The Pediatric Feeding Therapy Roadmap: Tools for Clinical Clarity

And so here's 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. If a 3-year-old is still munching, right, straight up and down, up and down, up and down, or they're pocketing food in their cheeks, That, my friends, is a sign that we need to intervene. It means the system has not fully matured and it's time for a feeding evaluation. 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 like, 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. So let me describe a situation that many of you know well. We've got a toddler or a young child who presents with limited food acceptance, gagging, texture avoidance, heightened stress at 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, you know, intervening. They're coaching parents or 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. Like I know a lot of us joke that we kind of live on this 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? Instead, it's that real-time clinical reasoning support from someone who understands feeding deeply, like on a real deep level, right? Most clinicians, most of us were trained in pieces of feeding. Like, 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's 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. Let me say that again. One therapist is focusing primarily on the observable skills, those skills that we can see with the naked eye, right? This table, you know, they're out there on the table for everyone to see, versus the other is really trying to identify the root cause. 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? And 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 you know, 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? Why this first? Or lead, you know, 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 the 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 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 hold 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, that's what we're talking about. So hopefully I give 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 reasoning that, you know, 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 who have an idea of you know, on average, 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 going longer than it should, like, we should have accomplished certain things by now, right? Hmm. 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. Maybe there's difficulty explaining your decisions that you're making and your recommendations to families or teams. And maybe, you know, 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 like documentation is spilling into nights and weekends, maybe because you're still trying to justify your own plan. 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 wanna 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 were never, unless you're one of our CPFTs where 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 gonna 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 this shift from treating feeding cases to directing them. This is the work that I have spent years now, years. I won't tell you how many years, at least 16, building inside of the work that I do on a daily basis. And I brought this into my Elevation Movement, which I didn't even know what this was when I first started my Feed the Peeds course, right? I was like, I know clinicians need information, but they don't just need information. They need mentorship. They need to refine their skills, right? They need that skillset, but also refinement of that. and we need an identity shift into whatever it is we desire, whatever it is that we desire. And right now, from the conversations that I'm having with individuals who want to get certified in pediatric feeding, that identity shift for many of them is into like clinical leadership, business owner, program developer at their work, bringing in like a pediatric feeding program where they work, or in their own practice, right? NICU therapist, like getting into the NICU, right? There's certain identity shifts that they desire in the clinical leadership path. And so I want to highlight that because I didn't set out to go, oh, I'm gonna, I'm gonna create this whole little thing. No, I just realized that these were the things that were like integrated into everything we were teaching because it's what I desired in my own career, and it's what I built for myself, and it's what I brought forward to you all along with many other brilliant minds who are educating and mentoring in our programs. And so here's the thing, like, if this is resonating with you This is what this signals. You're not looking for more techniques. I think many of us are trained to be like, we just need more, I need more treatment ideas, I need more techniques, give me some of this, give me some of that, I'll take a little bit of that, put it in my toolbox. Like, cool, but that's probably not the primary thing you're looking for right now. You're probably looking for precision, consistency, clinical alignment, right? And this is why when we were begged to create a certification by many of our graduates, We were like, okay, how do we do this, right? And it was several years in the making, and now we're going into year 3.

Can you believe that?

And we're going through accreditation, which is exciting, and it's going to take several years to go through that process as well to become an accredited certification— or to, I should say, we are already a CEU provider, but to have a certification that is accredited by an outside certification agency. Anywho, the Certified Pediatric Feeding Therapist, or CPFT, pathway exists for clinicians who are really ready to stop piecing feeding together and start leading it. So whether your goal is seeing private patients on your own terms, launching or expanding a feeding program, whether that's in your own business or in the practice that you work in, the hospital that you work in, whatever it may be, because we've helped individuals do all of that. Maybe you want to step into NICU-level work. Maybe you want to refine your role as a feeding specialist wherever you are. I'm talking to, like, right now, I think I spoke to handful of early intervention SLPs, private practice owners, and a couple individuals that are in certain outpatient hospital settings but want to also get into the inpatient and NICU. And so the pathway that we've created builds the clinical reasoning, the mentorship, and the professional support you need to get there. And one of the most unexpected outcomes that clinicians share with us is that they find they're feeding people. And that gives me goosebumps because, hi, these are the people that think the same way as you. They're the ones that you get to continue— you're connected to them during certification, but you also get to remain connected to them after if you so choose. And so these are the people that you can text when you have a hard case and you want to just check in. Hey, this is what I'm doing. This is what I think. Or, you know, am I missing anything? What are your thoughts? Right? These are the people that you grow alongside. Okay. And so if you're listening to this before March 6th, applications are currently open. And it's not because something is missing. This is because your experience is ready to be consolidated and elevated and applied with clarity. And so seasoned clinicians recognize when it's time to move from competent execution to confident, efficient clinical leadership. And now let me tell you, if you're still not feeling competent, we have many individuals who came in who are maybe a little bit newer to the field than others, and they were not feeling so competent. So You know, they also gained that competent execution and at the same time shifted to being more confident. And some of them stepped into leadership positions or filled their private practice schedules because now they're the specialist or the certified specialist in their area, right? And so here's the thing, if this landed, trust that, trust what you're feeling, trust what you're hearing. Okay. Trust, trust your gut. Let's talk about the one milestone that changes everything in feeding, but somehow No one teaches it in grad school, and many people seem to be missing it in their courses as well. What is it?

Chewing!

Most clinicians can tell you when a baby should babble or when they should crawl, but if you ask them when like that rotary chew should emerge, crickets. Absolute crickets. So today we're going to dive into the 4 stages of chewing development, how they connect to feeding milestones, what to look for clinically, and when we should start to get concerned. So let's first talk about like why chewing development even matters, because chewing isn't just about eating solid food, right? It's about function, airway development, and it's going to build strength, tongue control, coordination for speech and swallowing and breathing. And when we miss this window, we often see kids who can't manage textures. They might gag easily, they may rely on soft chews for a really long time, too long arguably.

And so I just want to highlight a couple things for you, right?

So the first thing I want to highlight is that chewing drives orofacial and airway growth. It is essential for proper jaw and palate development, right? We have delayed chewing, right? That leads to delayed oral motor maturity and potentially a feeding aversion. And so our chewing milestones that we're gonna talk about soon, help us gauge our readiness for solids, straw drinking, and eventually even like the speech sounds we should be expecting. You can't build that circular rotary chew pattern on a weak, unstable base. The base for me being like the jaw, okay? And the muscles that support the jaw. Stability drives mobility here. So if you've ever wondered like why your toddler or the kid that you're working with still is mashing food with their tongue, right? They're putting food between the tongue and the palate and they're just mash, mash, mash. I'm moving the wrong side. Mash, mash, mash, mash, mashing, right? This episode is gonna help you connect the dots. I wanna break down the progression of the 4 stages of chewing development from the early like munches to that full rotary chew, because I see too often that people go for the full rotary chew and I'm like, wait, wait, hold on a second. Like we forgot about all the other necessary milestones and skills that we need to develop that chew. We can't just go from not having it to having it. We gotta to, you know, there's a couple phases, a couple things happen in between. So number one is a basic bite reflex that is present in the first about 6 months of life. And it's a reflexive vertical jaw movement, like an up and down jaw movement. There's no voluntary chewing yet, right? So it's reflexive. The breast or bottle nipple goes in and that jaw is moving up and down and the tongue should be in doing that suck, swallow, breathe pattern. But we're gonna focus on chewing. So ignore that, that suck, swallow, breathe for a moment. So if you were to go in and like put your finger on the baby's gum, you might stimulate it. They might kind of close their, you know, jaw lightly. They're not going to clench down necessarily, but it's that reflexive movement that starts up and down, up and down, up and down. You're watching me keep moving the wrong palate. I mean to move the bottom one, the mandible. So this is typically seen as well when babies are learning to mouth toys, early teethers, you know, they're exploring intraorally. And this is really important because it helps to strengthen the jaw and prime the oral musculature for what's to come. Right. So you're going to see those up and down movements only. There's not going to be any lateral side-to-side motion yet. And clinically, this sets the stage for the munching phase. And so it just looks like, like I said, up, down, up, down, almost like chomping, if you will. This is a really good time to introduce, you know, meltables, dissolvable solids for safe practice and things. But, you know, depending on who you talk to, it's also a really good time to give baby you know, maybe give them a big— as we introduce texture through foods that are not just liquid, right? So the vertical munching pattern between 6 to 9 months where that jaw, you know, that's the first voluntary chew pattern. It's just that simple open and close of the jaw, up, down, up, down, right? And it's really common as babies begin purees, you know, to soft solids, even for babies following like a modified baby-led weaning program or baby-led weaning where they may be biting on hard things, you know, with supervision. Again, you're going to get that up and down jaw movement pattern, and arguably it's really good when you have those harder things for the jaw development, but we don't have to go there. So the tongue is going to stay mostly midline at this point with not— we're not going to see that side-to-side movement. Some people are giving, you know, steak bones, like the big ones. You're not going to break— the baby's not going to break a piece off of under supervision, or steak on a bone, or a hard carrot, or a hard piece of celery, something the baby's not going to break anything off of, but you're going to supervise just in case. Because it is really, really beneficial for jaw development and the masseter development and all those surrounding muscles to have this experience when the baby is voluntarily chewing up and down, up and down, up and down. But again, depends who you talk to. Okay, the diagonal chew pattern is next. That's number 3, right? So first was our basic bite reflex, second is our vertical munch pattern, and third is our diagonal chew pattern, and then fourth we finally get to the rotary chew. So for the diagonal chew, number 3, right, this is usually about 9 to 15 months or so. The jaw begins to move diagonally. Okay, so tongue actually starts to shift food from side to side, but it's usually staying more to one side. And this is like where true chewing starts to emerge, because the baby's going to use a lateral tongue motion and move this food over to the molars or to the teeth or to the gums. And then they're going to also bring their jaw over and up to the midline— down, over, up to midline— but we're not crossing the yet. Okay, that's why it's just like diagonal down, across, and up and around, right? Up but not around yet. So some people might start here with like softer fruits and veggies, small bites of pasta or meatballs to kind of play with this and have them have good success in this stage, or even just like little pieces of cut up like cubed chicken or steak or something that's a little more chewy. Clinically, right, this is a phase where some kids get stuck if they're not exposed properly. If they kind of, they might stay in the vertical and not actually move into, sorry, Yes, they may get stuck before they enter this stage is what I meant to say. They may get stuck in the vertical chew, the last stage we talked about, that munch, that up and down munching pattern, and they may not actually move into that diagonal coordination, that, you know, diagonal chew pattern. So a lot of the kids that we see typically are stuck in that munch chew pattern. Okay, just so you're, just so you're aware. Now, number 4 is that rotary chew pattern that we start to see between 15 to 36 months. Big range, but like by 3 years of age, they should have mastered that circular rotary chew, that mature chewing pattern where the jaw moves in a very clear circular. And if you're on YouTube, you can see this, a very clear, you know, food goes in, they might move it to one side, chew, chew, or moving it around. We're chewing or moving it around the tongue, right? And where the jaw is crossing this line here and moving in what looks like almost a circle one way or the other. And so what's happening here is that the tongue and the jaw are working in sync to break down tougher foods. More efficiently, and the child can chew on both sides. They can move the bolus around. The bolus again is just the chewed up food mixed with saliva. They can manage mixed textures, and this stage supports advanced feeding skills, right? And at this point, you're probably gonna have a more, you know, start to have clearer articulation closer to 3 than you did at 2, for example, right? You're not completely clear at 3. It's usually about 75% intelligible, but as your oral motor skills advance, So do your other skills, like your speech sound development skills. So if a 3-year-old is still munching, right, straight up and down, up and down, up and down, or they're pocketing food in their cheeks, that, my friends, is a sign that we need to intervene. It means the system has not fully matured and it's time for a feeding evaluation. So I like to run through that because like there's so much confusion around the 4 stages of chewing development. And so hopefully that phasic bite reflex into a vertical munch pattern into a diagonal chew pattern into the rotary chew pattern, hopefully that helps to kind of break that down and make that really, really clear. But here's what— here's where most therapists then, you know, and even parents miss the connection. Okay, the bottle to solid transition is really a chewing transition. The jaw and the tongue, right, they need stability before they can handle new textures. And so that's why, like, prolonged bottle use can actually delay chewing. Babies who never learn efficient suck-swallow-breathe patterns also tend to struggle to coordinate two swallow, breathe pattern. And early introduction of appropriate textures around 6 months, depending on like readiness cues, is going to help promote jaw and tongue dissociation. I kind of spoke about that a little bit. So what I want you to clinically watch for here is if there's like, there's no tongue lateralization past 10 to 12 months, they're relying on, you know, mouthing foods in the front and just kind of like munching. There's persistent gagging at times or even choking on lumpy textures. Usually it's more of a gagging than it is a choking. Fatiguing while eating or pocketing food, right? These are not picky eaters. These are the kids who have missed key oral motor milestones, and a lot of them might be flagged as picky eaters by their parents because they become picky as to which food they'll accept because of these things that we need to be watching for clinically, right? These skills that they just haven't developed. Is that always the case? No, this is the case a lot of the times in the kids that, that we see. And so the good news is that you can address this through functional feeding therapy, right? I wanna talk really quick again. I just wanna like review the age expectations and any red flags to look for. Okay, so let's talk about what's typical again and when to go deeper. And so age milestones really quickly, 0 to 6 months, that's when we want that reflexive bite. Okay, I'm kind of reviewing here. 6 to 9 months is when we want that voluntary vertical chew, a vertical munch, right? That chewing pattern. Then at 9 to 15 months, we want the diagonal chew to develop. And then around 15 to 36 months, the rotary chew should be established.

Okay?

And so if you're not seeing the following things that I'm going to share with you, these are signs that we need to look into this further. So what are those signs? No munching by 8 to 9 months. They're still vertical chewing only past 16 months, right? They've got that up and down chewy pattern only, and they're now 16 months old. They're gagging or choking with solids beyond the early learning phase, like they're no longer new to them, right? And most often, again, like I said, gagging is gonna be more common. Choking will be less common. Choking is like face is turning blue.

They can't breathe.

They can't, they're not audible. They can't make any noise because they literally cannot breathe. Their airway is completely blocked. Versus gagging is where they start to become a little like, you know, you'll hear them. It's audible. They don't like what's happening. Something's triggering their gag reflex. Maybe the food comes back out. That's a bit more common. And so I like to kind of highlight the difference. If the tongue is thrusting out, like pushing food out repeatedly, persistently, if there's difficulty transitioning textures or they're only chewing on one side, that's a big one. And then if mouth is open when they're chewing or they don't have a great lip seal, that's another thing too. Okay. Because these signs are all telling us that there's a breakdown in strength, in stability, or in coordination, or all of the above. And so it's our job to go in there as feeding therapists and figure out like where that breakdown lives. Like what is the root cause of all of this, right? I recently had a 2.5-year-old that I was looking at who could really only manage crackers and pouches, no proteins, no mixed textures. And when he was assessed, He had really good speech clarity actually at 2.5, but no rotary chew. Everything was that vertical, you know, and it wasn't even really the munch. He was actually mashing the food between his tongue and his palate. And within a few sessions of like targeted functional chewing work, think like food play, lateralization, jaw greening, he's starting to actually like manage ground meats and soft veggies a little bit easier to manage than like your grilled meats, right? And the secret wasn't sensory. It was motor. It was motor. Now you can't really separate sensory from motor, right? I always, I believe both are at play most of the time. However, there was a big motor component here, and that's why understanding the chewing progression changes everything about how you assess and how you treat. So next time you see a child who's stuck on soft textures or they're pocketing food, I want you to look behind you know, beyond that behavior that's surface level and ask like, what's happening with their chew pattern?

Are they vertical, diagonal, or rotary?

And if you want to see like real video examples of these chew stages and like learn how to assess them clinically, I got you. Because we've been— we were asked by so many students in the past to like just have more examples of this. So we have them inside Feed the Feeds.

Most of us were taught to watch the child eat. And then decide what's going on. But in the real world, especially with little ones, you might not even get to see them eat, especially for a screening. That's a little tricky, right? And that is why I teach my students that, like, your intake form— which obviously on a screening you don't have a full-blown intake form, but you can always maybe have a checklist or something parents can fill out even just for a screening—

but for an eval, your intake form is not just paperwork.

It's actually the first layer of your complete evaluation. And so that's what I wanna break down because what you ask on your intake can change a whole lot for you. And so I'm gonna give you 3 questions that you can ask today that will reveal red flags pretty quickly. And I know people don't love that word red flags, but I use it because we all, y'all know what I'm talking about when I say that, right? So let's just grin and bear it.

Okay.

Okay. So number 1, what position does your child eat in at home? Most people don't realize— when I say people, I mean like you and I, therapists, SLP, OTs, feeding therapists don't realize, and parents, right? Especially in everyday people, it's just don't realize that posture, our posture can impact everything from breathing to safe swallowing. Like if you have ever taken anything that I have done, or maybe you've hung around an OT who you've heard say this, but like we always say, what we see on the hips, we see on the lips because that posturing of the pelvis. Is it tilted anteriorly, posteriorly? Like, are they sitting on the edge of their seat and slouching back? Are they sitting really forward and pushing their chest forward? Like, how are they falling to one side? What is their positioning? What is their core strength? What are the hips doing? Because what we see on the hips, we see on the lips. And those lips, what's going on in the mouth, is going to be directly tied to what we see happening on the body. Okay, that's what I mean by that. So that's number 1. What position does a child eat in at home?

Okay.

Number 2, how long does mealtime usually take? If a toddler is taking like 45 or more minutes to eat, that's a clinical clue right there. That's not just a parenting style. So pay attention to that. Number 3, are there any sounds that you hear when your child is eating or drinking, right? Noisy breathing, gulping, coughing. Like these could be overlooked airway red flags. And so when you start listening to what parents are actually telling you, you'll uncover motor sensory and even structural concerns without needing to see the child take a single bite. So this is a short and sweet episode today because I wanted to bring you some like really helpful, like quick wins in an episode. And so this is just like a boom, like, hey, that was really cool. Let me add that and start to ask about these things. Because as you dive in, I talked about like the positioning, but like the length of the mealtime, why would that be happening? Well, maybe the child's having some sensory oral motor struggles. Maybe they're having a hard time breaking the food down. It's very fatiguing for them. Maybe they don't like what they're eating and there's some avoidance in there. Maybe they are not actually feeling hunger cues and they're not super hungry and they're not super motivated. Maybe their sensory system's overwhelmed. Like, there could be so many different things going on, but like, the fact that this child is still sitting and eating after 45 minutes, that's— that is a clue right there. Like, that's not— 20 minutes is usually a pretty good time, and that's a long time for even some toddlers, okay? And then as far as the sounds go, I mentioned like those sounds of when a child's eating and drinking, if there's noisy breathing, gulping, coughing, whatever, like Those are airway, those are airway hints. And so we're going to dive deeper into this, like I was saying, but I want to wrap this up in a pretty bow for you, even though this is like a super short episode today. If you only take away one thing from this super short episode, I want it to be this: a great feeding evaluation starts before the child ever enters the room. Okay. And so if you know what to ask, you can get 80% of the information that you need just from the intake. And then once you see them eat and you ask some follow-up questions, you get the rest of the information you need.

Okay.

Quick disclaimer: all information, content, and material of this podcast are the opinions of the speakers and serves as informational purposes only and not intended to 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 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.