Why Two Therapists Get Different Feeding Outcomes (And How to Fix It)

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. Have you ever noticed this? Two feeding therapists, same child, same diagnosis, same 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, stuck executing plans that just never quite feel done or straightforward? Right. That's what we're unpacking today.

Welcome to the Untethered podcast. I am your host, Hallie Bulkin I'm a certified myofunctional therapist, feeding specialist, podcaster, business owner, and mentor. This podcast is all about getting your questions answered and collaborating with colleagues to

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information in the orofacial myofunctional therapy, airway tether, dural tissue, and pediatric feeding therapy space. If you're new here, I challenge you to keep an open mind and join my mission to spread this message far and wide. If you've been around since June 2019,

thanks for being a loyal listener.

As we jump into today's episode, remember to listen with correct oral rest, posture,

tongue up, lips closed, teeth apart, breathe through your nose.

Let's get started.

All right, so like I said, 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 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. 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 two 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 dysphasia 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 10pm 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 in 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. 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 first. 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, 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 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 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 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 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. This is going longer than it should, like, we should have accomplished certain things by now, right? H. Is something else going on or is it a systems problem? Right. So if there's longer treatment times than expected, the timelines 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 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 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 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 are 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. 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 started my feed the peds 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 skill set, 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 therapists, like, getting into the NICU writers, 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 going to. I'm going to 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, wait, I 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 three. 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 outsider certification agency. Anyhow, 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 a 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 have created builds the clinical reasoning, the mentorship, and the professional support you need to get there. And one of the most unexpected outcomes, outcomes that clinicians share with us is that they find their 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 specialists 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. Thanks for joining me today. Be sure to go and click Learn More in the show Notes so that you can actually learn more and pop over to the application for the CPFT or the Certified Pediatric Feeding Therapist Certification. Once your application is done, if you're accepted, you'll hop on the phone with me and we will have a little chat about your goals and what makes sense for you and if that next step is a cpft. All right, I look forward to talking to some of y' all soon. Have a great day.

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the speakers and is for the informational purpose only and not intended to serve as a substitute for the consultation, diagnosis and or medical treatment of a qualified healthcare provider. Thanks for listening to this podcast. If you found value in this episode and want to hear more of these Myotots, Airway and Feeding related episodes, be sure to leave a review on Apple Podcasts and share this episode on your social media media platforms. You can access free resources and all I offer@halliebulin.com or pop over to Hollybulcan on Instagram to get all the latest updates.