Who Should Do Feeding Therapy: SLP, OT, or PT?

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 tube feeding.

One, you're not alone. We've all been there. We have all struggled with imposter syndrome, especially with pediatric feeding.

You coach the parent to take the pressure off. None of those things are automatically wrong. Like, let's be clear about that. The problem is that they're not a plan until you know why you're choosing them. And that is where I see clinicians get stuck. They have the tools, but they don't yet have a process for deciding which tool belongs in this case with this child at this point in time, right? And when we don't have that process, every difficult session can start to feel personal. We think, why is this not working? Am I missing something? Do I need a different activity? But feeding is a complex motor, sensory, physiologic, relational, and learned experience, my friends. Mouth matters, obviously. The jaw, the lips, the tongue, chewing, bolus control, swallowing, these things all matter, but the mouth is not floating around by itself. The child has to be able to breathe, remain supported enough to use their mouth efficiently, stay regulated enough to interact with food, and tolerate what happens after they swallow. And we have to remember they bring past experiences, medical history, family dynamics, hunger patterns, sensory preferences, and learned protective responses. These things all come to the table with them. So when we reduce a feeding concern to they just need more exposure, or we need to strengthen the tongue, we may be naming one piece without understanding the whole story. That is why 2 children can look similar on paper and still need completely different plans, right? 2 children may both refuse meat. One may not have the chewing skill or endurance for it. Another might be overwhelmed by the texture, or they're avoiding it because eating's been uncomfortable, you know, and maybe even another has learned that meals are stressful. So refusal begins before the food even reaches the plate, before they even know it's gonna be served to them. Same symptom, different story. That is the part we were not always taught to slow down and find. One of the biggest gaps I see in feeding evaluations is that we collect information, but we don't always know how to connect We collect it, but we need to connect it. For hundreds of episodes, we have talked about the connections between feeding, speech, airway, oral function, sensory regulation, posture, movement, and the nervous system. Not because every child has a problem in every system or because we need to become every kind of provider. This is because feeding does not happen in a silo.

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 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 Peds.

I love to hear that.

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, but then 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. 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 parents' goals, right? What are the parents' 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, because that's what I learned in this course. Not our course, 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 eat— 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 going to try all the things with 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 helping. 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.

Why didn't anyone tell me this question? Like, that is like the goal. Like, that's the golden question that I feel like every parent would ask me, whether it was like we were identifying a tongue tie for the first time or we're looking under the tongue and watching what the tongue can do and telling the parent, oh, but the tongue is struggling, it's not doing X, Y, and Z. And the parent would be like, well, why has nobody else looked in the mouth? Why has nobody else told me that before? And so it was really interesting Because I feel like that question alone, and like you said, meeting the parents where they're at too, all at the same time, was really something that I tried to almost preface conversations with and say to parents, listen, I don't know if you've ever heard this before or if anyone's ever told you this, because this takes a special— a specialized training and not everybody has this, but here's what I'm seeing, right? And then it was almost like setting it up for them. But I can't tell you how many times, right, parents ask that question and it's I don't wanna throw anybody under the bus, but I wanna be like, well, they're just not trained in it.

So I was lucky that I had that foundation. And still with that, I felt like something was missing. And I realized what that was after I took your Mayo Method and your CMT.

Love it.

I certainly said this was definitely the missing piece for me. It was the missing piece because I realized that many of these children that we were treating had similar challenges, but I felt also we weren't addressing like the underlying causes of why we are seeing these patterns. And I felt the way your course was presented, I mean, for me personally, I feel because I've had prior experience and knowledge, so it was both A huge addition to what I already knew, but also very, very humbling. And I thank you for that.

You're welcome.

Because yeah, it was very humbling. I mean, you know, I had to really rethink the way I thought about certain, I guess, areas in feeding. And of course, specifically with the younger population, because you don't really do mayo with the preschoolers and the toddlers. Really being able to address the myofunctional goals through feeding and being very creative in how you do that.

Yeah.

So for me, it was really a full circle moment where I felt like, oh my gosh, I really found that missing link for me.

And it's funny too, because in the beginning I thought about this when you were talking about being in early intervention and not being able to go into the kid's mouth. I feel like when I was in early intervention, because I was there for only a year, I started in the schools and I was in, I was working with preschoolers. preschoolers only for 2 years. They wouldn't let me go into EI because I didn't have experience right out of grad school yet. And then the 3rd year, they let me go into like full-time, you know, early intervention. And it was at the point that they were switching over, at least in our county, from being able to bring toys into bagless therapy and from being able to do even more direct therapy to doing parent coaching model. And I was like, whoa, whoa, whoa, okay, first of all, half these kids— because we were also going— some of the kids were very wealthy and some of the kids were living in poverty. We had like both ends of the spectrum where we were. And I was like, these kids, you know, have nothing. I would gladly go and buy a toy and leave it at their house for the week if that means that like, if that doesn't break the rules, I'm in, I'm all in, right? So, and that's what I did because they literally would say, if the kid's not going to have it to play with for the week, you can't bring it in. Fine, here you go. I don't get it back, I don't get it back. If I do, I clean it, I lend it to the next family.

Right.

So, but it was the same thing with like, I honestly could not go in there, right? And not actually give the child the intervention that they thought that they needed and deserved. And just because there's some silly rule that like, I'm not supposed to touch the kid's face or mouth, but the kid's not eating. I'm like, they're not just gonna, you know, magically start eating because I'm coaching the parent. That's just not—

it's—

if that was the case, we would've solved this problem a long time ago. So, and even like walking the parent through how to do things so that they could go into the mouth. I tried it all, but at the end of the day, I was like, fire me if you don't like my ways. I am going into this kid's mouth. I'm giving them the therapy I think they deserve. And that's where I walked away because I was like, this is not for me. This is not the way that I feel like I can best help these children. Look, half the time we're not— I'm not even in their mouth that long or doing that much. It's just being able to get in there to assess, to know what's going on, and then to work with them and build some skills that the parents can then feel really empowered to continue on with. You know, at, like you said, doing some of that pre-oral work while the parent's cooking dinner. There's all these things that are so powerful and So helpful to the work we're doing. But anyways, I had to share that because I forgot to mention it earlier. And I was just like, it's kind of a, it's just such a disservice to these kids.

It is.

Not let therapists go in their mouth.

It is a disservice. And it's very hard because there's a team that comes in to assess and then we come in to treat, but there's never a thorough oral motor exam.

Yeah.

So we're just going to assume Mm-hmm. That there may potentially be some restriction or, you know, a tie or anything else. We can't assume, right? A lot of times parents will say, well, their speech is fine. I said, okay, guess what? I'm going to evaluate speech anyway. So I do a formal. So I really, my evaluations are speech, feeding, and if it's appropriate, myo, but nonetheless, we do a full oral motor exam. And of course, As we know, and as I explained to a lot of parents, everything is very much related. So if we don't have good lip closure, if we have no tongue tip elevation, most probably it's going to affect some bilabials and linguovelars, and they're going to be substitutions. And of course, sometimes it's appropriate and sometimes not, but I think when you look at things from a myolens, it's very difficult to not see it that way.

Mm-hmm.

So that's one. And also for years, all my evals, I personally, I've been always trained to look at a child from the bottom up. So I've always been trained with sensory providers, occupational therapists that are huge in sensory integration, and a lot of times parents are confused What do you do? Are you a speech pathologist? Why are you looking at how this child is sitting? So there's a lot of education in that, trying to have them connect the dots between posture, postural stability, you know, what happens at the hips happens at the lips.

Yeah.

Am I referring out potentially to an occupational therapist or a physical therapist or a body worker or, you know, making these referrals? And so when I come in and do that assessment, They really feel like, oh wow, okay, I called you in for difficulty transitioning to solids, but oh, okay, so now I don't need to seek 3 different therapists, right, to do speech, to do— and that I find is to be the case like 7 out of 10 times.

Yeah.

So they really do get the speech, the myo, and we address All of it, and of course, sometimes more than others in terms of what the child needs each and every single session. And like I said, I like to talk through my sessions. So the parents do see that sometimes we don't actually address articulation after all the exercises and doing motor work, the strength, you know, the dissociative movements, the coordination that we build on. All of a sudden, This clarity of speech is just tremendous, and that I see 9 out of 10 times.

I'd love to start is where I think most people are confused, probably because I started out a little bit confused here. So can you walk us through what the pelvic floor actually is and maybe tell us a little bit about what it's doing during a bowel movement?

So the pelvic floor is actually part of your core. Most people don't realize that. It's like a whole system that's part of your core. When you think about the core, You have in the front your inner abdominals, the back your inner back muscles, your multifidus, the top your diaphragm, the bottom of the pelvic floor. The whole system's like a pressure gauge and just needs to work together, right? It needs to come up, come down, come up, come down. So the pelvic floor sits in the bottom of this sling, and it's just like any other muscle in our body. It's constantly moving. It's coming up when you need it. It comes down. It comes up, comes down. And then we start to have issues, not so much if the muscle's too weak or stuff, it's when it doesn't move. When our muscles stop moving the way they need to move, just with our breath, with everything that we do, that's where we can have issues. And if those muscles kind of get too tense or stay up when we clench all day or when we stay tight and they don't come down and relax. After a while, that's what can cause constipation. And those muscles, when you have a bowel movement, really need to also be able to relax. So if you can't, even though people are still going, if they're not fully relaxing, then that can inhibit from you having a good complete bowel movement. Okay.

So a lot of people feel like tight is the goal, right?

So tight is not the goal. We don't want things tight. 'Cause I know like when you're here, you're always helping to make things more mobile, if you will.

Yeah, everybody wants, everybody says they want tight, tight, but that in reality, what other muscle are you always trying to keep tight? If you want a strong bicep, are you just going to walk around keeping that muscle tight all day? No, because then it won't be functional. You want a functional muscle. You want a muscle to be able to contract when it contracts, relax when it relaxes. And if you are a CrossFitter or lifting a lot of weight, you need a particularly stronger pelvic floor. If your average day is not anything crazy, then you really just want a moving pelvic floor.

Breathing affects like digestion and the bowel habits.

So one of the things like all pelvic floor therapists, and this usually is like our, we kind of call it our desert exercise, right? If we can pick one thing to do for any patient, it would be to teach them diaphragmatic breathing. And what diaphragmatic breathing is, what we're really doing is we're trying to connect the diaphragm to work with the abdomen and the pelvic floor. So we want to kind of teach that everything comes down and up. So when you inhale, your diaphragm comes down and your pelvic floor comes down. And when you exhale, it all comes up. So when we do diaphragmatic breathing, you want to put your hands around your ribs and really concentrate on that inhale, expand. Expanding laterally, not so much from the chest, but lower down. And on the inhale, like really feeling your pelvic floor descend. You want to feel it to come down because like, I think we're also used to kind of like breathing fast, saying everything, staying stressed, clenched. That pelvic floor is just sitting like this all day long that you want. I always tell patients try to do 2 minutes, 4 or 5 times a day of just that nice, like breathing in. Feeling everything relax and then just exhaling regularly. Really working on that relaxation. Because if you don't have the relaxation of the pelvic floor, you're not going to have your parasympathetic nervous system working, your rest and digest. And if you don't have the rest and digest, you're not going to be having your good daily bowel movements.

Yeah. Yeah. I love that. And maybe we were talking too about how in feeding, we talk a lot about the nervous system and Rest and digest versus fight or flight and everything. And so again, it's just, it's all so interconnected.

So yes.

Okay. And I know, and I, and we talk to families a lot too about how we don't digest well, like when we're stressed, when we're in that fight or flight. It's so interconnected.

Okay.

Amazing. So do you have any tips if people are like, how do I move into rest and digest? Or how do I know what this diaphragmatic breathing looks like? Or how maybe like they wanna move into that before they eat a meal or before they go and try to use the bathroom? Do you have any pointers?

Really just kind of like to sit, lie down somewhere comfortably, have your hands on your ribs, feel what your body's doing, try to feel some nice relaxation in the pelvic floor. I say you're not pushing out, but you should just feel it coming down a little bit every time you inhale, and just try to relax your nervous system when you do it. Just nice deep breaths, nothing too much. Sometimes I'll send patients home with diaphragmatic breathing, and then they'll come back and I'll ask them to show me, and they're like. Taking these inhales and I can see the whole body tensing and I'm like, no, no, no. Remember, this is relaxation. Nothing crazy. I just want a nice inhale. Feel everything come down with a good exhale. Try to start your day, try to do it before you eat some food, after you eat some food, when you're sitting in the bathroom, just that nice relaxation of feeling everything come down. And like you say, like with the mouth, like if you're doing it and you're like, Clenching, it's not going to help relax that pelvic floor.

Okay.

So let's go back to talking about the pelvic floor a little bit and what else maybe it leads to or causes, because I think there's other symptoms besides like constipation or issues with, I know you mentioned the urinary urgency and everything. I know you mentioned if the mom's jumping on a trampoline and she leaks, I know a lot of moms will joke like, oh, if I sneeze, I literally pee my pants. So are there other symptoms that might exist? Besides constipation, where things might be a little too tight versus—

So when we talk about like weakness, we usually talk about stress incontinence, which is that you leak with like a physical stress incontinence, like coughing, laughing, sneezing, jumping, that kind of stuff. And then also with weakness, you can have prolapse with things like falling out or getting loose down there. And then when you have a tighter pelvic floor, like more tension, and I just want to really specify before we even talk about tight Pelvic floor, it does not mean it's strong. Like a tight pelvic floor does not mean it's a strong pelvic floor. It just means it has tension, and that can be from weakness, from all that. So a pelvic floor with tension symptoms you can have are urinary frequency. So needing to go to the bathroom, like I would say more than six to eight times in twenty four hours, despite how much you're drinking. Everyone's like, "I drink a lot." I'm like, "So urinary frequency, going to the bathroom at night too much." Right. So really you should be able to sleep through the full night without needing to go to the bathroom. Incomplete bladder emptying. So not being able to get it all out at once, or after you get up, you like still have to go. Incomplete balancing. So a lot of people will be like, yeah, I, I'm not constipated. I went today. But like, they definitely, they felt like they had to wipe more than usual, or they still felt it, but they didn't get it all out. You can have pelvic pain. Rectal pain, a common one more common than we think is called dyspareunia pain with intercourse. That can be with like increased pelvic floor tone. PRI is very cool. I did one of the courses through like it was like breath and pelvic floor, and I think there's so many. It's one of those. I think you need to take the same course three to four times to fully get it. It was probably one of the most complicated things I've done, but so educational. And yeah, it really connects of if someone isn't breathing well, and then they can have. left hip pain because they're like not connecting it to the right thing. Or you'll find 80% of patients will have more of this issue because the body isn't aligned. You'll have more organs on one side than the other. So then you got to retrain all the muscles so then you can be like more naturally aligned with it.

You said that the CPFT, Certified Pediatric Feeding Therapist certification, changed your career. Tell me what it was like before. Certification.

So I did Feed the Peeds Intro directly before CPFT. I was very lucky that I was in a cohort that ended right before CPFT began, so it kind of all happened for me at once. But before that, I was picking and choosing based on the clients that I had at the time what courses to take. I really didn't have a broad scope. Of understanding feeding or where to really get all those basics. I mean, grad school is wonderful, but it doesn't set us up for pediatric therapy. I had one class and was told, you'll probably never see this, don't worry about it. Now it's all I do every day, so I'm glad that was wrong because I love it. But I've taken several courses. Feed the Feeds really started it off for me though, to see kids in a more broad picture and understand development going into all the way where certain breakdowns in development happen and what that can cause in feeding. Sometimes it's from birth, sometimes it's a little bit later on, and understanding more so about how to assess a child just overall and understand where that breakdown happened. Because if we don't understand where the breakdown happens, we can't really meet them on how to grow. Yes, the parents may want 10 more foods in their diet, but what's causing them to have difficulty getting those foods? Do we have trouble chewing? Does our tongue have trouble bringing the food to the back of our mouth? Like, we have to understand the child. We have to understand oral motor, sensory, the whole picture of medical to fully understand where to go. We can't just be like, okay, 10 foods.

How are you working with that when you do get these like tongue-tied infants or you suspect there might be tethered oral tissues, tongue or lip ties or even cheek ties? Do you push for referrals? Are you kind of just like working through what's there? Like, what does that look like for you?

So I've done a couple of the TOTS courses. I'm TOTS certified. But of course, I cannot diagnose a lip tie, tongue tie, cheek tie. That's outside of my scope. But I can notice those red flags, right? So when a baby comes in, and we hear some of those Red flag words. They're just chomping at the breast. They won't open their mouth very wide. If I go to rub their face, they're so tight. Oh yeah, they're going to PT for torticollis. Okay. So I go in already being like, I need to get under that tongue. I need to check in those cheeks. I need to see if there's any tethering. However, just because I find it doesn't mean I send them out that day. I see. Okay, this is my structure. Is there planching? Is it thick? Where's the insertion points? How much function do I have with the structure that's present? How much tension is present in that baby's body? Or if they're so tense and they're in this extensor pattern all the time, or on the opposite, they're always in this flex pattern, they won't bring their head up. I know I need to open up a lot before I really know, do I want to send them to a referral or do we need to really get down into the bodywork of all this, get some function moving through? And then I'm like, okay, how far can we get function before we hit a roadblock? And when I get to that roadblock, and that might be 2 weeks, depends on how good that home carryover is, right? Might be 2 weeks. I'm like, I'm not really seeing the tension anymore, but this structure really isn't getting us very far.

You know, in my area as well, you know, you really have to make an effort to seek out preferred providers because, you know, there are a lot of people recommended on all these Facebook groups or whatnot. And I stick to the people that I work in tandem with and who I know have the same philosophy and who I know that if I send or refer someone to them, they're not going to come back and tell me, well, this was a waste of time, or why did you? And then also, you know, I feel having the variety— not variety, but having a choice of various providers after knowing their methods and their approaches and their style and their also, you know, bedside manners.

Yeah.

I feel more comfortable knowing, okay, perhaps this family will be better suited to to see this provider versus this family will be better suited, you know, to see this provider. And also knowing who offers anesthesia, you know, for those kids that have severe oral aversions, right? Maybe having that option is wonderful, and who doesn't?

Okay, let's talk about like advocating for our clients on the team because, you know, advocating, we've talked already about how there's specialists referring and maybe pediatricians involved and the families and everything, but we need to talk, I think, about that advocacy side, right? Advocating for our actual clients with these specialists and pediatricians at times. And I know you've got some fabulous ones on your team, so I'm not necessarily saying them, but why is it something that you think is a sticking point? Like, I feel like we talk a lot about team alignment and I just think it's not something that is well achieved in most areas yet.

I think it takes work on our part. To have team alignment. I don't think any of us are quite lucky enough to just walk into an area and start seeing kiddos and specialists take your word as gold. We really have to reach out. And maybe it's the tube-fed kiddo that you're seeing at this time and you're noticing, wow, their overnight feeds are really heavy and they're just not eating in the day. But the GI said only do tube feeds in the night to try to get them to eat in the day. And you're like, okay, well, they're not hungry. So reaching out to GI, getting nutritionists on board, and really advocating for that piece of, hey, let's look at them as a 24-hour period, right? Maybe we do bring back tube feeds in the daytime alongside of meals. And talking to them and bouncing ideas back and forth. And not every doctor is okay with you coming with an opinion, and that's okay because as long as you have a reason for your opinion and your opinion makes sense, it's okay to have an opinion someone doesn't agree with. That's where advocacy comes in. You're coming to a doctor who may have a different opinion and you're giving that evidence and that reasoning of why we should consider it.

Why you're working on that. You know what you're measuring. You know what would count as progress even, and you know what you'll reconsider if progress doesn't happen or it starts but then stops or slows down, right? That is the difference between just doing exercises and practicing clinically. 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, GI 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 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. This is also where we move from reactive care to Proactive care. Reactive care says, the child is struggling with this food, so let's find a strategy for this food. Proactive care says, let's understand the pattern before this becomes a longer, harder, more, like, you know, serious problem to treat, right? It looks at the child who's coughing, tiring, they're avoiding, they're compensating, it feels like they're falling further behind, and we go, what deserves a closer look right now?

Right.

It recognizes that early support is not about labeling every difference as a disorder as well. It's about noticing when the developmental trajectory is changing, And responding before the family has spent years being told to wait. Please don't do that. Please don't make these families wait. And here's the other thing. When you use the same framework across cases, something else happens. You start building pattern recognition, which I always thought was something that everybody had, but apparently just very innate to me. And so people will be like, Hallie, how do you do this in therapy? And why is it that you have such success with kids? And, you know, your families stay and they complete therapy and the kids make quick progress and so on and so on and so on. And I was like, well, doesn't everybody just like have this intuitive, like, nature of knowing like this is what the kid needs based on their energy and their performance right now. And I know this might sound kind of woo to some of you, but I realized I had a framework I'd put in place without realizing it, and I had built pattern recognition. I'm really good at seeing patterns and then trusting that, you know, my gut, that we gotta go with that. That's what we need to be targeting right now. Let me give you some more concrete examples. You know, you notice that a child who can't manage the chewy textures is using very limited jaw movement. Okay, maybe you notice that the child who melts down at the table arrives Super dysregulated. They come to the table dysregulated and they've been grazing all afternoon. Like, they're not gonna be hungry to eat. And they're like, in no place are they ready to be available to us either, right? You notice the months of exposure have not changed the fact that another child still looks really uncomfortable after eating. They look uncomfortable after eating. It's done. Why do they look uncomfortable now? Right? So the framework does not hand you a single answer. I wanna be clear about that. It just helps you ask Better questions. And better questions lead to better decisions. And that is how we actually develop our confidence. Not because you memorize every diagnosis and you never need help and every case becomes easy, because that's not true.

Okay?

Confidence comes from knowing how to think when the answer is not so obvious. It comes from being able to say, hmm, here's what I'm seeing. Here are what may be contributing. Here's what's within my scope. Who else might need to be involved? And the next best step is X. Right? That's a very different kind of confidence than pretending like you know everything. Please don't do that. I've never pretended like I knew everything. In fact, families, I tell people this when we do our 3-day training for Feed the Peeds. I always tell everybody that parents really appreciate when you don't know everything. You say, hey, you know what? I'm not sure about that, but let me talk to my colleagues and get back to you. The fact that you are saying, hey, I don't know everything, it's refreshing. It is refreshing for medical providers not to BS you, gaslight you, and make stuff up. It's also really nice when they go, oh, you're gonna take time outta your schedule outside of this session to help something that could benefit my child? Like, when you start to look at that frame, right, you reframe it and go like, oh, wow, I'm actually going to be working on stuff outside of this session and it's benefit you and your child. Parents appreciate that.

Okay.

So here's the thing. Don't pretend like you know everything. None of us do. I don't even know everything. So if feeding therapy has felt like guesswork to you, this is what I want you to take away. You probably don't need more random activities or strategies or exercises or whatever. Okay. You need a repeatable process, and I want you to start with the whole child. Watch feeding functionally. Look for patterns across systems. Prioritize the barriers that matter most. Treat what is within your scope. Collaborate when the story extends beyond your scope and measure what changes when you can.

Okay?

That's how we stop throwing those strategies at symptoms and begin making decisions with intention behind them. And my friends, that is the foundation of Feed the Peace. I created Feed the Peas because clinicians were asking for more than just information. They wanted to know how to assess and connect what they were seeing, choose treatment priorities, build a plan, and know when to treat, adjust, collaborate, and refer. And at the end of September, I'm actually hosting that free 3-day training I was just mentioning. I'm going to host another one from September 28th through September 30th. We're going to walk through the foundations that help feeding therapy feel more organized, More intentional, and a whole lot less like guesswork. Okay, so you can get on the waitlist at feedthepeds.com/training for that three-day training. And before you go, think about just one child on your caseload who is not progressing the way you expected. Maybe it's not the easiest case, the one you keep thinking about after the session ends, right? I want you to ask yourself: Have I been treating this symptom, or? Have I stepped back far enough to understand the whole story? That is where I would start. Thank you so much for being here. I will see you in the next episode. 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. 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 @healthline.

Thanks, Hallie.

Bulkin.

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.