Pediatric Feeding Therapy 101: Signs, Strategies & What Every Clinician Needs to Know

One of the big goals of feeding therapy is to improve a child's relationship with food, and so we want to ultimately, if we can, prevent any aversions.

That's always a huge goal in feeding therapy, but the new question isn't like, should I learn MYO? It's how soon and how can I integrate it into my feeding practice? What's usually missing isn't information, right? It's feedback while decisions are being made.

Okay friends, so I wanted to dive into Feeding Therapy 101 today. And feeding can be like— and swallowing, right? It can be such a complex topic, but I want to just break it down into some very simple bite-sized digestible little nuggets. Maybe get yourself a snack, sit back, relax, and let's talk about feeding therapy. So what is feeding therapy? Let's just understand it very basically, right? It's basically when you have an individualized program that is designed based on the patient in front of you. If we're talking about pediatric, we're talking about birth to 21. A lot of the times over here, I'm even more hyper-focused on birth to 5 and even birth to 3, because that's typically when we develop a lot of our basic skills. And so sometimes when we have challenges present themselves related to eating, feeding, swallowing, this is where we really need to have a good grasp on what feeding therapy is, what happens in it. First, we need to understand that these challenges can stem different medical issues going on. Maybe there's something sensory happening. Maybe there may be some behavior, but I will tell you behaviors are usually the root of something else. Ultimately, there's maybe something developmental or something that's just kind of going awry that needs to be addressed to help the child get back on track and/or develop skills that they either have never had or maybe they had and they lost, right? One of the big goals of feeding therapy is to improve a child's relationship with food. And so we want to ultimately, if we can, prevent any aversions. That's always a huge goal in feeding therapy. But if the aversions are already present, then we're going to want to address those, right? And aversions are any difficulties surrounding the relationship with food. We want to promote healthier eating habits, but first we have to make sure that we build rapport with the patient and then the patient starts to trust us so they know we're never going to ask them to do anything that might be detrimental to nervous system, really. And so it is really important that in order to understand it deeper, we dive into continuing education and/or we seek guidance, mentorship from other professionals like speech-language pathologists who are in the feeding space, maybe an occupational therapist, feeding specialists in general. There's even some PTs that are highly specialized in feeding. It's less common than the SLPs and OTs, but I want to plug that in there. What are some signs that we might want to look for? I want to go over some signs that might signal the need for feeding therapy, what our role is as feeding therapists, and the importance of early intervention. And that's all we're going to really dive into today. Signs that may signal the need for feeding therapy with one of our patients— sometimes these patients are already on our caseload— there could be picky eating that is going to become really— they're going to become very, very significantly or severely limited in the number of foods that they will accept or eat or be around. And so it's no longer really picky feeding at that point. Then it becomes sort of like a problem, right? Because now we have an issue where the child is refusing so much and it's stressful for everybody. We're worried they're not getting proper nutrition. The child just keeps cutting more and more foods out, right? And we tend to get parents who will panic around the time that kids maybe cut out foods to the point of having only 20 foods they'll accept. We definitely get parents giving us calls when they're down to 10 foods. Parents are in absolute utter chaos once their child is down to 5 foods. That's been our experience. Now, some parents are obviously going to be calm, cool, and collected throughout it all, and that's great. They have a very in-check nervous system. But oftentimes the calls that we get are because parents are like, ah, we're down to 10 or 5 foods and we need help. We don't know what to do anymore. What do we do? We come in and we evaluate, right? But some other signs that may signal a need for feeding therapy include if there's difficulty swallowing, if they are gagging a lot. It's not just like a gag on initial introduction to a food for a first time and then they're okay thereafter. It's like repeated gagging, it becomes an issue. It's interfering with feeding, or if there's actually choking episodes and it happens more than once, that choking is never good. The big difference between gagging and choking, just to clarify here, gagging is when we're trying to protect our airway. And so the body starts to try and push the food out because it fears that that food or that liquid is going to go enter the airway. It's going to go into our trachea instead of our esophagus.

And so we start to A gag is almost like a—

sometimes people will say, oh my gosh, they're gonna throw up. Well, it's a way we're trying to expel that food, right? We're trying to protect the airway. We can still breathe, we can still make noise. However, that's a big difference between gagging versus choking, where with choking the airway becomes blocked, it is now obstructed, we cannot make any noises, the skin color will tend to change, you might become more bluish or purplish because of the depleted oxygen, right? And so we cannot breathe, and that is true choking. So we'll get a lot of families to say, oh, my kid chokes a lot, We need to clarify what that looks like. We need to educate, but I always like to say to parents, okay, can you tell me what happens? Like, what are the noises they're making? Are they not making any noises? Does the color of their skin change? Are they vomiting? What else is happening during this time? Are you having to do a Heimlich on them? Have you had to use one of those tools to expel the food out of their throat? What does this look like, right? Difficulty with swallowing, gagging, or choking during meals. If there's just an absolute outright refusal to try new foods, extreme reactions to certain textures or flavors. And that could be them crying. It could be them pushing the food on the floor. It could be them throwing up. It could be a gag when the food has come nowhere near them, right? There's all different kinds of reactions when touching certain textures or experiencing certain flavors, even temperatures sometimes. So something to be aware of. And then mealtime battles, when there is stress or anxiety or both for the child, for you as the caregiver or the therapist, right? That usually tells us we need to intervene or we need to assess to see what's going on, right? Let's talk about the role of feeding therapists because now we know kind of what to look for, and obviously there's many other signs and symptoms, but those are some general ones that really can be very obvious if you sit down and have a snack with kids on your caseload. And here I am talking to you therapists, you've got these kids on your caseload already who probably need help you may not be aware. Have a snack with them this week. Have the teacher provide it, the parent provide it, you don't have to provide the snack because, hi, we live in a world where there's all kinds of challenges when When it comes to allergies, I always like the parent to either approve the snack or to send the snack in, or the school, if we're going into a school, they'll provide it. So the role of a feeding therapist, basically as feeding therapists, we assess, we can screen, right? But then we can assess, fully assess a child's feeding and swallowing abilities. We then identify our concerns, areas either for further assessment and/or when we're doing our assessment, we recognize that there are some problems we want to address. From there, we can create a treatment plan, a personalized, individualized treatment plan to address these, these issues, right? We set goals and we address them in therapy. We intervene. So when we do this, we also work closely with the family to develop strategies that are going to be successful for the child when working with us and when the parents are implementing them at home. So it needs to be very tailored to that family, and feeding therapy looks very different from one patient to the next. We want the parents to be able, or the caregivers to be able to support progress at home, and so we need to work with them to develop strategies that they can actually carry over and that are realistic for their schedule, for their home life, culturally, and so on and so forth, right? And then as a feeding therapist, our role is to figure out basically what tools in our toolbox, what range of techniques are we going to include in our intervention. Maybe we're using some form of oral motor exercises, sensory integration. Sometimes there may be behavior modification depending on the child and the situation. To basically help shape positive eating experiences and let the child know, again, you're safe with me, you're safe with this food. I will never make you do anything. Your parents will never make you do anything. Your caregivers, right, will never make you do anything that makes you uncomfortable. We might stretch you a little bit, but we're never going to do anything that will hurt you, right? And so we have to figure out what tools in our toolbox will help us make that progress while keeping the child safe and helping them know that they're safe and allowing them to continue to feel So that is a big role of ours. I like to follow the child's lead and they will communicate a whole lot to you if you're listening and you're just paying attention.

All right.

And then the importance of early intervention. I can't record this without at least talking about that, especially because I tend to focus a lot on the birth to 5 population, but the earlier the better, right? Early identification and intervention significantly improves a child's relationship with food and can prevent longer-term feeding difficulties. Now, is it too late if your child is older? Absolutely not. I will just be completely honest, it may be a little more challenging. It may take a little bit longer and it may not, right? It just depends. Sometimes we say there's more layers to the onion. The older you get, like the snowball snowballs bigger. And so as we have to peel back more layers around things, sometimes it's just we have to massage it a little bit differently, right? It takes a little bit longer, but it's absolutely possible. The sooner a child does receive support, the better the chances are of helping them develop healthy eating habits, really just helping them to enjoy mealtime, like have a positive mealtime experience and have that continue more long-term. So the one last thing I really want to say is that parents and caregivers play a really critical role in observing and addressing feeding concerns in their children and seeking professional help when needed. So it is also our job to educate them early and often so they can help recognize when something is going on and then help get their child the services that they need. So feeding therapy obviously is a very vital resource for families that require them and for children that require them. And so I just wanted to kind of hit home on the basics of feeding therapy, what it looks like taking the initial steps towards assessing, treating, what we're looking for in children who are really overtly needing these interventions, and just really highlighting that we want to help the child have it, the caregiver, the family unit really have a positive relationship with food and have a nervous system that's in check, right?

If you've been in pediatric feeding for any length of time, you've probably noticed things are shifting fast from new research on oral function and airway development to the growing emphasis on collaboration across disciplines, which I think I've been preaching for the past 5 years. Let's start with what the latest research and clinical trends are showing. Okay. And how they're reshaping our work as feeding therapists. So there's probably, let's see, 5 different areas I want to go over. And the first one is oral function became the foundation. 2025 has become the year of, or became the year of, function-first thinking, right? The best clinicians are no longer treating symptoms, they're identifying root causes in tongue mobility, in jaw stability, and oral motor coordination. Research highlighted this year how oral function impacts not just feeding, but we now are seeing what we've already known, but now it's published, right? It impacts speech, airway development, and even sleep. And more professionals are learning to screen for tethered oral tissues and oral facial dysfunction as part of a full functional assessment. Yeah, that excites me. So even if ASHA, our national organization, cannot seem to bring forward talks and presentations on topics like myofunctional therapy, we still as a collective whole have really made a lot of strides this year with bringing oral function forward as a foundation, having a lot— I've seen so many more conversations around that. So yay! The feeding pyramid, right, that got a redesign. So we've moved from working on isolated skills like spoon or cup drills to full system integration. Okay, and yeah, we still obviously address those things, but 2025 really solidified that stability drives mobility, meaning we can't separate the trunk from the jaw from the tongue, right? The function of all these systems, these areas, from our overall posture and breathing. And so functional feeding approaches now prioritize regulation leading to, you know, posture to respiration to oral motor control of leading with the focus really, you know, building efficient movers, not compensators, if you will. Because if you know anything about me, I don't believe in teaching compensation. I believe in undoing compensation so that we can get fully functional or function to the best of our ability. Okay, collaboration became the expectation for many. I know it's not for everybody yet, but it's— and it's maybe not happening everywhere, but 2025 normalized collaboration across feeding and myo and airway and bodywork disciplines. And so I'm seeing pediatric feeding therapists working hand in hand with more ENTs, more dentists, orthodontists, lactation consultants, PTs, OTs for more integrated care. And this is where I'm really happy and excited to see the future of medicine continue to move. The era of one provider does all or fixes all, that is over. Families now are educated. Families became very educated in the past couple years, but especially this year, and now they expect a team-based approach that looks at the whole system. All right, number 4. So, myo exploded. We have seen a major rise in understanding how orofacial myofunctional principles support feeding therapy, whether it's, you know, from infant tongue elevation to chewing coordination. And I know we don't do myo with the little ones, but in my program I do teach how people who are properly licensed—SLPs, OTs, PTs—you can address this in pediatric feeding therapy, right? So from infant tongue elevation to chewing coordination, the feeding-myo overlap, it's there. It's— we can't deny it. So that's why I teach how we adapt it in Feed the Peets. But here's the thing, the new question isn't like, should I learn myo? It's how soon and how can I integrate it into my feeding practice? AI and technology entered the chat, my friends. So 2025 was the first year that therapists really dove in and started using AI tools to help analyze patterns, write notes, guide parent education. But the key lesson here is that AI can support, not replace, clinical reasoning. And so the clinicians who are leveraging it ethically to streamline, right, not to substitute, are gaining massive time freedom while improving quality of care. And this is something that we're teaching inside our programs because it's so important. It's so, so important. All right. So these are like some of the key updates that I've seen as far as like research goes and practice updates and everything in 2025. So number 1, the rise of specialists. The days of being a generalist who also does feeding are fading fast. I am seeing parents seek out experts, seek out feeding therapists who understand complex feeding issues, tethered oral tissues, airway issues, oral motor development. Number 2, mentorship over webinars. So therapists— and I think this has been going on for a while— but therapists, y'all are done with surface-level CEUs, right? 2025 really proved that mentorship, support, and case-based learning actually moves the needle clinically. All right, and families now expect education, right? Parents are showing up informed, my friends. They're not always accurately informed because it depends where they're getting their information from. You know, they're learning from TikTok, Instagram, Google, but they're coming in with solid questions, right? Questions about ties, transitioning to solids, airway, etc. So clinicians who know how to educate confidently and correct misinformation without judgment are the ones who are building trust faster than ever and fill in their caseloads even in a down economy. Let me, all right. And so, you know, the last piece here that I wanna highlight as far as like the trends that I've seen in the field is that airway is a new frontier, my friends. We've been waiting for this day. I don't think we're completely there, but we're getting there more so every single day. Airway and feeding are inseparable. So clinicians are finally screening for breathing patterns, mouth posture, sleep symptoms as part of feeding assessments. Yay, feed the feeds. This shift is positioning feeding therapists as key players in early airway intervention, right? That, my friends, is a massive opportunity for having massive impact. Okay. All right. So I wanna move on to my predictions for 2026. Okay. So let's spend a few minutes just talking about where all of this is headed in the next year because I have some strong predictions for 2026. Function first becomes industry standard. Come on guys, work with me here, right? The focus on true functional assessment, not appearance, not isolated skills, but functional assessment is going to define best practice in 2026, right? So I want you to expect more frameworks like our functional diagnosis model. I want things like that to be adopted by feeding and myoclinicians alike, right? And the question again should be shifting from what exercise should I use to What function am I restoring? And then we have muscle-informed exercises that we use, which is what I teach in the Myo Method. Feeding and myo converge, right? The integration will no longer be optional. It'll be essential. Therapists who understand both systems, systems like oral motor, orofacial function, will be the leading care teams. Measurable outcomes matter. 2026 will be the year of data in private practice, right? I believe clinics should be tracking like time to progress, carryover, success metrics, and using that to market their impacts. Because I think so many of you that I have coached, I've mentored, are not realizing the positive impact that you have on your patients and how much quicker when you are properly trained, your patients often will move through therapy. And so that is something that needs to be highlighted, right? This shift will help to elevate the entire field, honestly, because we want to drive everybody to be a little bit more evidence-driven, you know, and we want to be a more medically recognized profession. We, we talk about these things. So I do think that, you know, this could be one way that we got there. Have you ever noticed this? Two feeding therapists, same child, same diagnosis, same family goals, and yet very different outcomes. One therapist sees steady functional progress that actually carries over into real life, and the other feels like therapy is— like they're in therapy working harder than they should, right? What's confusing is this, right? Both clinicians are experienced, they both care deeply, they've taken continuing education, they're doing thoughtful work. So why does pediatric feeding therapy still feel more complex than it needs to be? And why do some clinicians eventually lead feeding cases while others stay stuck executing plans that just never quite feel done or straightforward, right? That's what we're unpacking today. All right, so we're diving into why two feeding therapists can treat the same child and get completely different results, right? So let me describe a situation that many of you know. We've got a toddler or a young child who presents with limited food acceptance, gagging, texture avoidance, heightened stress meals, all the things, right? We've got two therapists that evaluate the child, okay? And this is just like a hypothetical situation, but you might start to see yourself in this, so pay attention. They both identify oral motor challenges, right? Both consider the sensory responses. Both are intervening, they're coaching parents, they're adjusting the environment. On paper, the plan looks solid. This happens in early intervention, right? This happens in outpatient clinics. It happens in hospital-based programs, in NICU-adjacent feeding work, right? Different settings, same pattern. But over time, the outcomes diverge. One therapist sees changes that generalize beyond the sessions, and the other sees effort without the same level of functional carryover. And this distinction matters, my friends, not because one clinician is better, but because something deeper is shaping the work. So if you're someone who is practicing, maybe you've been practicing for a while, this probably feels familiar. And let me be clear about something. This does not point to a lack of knowledge, okay? It doesn't mean that you need more tools. It doesn't mean feeding isn't your area. Most clinicians that I talk to are actually very capable, more capable than they give themselves credit for most of the time. What's usually missing isn't information. Right? It's feedback while decisions are being made, not after the case is over, not in isolation. I know a lot of us joke that we kind of live on Dysphagia Island, right? No more Dysphagia Island, no more isolation, right? But unfortunately, that is the reality for so many of us. And it's also not through trial and error at 10 PM at night while you're wrapping up your documentation, right? It's that real-time clinical reasoning support from someone who understands feeding deeply on a real deep level, right? Most clinicians, most of us were trained in pieces of feeding. We were given this puzzle piece and that puzzle piece, and we're all trying to put the puzzle pieces together, right? Very few of us were actually trained in an integrated way of thinking, especially through those complexities that appear with many of our pediatric feeding patients and their cases, right? And so here is what actually separates these two therapists that I'm talking about. They're organizing information differently. One therapist is focusing primarily on observable skills. The other is identifying the primary system that's driving the feeding pattern. What is the primary system? What is the primary driver that is leading to what we are seeing? Big difference. And that distinction really changes everything because pediatric feeding is rarely an isolated event, right? It's motor, sensory, medical, structure, regulatory, developmental, right? These are all systems, if you will, okay? When these systems are not clearly prioritized, therapy becomes broader than it needs to be. We have more goals, we have more strategies, more moving parts, and Here's the thing, most continuing education does a really great job of teaching us theory and sometimes techniques, but it rarely teaches us how to sequence our decisions, prioritize the systems, justify why you start with something first over something else, right? It rarely teaches us how to lead with a feeding plan across providers and settings. And so there's actually a lot of efficiency that's lost, in a sense, for lack of a better term. And that is a difference, my friends, between treating feeding and being trusted to design feeding programs, lead NICU discussions, get into the NICU if that's what you desire, right? Or build services that others rely on. And I want to stop and pause here for a second, and we'll dive deeper into this. But I want to pause here for a second because you've probably heard, if you follow me for a while, you've probably heard me talk about dysphagia island and working in isolation and how we're kind of expected to do that as feeding therapists and like, no more, right? But also treating, you've probably heard me talk about assessing and treating in silos, right? And you know, if you think of a silo and not my area of expertise, but think of a farm and they've got those cylinder-shaped silos that holds like the grains, for example, and it's meant to contain them so they stay dry, right? So it's isolating it and keeping it away from the other elements and the other things because it's trying to create a container in which to protect that individual thing. Unfortunately, and so when we say treating in silos, assessing in silos, that's what we're talking about. So hopefully that gives you that visual of that like container, that, that silo, that cylinder that's holding like one individual thing and trying to keep it away from everything else. We cannot approach assessment and treatment with patients in a siloed fashion, but unfortunately that is how the medical system works today, right? Oh, we think you have this problem, go see this specialist. This specialist goes, nope, I think it's that, go see that specialist. And like before you know it, you've been passed around to different specialists and you still have zero answers. Nothing has changed. I know as adults, many of us have experienced this in our lifetime. And so let's not do that to these kids. Right? And I know this is highly dictated by the insurance system, and we're not getting into that today. That's not why I'm talking about this, but that's the reality. And so we have to figure out how to work with these children and take a more systemic, integrated approach, not a siloed approach, because that's really what they need. That is what they need, okay? And we need structure as clinicians. We need to use clinical clinical reasoning that is structured, because when clinical reasoning is not structured, there is a real cost. It might be subtle, but it's there, and this is what it shows up as, right? Longer treatment times than maybe you're anticipating. And I know every parent asks, and we're like, we don't have a crystal ball, and we don't. We don't know usually how long treatment is going to take for an individual. However, if you've worked with a number of individuals, you have an idea of maybe how long it takes for a kiddo to go through. Now, there's always variables, because we're working with humans and everybody's case is different. But if you're like, this is, this is going longer than it should, like we should have accomplished certain things by now, right? Is something else going on or is it a systems problem? Right? So if there's longer treatment times than expected, the timeline's just kind of going and going, right? Maybe the cases feel heavier than maybe their diagnosis would suggest or their presentation when they first came to you and you haven't unleashed or established anything beyond what you knew was going on in the beginning, difficulty explaining your decisions that you're making and your recommendations to families or teams. Maybe your interventions work, but they're not as efficient as they could be. They're not as straightforward, effective, right, as they could be. And so for many clinicians, this is the cost of working without structure, and it shows up again. It shows up as documentation is spilling into nights and weekends. Maybe because you're still trying to justify your own plan. And that's, it's not a motivation thing. It's not a motivation issue, right? It's what happens when highly skilled clinicians like yourself are working without a shared framework or mentorship. And so what I want to remind you all of is that pediatric feeding requires an organized way of thinking.

And here's the thing, most of us were never formally taught that.

I can guarantee that most of you listening, unless you're one of our CPFTs or you've gone through maybe Feed the Peeds, you were never formally taught how to think in an organized way to approach your pediatric feeding patients. So experienced clinicians, right, eventually reach a point where growth isn't about learning more. Like, yes, we are going to still need our intermediate to advanced CEUs, and we want to learn more, and we're lifelong learners, and that's really important. But the growth that we're seeking as therapists is not necessarily just simply about learning more. It's about refining what we know, maybe filling some holes, right, in our knowledge. But also clarifying how we analyze cases, strengthening how we prioritize drivers, leading feeding plans with intention instead of just accumulation, right, of more, more, more, more, more. And this is the shift from treating feeding cases to directing them.

Quick disclaimer: all information, content, and material of this podcast are the opinions of the speakers and is for the informational purpose only and not intended serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified healthcare provider.

That wraps up today's special compilation. My goal with these episodes is to bring together the conversations and the insights that are truly moving the needle in our field right now. Next, whether you're a parent looking for answers or a clinician looking to sharpen your skills, remember that the most important tool you have is your own clinical reasoning. Don't just look at the surface level symptoms, look at the underlying systems. If today's episode shifted your perspective or gave you a new aha moment, I would love to hear about it.

Take a screenshot of you listening, post it to your stories, and tag me @HallieBulkin.

You can always find more resources and past episodes over at untetheredpodcast.com. Thanks for tuning in, and I'll see you back here next week on The Untethered Podcast.