Hallie BulkinAsk HallieAI:Your On-Demand Mentor in Pediatric Feeding & Myo

Months of stalled progress? You're missing the root cause

10 Jun 2026 · 1 min

Watch on YouTube

0:50

In this brief clinical vignette, Hallie Bulkin describes a 3‑year‑old who was referred for feeding therapy due to picky eating, slow feeding, and gagging. After four months of standard oral sensory‑motor interventions with little improvement, Hallie observed chronic mouth breathing, a high‑narrow palate, forward head posture, and elevated shoulders. A basic airway screen indicated significant obstruction, leading her to conclude that the child required an ENT evaluation rather than continued feeding therapy alone. The segment emphasizes that while therapy was not harmful, it failed to address the underlying airway issue, underscoring the need for interdisciplinary assessment when feeding progress stalls.

Chapters

3-year-old come in to our practice last month for feeding therapy. Mom reported picky eating, slow feeding, some gagging. Pretty classic feeding referral, right? They have been working on oral sensory motor skills, desensitization, texture progression for 4 months with minimal progress. And when I took a look at this kid, the first thing that I noticed was mouth breathing. Chronic mouth breathing. And then I looked at the palate. High, narrow, really constricted, right? There was a forward head posture, there were elevated shoulders. My team and I actually did the basic airway screen. It was obvious this kid had significant obstruction. This child has been in feeding therapy when the child actually really needed an ENT appointment. Now, did the therapy hurt the child? No, but it wasn't addressing the root cause.