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

Stop Chasing Symptoms in Feeding Therapy!

4 Sept 2026 · 1 min

Watch on YouTube

1:07

In this segment Hallie Bulkin warns clinicians against the common trap of "symptom chasing" in feeding therapy—treating observable behaviors like gagging, refusal, or pocketing as the primary target. She explains that these symptoms are signals of underlying issues such as skill deficits, sensory processing challenges, pacing problems, texture intolerance, fear, airway discomfort, tethered oral tissue, reduced oral awareness, inefficient chewing, fatigue, limited tongue movement, or oversized bites. Rather than focusing solely on eliminating the behavior, Bulkin urges therapists to ask, "What is this behavior showing me?" This shift reframes the symptom as communication, guiding a more nuanced assessment and treatment plan that addresses the root causes.

Chapters

A structured approach also protects you from one of the easiest traps in feeding therapy, which is chasing the symptom, my friends. The child gags, so we target gagging. The child refuses, so we target refusal. The child pockets food, so we cue them to clear the pocket. But the symptom, that's just information. It's not always the place to begin. Gagging may be related to skill or sensory processing or pacing or texture, fear, airway discomfort, tethered oral tissue, or a combination of factors. Okay, refusal may be communication. Pocketing might reflect reduced awareness. Maybe there's inefficient chewing or fatigue. Maybe there's just like limited tongue movement happening. Maybe they're taking oversized bites, which a lot of our kids do when they feel like they can't manage a smaller bite. It seems so counterintuitive, but here we are, right? It's what they do, especially with tethered oral tissues. Or maybe they've tried to eat a food that they're not ready to manage, and so they pocket it, right? When we only try to make the symptom disappear. We can miss what the symptom is actually trying to communicate to us, right? So instead of asking, how do I stop this behavior? I want you to ask, what is this behavior showing me? That one question can change the entire direction of a session.