layers of the feeding process. In a way where families take it and are able to run with it is such a gift. And I— and Feed the Peeds creates the foundation for that to happen.

I love to hear that. I love to hear that. Okay, so you took it even one step further and now you're a mentor. Now talk to me about that because I know you're obviously a mentor inside of the PEED Feeding Hub. What's it been like being a mentor in there?

It's been so fun. I've always loved mentoring. The next generation, whether it was a new grad or student or CODAs. I think I've always had a teaching side of me, and so the Hub gives me an opportunity to do that under the lens of pediatric feeding therapy. And for me, I love it because I think it's for those clinicians who are second-guessing themselves. It's for the clinicians who are up late Googling What do I do for this client? And it's a space where then they can be seen and heard and they can get the help they need. And all the mentors are super passionate about feeding. We all love helping and we all love giving answers. And there's so much experience in the hub too, from the mentor side and from even the therapists who are in there. And there's so much wisdom and knowledge and I feel like every question that's asked, I'm learning still, just because everyone has so much knowledge to share. And it's been one of the best things I think I've gotten to be a part of in the last year.

Aw, I love that. I love to hear that. And okay, so in your timeline, when did you launch your private practice? Cause I know you said you didn't really advertise feeding in it for a whole year, but like when did you actually launch it?

Yeah, officially 2025.

Okay, amazing. And oh, and your practice is called NOSH, N-O-S-H. And I know you talked about how family is the heart of everything you do. So will you just, will you share a little bit with our listeners? Because there are people sometimes who we talk to who are, oh, I would love to see private clients, but I don't really know what that looks like. Or they have a dream of owning their own business or private practice. And so I just would love everyone to kind of hear from your perspective a little bit, if you wanna share about what it's like to build that practice and promote yourself even in, in this pediatric feeding space. And I'll add one other thing real quick. I was doing a business mentorship call yesterday with someone who's gone through some of our programs and who has her own small private practice and she contracts elsewhere. And I will tell you that, and we talk about this in the 3-day training, the more you learn, the more you start to second-guess yourself too, right? It's like that whole, the less you know, the more you think you know effect, that Dunning-Kruger effect that I talk about in the 3-day training. and it was like so prevalent because I'm like, this person is such a genius, so specialized, so experienced, but still second-guessing themselves. So I'm like, I know that we've all been there, we all can take— we're all human, right? That's normal. So if that ever happened to you, feel free to share that as well.

I think that was all of 2023 and 2024 where I second-guessed myself and felt like I needed to take all these courses to validate that I knew what I was doing as a pediatric feeding therapist. When we came back to Texas again, I knew I wanted to create a practice where I can meet families where they were and working in different settings, getting to work in home health, in a children's hospital, in outpatient clinics. I thrived in the homes. And so I knew I wanted to do that again because for me, I also feel like getting to be at the kitchen table, getting to sit with the families while we're working on feeding. Is such a gift. You're in the mess, you're in the chaos, and you get to slowly make those changes that then help make the chaos less and make mealtimes more joyful. And I was doing a lot of research, writing my vision, my, my core values, and I'd come across a research that was a qualitative study, and it was asking caregivers with children who had feeding disorders. What do you value most working with pediatric feeding therapists? And it was super eye-opening because it wasn't an approach, it wasn't a protocol. It was clinicians who were knowledgeable, it was clinicians who were personable, and it was clinicians who were approachable. And so they wanted a clinician who helps them feel seen and heard and understood, and they wanted a space where they could share their story. And know that they were being listened to and that they were being cared for. I think that study also showed just how much feeding disorders impact families. They shared, like, feeding impacts every facet of life. It impacts birthday parties, school, playdates, dinners, vacations. It's not just this isolated thing that happens 3 times a day. It flows into daily life. And then also that families, yes, they want their child to eat a variety of foods. They want their child to eat the right nutritious foods and the right quantity and amount of foods. But also they just want mealtimes to be that time where they can sit down and connect as a family, where they can talk about their day, where they're not having to worry, is there gonna be a power struggle or is there gonna be a meltdown or are there gonna be tears or Am I going to make this really great food and meal and my child is not going to even touch it? And so going back to the focus of we want mealtimes to be simple and to be joyful and to be stress-free. And then there were two other parts. Having a child with feeding disorders, these families face real barriers. They— it's time, money, resources, energy, a lack of community knowledge, a lack of community awareness. And then that isolation piece of they feel alone, they feel like they're the only family who's experiencing this, which is baffling to me because this is such an epidemic. There are so many kids who struggle with some sort of feeding challenge or feeding disorder, and these parents still feel like they're alone on an island, which just makes me so sad as a feeding therapist because we know it's so prevalent and it's only becoming more and more prevalent in our society. Um, and then the last thing was that again, they just really want therapists who are in their corner. Um, and they want therapists who listen to them.

And to that point, and I love that you highlighted that because I— a lot of clinicians will say to me, oh my gosh, it comes so natural to you. How did you— they don't even say how do you connect with the families, but how do you get the families that just keep coming back? How do you make progress? For one, I have no agenda, right? When they first come in, sometimes I don't even look at the intake. I look enough to kind of know what the main concern is, but I wanna sit and talk and find out where we're going and why we're here and what is it you're seeking my help with. Because if I start reading that intake before I even meet the person, I'm like, I have preconceived notions of what they're coming in for and that already starts to set my wheels in motion as to like how I'm gonna approach them, what we're gonna it's almost— and most people won't do this, but I had a really great grad supervisor who— and this was for fluency, and I only ever did one fluency evaluation, and I think treated one fluency patient. I was the only one at my university that did not go through an official fluency program. And so I'm like, I just will never work with those cases because one, I didn't have the experience. Two, it just wasn't what lit my world up, like feeding and myo and all this other stuff. There's plenty of other specialists for that. So I remember though, right? So I'm totally uncomfortable because first feeding eval ever. I've got all my questions prepped. I've typed them all out. They're on a clipboard. I got space to write. I'm grad school ready, right? I am like, we are going in. I got this. And my supervisor, she's, oh, can I see your questions? And like, we're sitting pre-meeting before I go in and I'm like, yeah, sure. So I hand them to her and she goes, okay, go. And I was like, can I have my questions back? She's like, no, you're gonna walk in. With a 16-year-old boy who is disfluent with a clipboard and you're gonna start writing things down? She was like, how do you think that's gonna go? You think you're gonna get natural responses? And I was like, good point. And what do I do? What do I say? I don't know. You've got this. You prepped all the things. I went in, it was fantastic, but it also, I had an oh crap moment. I was like, ah, what do I do? And I just feel that that was how I felt before every session I was going into. Right, with some of these cases. And so I think it really helps to have more experience and to be honest when you're new to something and to have mentorship to guide you. But right, all the things. But I just feel like that, as that clinician who felt newer at the time, one of the biggest things was like never feeling prepared, but also actually being overprepared to the point where it created preconceived notions about what I was walking into. And when I was able to drop that and just walk in and be present fully present for that human, that child, and their caregivers, everything changed because all of a sudden I was like totally in tune.

Absolutely.

Yeah, it was like, oh, okay, hi, hi, how are you? Okay. And I would get down and I would play with the child while I started talking with the caregiver, and I would just model back whatever, imitate what the child was doing, especially those kids who are not looking at you at first and like a little standoffish. And they're like, oh, she's doing what I'm doing, let me let— I'm gonna let her enter my world a little more, right? And within a few minutes, all of a sudden we're playing they're interacting whether they have language or not. And now I've got a parent who's already got their guard down because they're like, oh my gosh, you've connected with my child and now you're connecting with me, right? And so I always like to remind people, like what you were saying, human first. Put the human first. No matter what you've been trained on, what you think you know, none of that matters until you know why they are there and whether they trust you. Building that rapport should be goal number one, and then you go from there, right? And I tell parents this in the first sessions. I'd say, listen, we're gonna get spend time getting to know each other, so it's not going to look super clinical at first. We will get into that, but if I don't get your child's trust, we're not gonna— we're not gonna have any success. And so if you just— people are like, parents are going to pay for that. Yes, they do, when you tell them exactly what to expect up front, right? So such an important thing you highlighted. I don't know if you want to add anything to that, but I just think— and then asking the parents outright, what are your goals? Why are you here? How can I help you? Those words, if that's all you ask in an evaluation session while you watch and observe and take notes and whatever else you want to do, fine. I'm telling you, that goes so far.

It does, it does. And I think also continuing to ask, because I can think of a family that I'm working with right now that they came to me because she didn't eat— she, she avoided certain textures, and they wanted to work on increasing variety. And I've only been working with her for 10 sessions, so 5, 6 weeks. It hasn't been very long, but the other day I asked, how was your weekend? And mom said she's been doing really good in our controlled environment at home. We've set up the safe space for her to eat. She has a box under her feet because she's super petite and can't touch the ground. And we have positioning. We've been working on oral motor because she was not chewing before she swallowed. And, but that was something mom and dad didn't— they hadn't noticed, or they hadn't connected that dot. That's impacting variety. And so in a controlled environment, she was doing great. But this family, they love to go eat brunch on Saturdays. They love then to go and be able to explore, whether it's shopping or doing an activity or whatever. And she isn't at the spot yet where she can handle that uncontrolled environment of eating out. And for me, that, that was the bigger picture. That's the goal we're working on. That's the goal that we want to achieve. And I'm going to take all these little pieces in that we need for that to happen. And I'm going to do it in a way where it feels easy for you to replicate. It feels easy for you to do. And I was even chatting with them yesterday because I feel like the advice I've given them, the recommendations, I'm able to do it in such a way that it seems so simple and so insignificant. But if you look back where we were 6 weeks ago, she wasn't sitting down for mealtime. She was running around. She wasn't chewing before she swallowed. And so we've been able to make all this progress because I'm also giving the families small little tangible things to work on that isn't overwhelming, that they can incorporate into their everyday meal or their everyday routine. And it just feels easy for them and it gives them a path to take. Whereas before they were so unsure of what do we even do to get her to eat variety? And so Dad mentioned, he goes, we're still not eating different things. And I said, no, but we haven't been working on that. But we're laying the foundation so then when we get there, she's going to be way more competent and way more able to take on the challenge of those harder textures or those no foods that she wasn't able to do 6 weeks ago.

I love that. I love that. It really just brings it all back to the family's goals, right? It's really why are they here? How can we support them? If you're not paying attention to your families and you want to know why you're losing patients, like why they're not coming back or they're not completing your program or staying through the end of what you would consider ready for discharge, That's why. That is most likely why, right? So I really love that you highlighted that. Now, the one other thing we haven't talked about is growing up as the picky eater. Um, you've got some lived experiences, so if you're okay sharing that with us, I would love for everyone to kind of understand like your experiences, how that shaped you into who you are today. Because I know we all have our stories, and it's not that often that I talk to somebody on here that says that it's like them or their lived experience as a picky eater specifically. So Tell us more.

Yeah, I was the capital T-H-E picky eater of the family, and I feel like it's an identity that I still wear in my family, which I feel like isn't 100% fair because I've done a lot of work. And my husband and I joke that every session I do is I'm also giving myself feeding therapy and giving myself the tools and resources I need to not be a picky eater. And so I would say I'm more selective now than I am picky. Picky, but I did. I grew up being the child who was the picky eater, being the teenager, the college student, the young professional. And even today, like, I'm the pediatric feeding therapist who is the picky eater. And I think that gives me such a unique perspective because obviously not every child is a picky eater for the same reason. We all have different underlying roots of what leads us to be that, but I'm able to share my experience with families and give them words and understanding that their child is unable to give. And I think that brings such valuable insights. And I think it's also really interesting because, again, talking to mom and dad, what were your feeding preferences like as a child or as an adult? And going back to the family that I'm working with, they really wanted her, the daughter, to eat oatmeal. And mom piped up and she goes, but I didn't eat oatmeal till college. And so by sharing my experience, it opens the door then for parents to be, oh, I also have some food preferences that maybe I've unintentionally passed down to my child, or maybe that we don't eat veggies as much as we think we do, and— but we're expecting our little one to eat all the veggies. And so it's been So sweet to be able to share that with families and to be able to understand how that plays such a valuable role in what I do as a pediatric feeding therapist.

Amazing. So good. I think whenever you can also connect with your patients like that on a very personal level, like I know for me it was more about having a child who had feeding struggles, right? And just having, and I'm not saying that everyone's obviously not gonna have that or have what you explained, But if you can personalize it, if you can connect with families on something that they feel like, oh my gosh, you get it, right? It goes so far, so much further. Because like you said in the very beginning of all this, you were like, these families just want to be seen. They want to feel heard. They want to know. I've had parents, moms mostly, cry in my office because they're like, you're the first person who's listened to me. You're the first person who believes what I was saying. You're the first person who seems to understand or is willing to help us. And it makes me so sad for these parents because they're not making this up. Their children are struggling, and that means they're struggling because we know that what happens— you're the OT here— but if the child's dysregulated, the parents dysregulate it and vice versa. It works both directions, right? And so a dysregulated child is not going to feed well, right? Um, and I know you shared a light bulb. Yeah, well, that you recommend to your families. I'm like over here about to Google it and order something. So tell me more about the regulation light bulb. Yes. Yeah.

Before I get to that, I think also something that I realized that I even do this as an adult now, the parents have shared that they look at the menu before they go out to eat to make sure there's something their child will eat at the restaurant they're going. I do that even now as an adult where if we're going out with friends and it's a place I've never been, I'm looking at that menu before we do that because I want to know Is there something on the menu that I feel safe enough to eat? And, and so I think being able to connect all those pieces to help the families understand, again, they're not alone in this.

They—

this is something that so many people struggle with and there's support for it, which leads me then, yeah, to the regulation piece. So Chick-fil-A last year did a year-end review. Points, and you could see how many points you accumulated throughout the year. And I accumulated 44,000 points, and which I Googled, and it wasn't as much as my husband made me believe, but I posted it on Instagram joking, I have a problem. And so many friends were like, you need help. But behind the scenes, for me, it was such a lightbulb moment because for me, Chick-fil-A is my comfort food. It's my safe food. And to me, that number was a reflection of how dysregulated I was around mealtimes in 2025. And it could be something as simple as I was having a good day and something happened and I was dysregulated. And so I would go get Chick-fil-A to help regulate me. And I don't have sensory processing issues. I don't have underlying medical issues. I don't have any learning differences. And so for me, an adult who— I'm an OT, I live in the regulation world all day. I help others with their coping strategies and techniques. And for me, that was such, yeah, just a lightbulb moment of I'm coping with Chick-fil-A. And so I need one to have better coping strategies and techniques, but then also it doesn't matter what positioning look like. It doesn't matter how beautiful your oral motor skills are or if you're giving foods that your child ate yesterday, if they are dysregulated, nothing's going to matter. That regulation piece is the foundational piece for feeding because with— if you're not regulated, your body's telling you that you're in fight or flight, that you're in height— you're heightened, you're not safe, even if that's not true. But that's what their nervous system is telling their body. And so they're not going to be in their window, their threshold of being able to then sit down and eat food the way they're supposed to. And so it makes so much sense then why kids who struggle with feeding want the same foods over and over again, because it's safe, it's familiar, it's something that they can tolerate while they're dysregu— And, and I know for me, I have a really sweet friend and I will eat whatever she cooks, no questions asked. And my husband asks 'Why do you eat what she cooks, but you don't eat what I cook?' And I was reflecting on it, and it's because her home is so warm and inviting. She is a warm hug of a person, and I feel so regulated when I'm with her. And so I don't care what she puts on my plate, I'll eat it, even if it's something I've never tried before. And so that to me just again validates how key and how instrumental regulation is for all of these kids that we're working with.

Yeah, that's such a cool story and example of how important regulation is. And like how we were having this conversation last night because my one daughter, like when she eats— and by the way, I totally thought you were going to tell us about some cool light bulb, like one more moment. So with either— some people are like, oh, you want no blue light at night and have red lights by your house, the lights, these red films. And I was like, is there new data around this? What do I need to know? Anyway, so that was really funny.

No, it's just my lived experience of being a Chick-fil-A addict.

So when I was like, CFA 44,000, I was like looking it up. I'm like, no, I can't find anything. I actually Googled it and I was like, I'm just going to ask her. We'll talk about it. Now it makes sense. That's really funny. So my oldest, who was one who struggled, as you learned in a 3-day training, she likes to stand up when she eats. She will have a knee on her chair, but she'll be standing. Otherwise she would like to move around. She's humming, singing. She just would probably be that kid who works really well in, like, and as an adult, like, really well in a cafe, right, with that background music and noise. Whereas for me, it's so distracting, and I'm so distracted by all the people moving around me, and like, I need my quiet spaces, right, to be regulated. So it's so funny too, because as I've lived through having her and then my second one and me, and then there's my husband, it's like everybody has different needs for when it even— what it means to even become regulated. And I'm like, okay, we're no longer in this moment of, oh my gosh, she doesn't eat anything, or oh my gosh, feeding is a struggle. She's 10 and a half, she's more exploratory at this point. And I'm over here, I never really cared about her sitting or not sitting. I'm like, you want to put your knee on the chair and have one leg on the floor like you're eating? Cool, we're good. But I've just noticed that sometimes we play music at dinner, or I was getting this whole Human Design thing, which is a whole nother conversation for another day, but she was like, oh yeah, your child would also do really well. People say don't eat in front of the TV, some kids do really well with the TV on because it actually calms her nervous system. And just having that background noise, even if she's not directly watching it, and it was like, that is so interesting, you are so spot on. I feel like she's— but she's like, but you can achieve the same thing through some background music. And I was like, okay. Kid walks around humming, singing all the time, and I'm like the kind of person who again needs that silence. I'm like, shh, I'm trying to focus, I'm trying to work. But meanwhile, she's just regulating her way through life, right? And so it's just— it's very interesting when you start to take a step back and look at how people go through life. And what you were talking about with like Chip, you kind of step into doing things that automatically regulate you without even recognizing the frequency in which you do them, or that you're even really doing it as much as you might be doing it at all. It's— I love that you share that because I'm like, that's literally what I was like yesterday having this conversation. I was just like, okay, we'll put on more background noise at dinner and I'll let her continue to move around, and she's eating great, I'm happy. But I think it also speaks to some parents who are like, I just want them to sit down at the table.

I don't—

I'm like, raising is one thing, but then needing to move or needing to be positioned a certain way, that's a whole nother. And so I was like, I feel like we break people's brains when we go, hey, it's not always the way that the textbook says it should be.

Anyways, and I think you bring up such a good piece also of that regulation for the child doesn't always look the same for regulation for the parent. And so even then, there's that other layer of we can get the child regulated, but we also need to look at mom and dad and help them figure out what regulates them, because like you said, you prefer a quiet environment, but your little one prefers some background noise. And so we don't want you being dysregulated at meal times either, because that's not good for anyone. And so finding that, that sweet spot where everyone feels like they're regulated at the table, knowing that we all have different thresholds and knowing that we all have different things that regulate us in different ways. And I feel like that's something that you don't get always when you're in the clinic because families come in, you're in this controlled environment, you're meeting your goals, and then the family's going home, but you're not able to see what that really looks like. And that, again, that's my preference. That's where I thrive and why I enjoy being in the home so much because I'm able to see what that really looks like and I'm able to see Can we make one or two little small changes that really change the whole mealtime experience for everyone?

Yeah, I love that. I love that because I have found that we can play certain music that doesn't dysregulate me and that she's very regulated, and I feel like everyone's just at ease and calm at the table. And so I'm like, it works, right? But it's like you said, we have to kind of figure out what's that happy middle point for everybody. Okay, this has been so amazing, and you're welcome to share anything else you want, but what would say to someone who feels really stuck or unsure right now, like a, a clinician who's just, oh my gosh, I've taken all the courses, or I just feel so lost when it comes to PEEP feeding?

Yeah. One, you're not alone. We've all been there. We have all struggled with imposter syndrome, especially with pediatric feeding. We've all questioned ourselves and our ability, and I think 2, there are systems in place where you can get the support you need, whether that's through Feed the Peds or through the Pediatric Feeding Hub. Both— Feed the Peds offers the framework in which I do everything for, and then the Hub is just the place where you get to come and ask those hard questions. And there are some really hard questions. There's one therapist I feel so bad for. She has one complicated case after another complicated case, and she's still coming weekly with her questions. And so there's your— there's a seat for you at the table, whatever table you want that to be. Like, there's a seat for you here. And we would— yeah, it'd be fun to get to walk alongside you.

Courtney, thank you so much for sharing all of your beautiful advice as well as your journey from picky eater to helping these kiddos and everything in between. And I think it's just to reinforce what you said, you don't have to figure this out alone, right? There is the— and one thing you said earlier too is these parents feel like they're on an island by themselves. But I know us as therapists too, we've said you don't have to feel like you're alone. We feel like we're on dysphagia island, and none of that has to be true, right? There are places now in our communities especially where you are not alone. You are— you can get off dysphagia island, come join us in. We've got a community of feeding therapists all doing the work, but then also as therapists we can also work together to help our families feel like they're not alone either. And I think that's such beautiful work that comes out of what feels like such hard work that we're doing, that's the easy work. That's the stuff that you can just reinforce, hey, I'm here, I'm here to help you. Let's figure this out together. Even if I don't know everything, I want to figure this out with you. Families are not used to hearing that these days. Medicine doesn't really traditionally operate that way. And so if you can be that light for these families, I just, I feel like that you've given us so much of that in that advice today and just shown us through your own lived experience as a private practice owner and as a mentor like how it can be. So thank you so much for that because I think that this is just phenomenal. Now depending on when you guys listen to this, we do have some really exciting things coming down the pike. I'm not going to announce it live on this episode, but again, if you listen to this prior to summer 2026, it's not out yet, but coming soon. We want to invite you into the Pediatric Feeding Hub if you do want that mentorship though, and/or Feed the Teeds right now. We'd love to have you in there as well if you're like, just, I need some guidance around pediatric feeding and I really want the foundational understanding and I want to know the why behind what I'm doing and I want to feel like I can treatment plan and start treating my patients. That is Feed the Peeds. And then the hub is really for mentorship when you're treating. So yes, thank you, Courtney, for sharing that. And we welcome everybody to join us in there. But keep your eyes and ears peeled because we have some fun things coming down the pike and it's really more around creating. We've got a big mission that I think we're all going to embark on together and it's a big collective. And so we're going to we're going to be screaming it from the rooftops. If you follow me, you'll know about it. But I'm really excited because it just, it continues. My goal is to continue to elevate our patients and all of you, the mentors, the clinicians, everybody, because that at the end of the day, that's what moves the needle forward. And that's the best way that we can all go and help our patients and really feel good about the work we're doing. So I love having people like Courtney, like you in our circle, because you're just, you're helping us with that mission. And again, it just all goes back to the therapists and the kids. And so thank you for all the work that you're doing with us and that you do out in the world for all of these kiddos and their families.

Thank you for having me today. I really appreciate it.

Thank you for joining me. And for those of you who want to look her up, NOSH— and we'll link your everything below the episode— but NOSH is H, right? Is the name of your private practice?

Yes. NOSH Feeding is the website, noshfeeding.com, or on all social media it's NOSH N-O-S-H, Feeding.

Amazing. All right, that's Courtney. So go check her out and come and join us inside Feed the Peeds and the Feeding Hub. All right, Courtney, thank you so much.

Thank you. Have a good day.

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