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Interdisciplinary Roles in Feeding & Eating

Updated: Jun 29, 2023

FIRST! eating is not the top priority for the body - ensure the first two steps are addressed before addressing eating!


1. Breathing

2. Postural stability

3. Eating


For eating, feeding, and swallowing difficulties, “a collaborative team approach is essential for assessment and ongoing management of feeding difficulties" (McComish et al., 2016).


Roles

  • Speech Language Pathologist: SLPs focus mainly on the oral structure and swallowing problems. SLPs can conduct a swallow barium study and endoscopic assessment to determine where the food is going and how the child’s swallow looks internally.

  • Occupational Therapist: Occupational therapists focus on maximizing the child’s engagement in therapeutic activities in daily living, such as eating, feeding, and swallowing. OTs help the child develop the fine motor skills needed to hold utensils or to bring food to the mouth, develop social skills of what food they like and do not like (how to ask for more, expressing feelings of hunger/stomach ache/fullness), address seating and positioning at the table, and regain/adapt functions to have successful eating habits (Blayden et al., 2021). Children with feeding problems often have sensory challenges that impact their participation in eating; therefore, an occupational therapist is important to address these sensory sensitivities (Gettier, 2022). OTs are responsible for creating a positive feeding experience while expanding oral motor development for children with inadequate oral skills to increase their confidence in food exploration (Petrozelle & Moll, 2020).

  • Physical Therapist: Physical therapists address the postural tone and movement of the child's body. Postural control comes first when it comes to eating and feeding oneself; if it is not strong, eating becomes an undesired experience. Specific postural components the physical therapist will work on are head control, trunk control, and specializing the seating arrangements for feeding if needed.

  • Nutritionists/Dieticians: Nutritionists and dieticians are the food and nutrition experts. This discipline “evaluates the growth parameters and growth potential and assesses caloric and nutrient need and tolerance. Teach parents food and formula preparation and provide information on nutritional needs. Dieticians recommend specialized formulas chosen for caloric and nutrient properties and for tolerance” (McComish et al., 2016). “They work with families toward a balanced healthy diet using food from all food groups as well as normalizing feeding schedules” (McComish et al., 2016).

  • Lactation Consultant: A lactation consultant assesses "the maternal lactation status in conjunction with the infant's breastfeeding ability and supports the mother to achieve her breastfeeding goals" (Marcus & Breton, 2022). Lactation consultants are crucial in the NICU setting and ensuring breastfeeding is smooth.

  • Gastroenterologist: A gastroenterologist will evaluate any pain or diarrhea experienced, poor weight gain, reflux, and constipation (Haiao, 2014).

  • Behavioral Psychologist: When a child's behavior, such as shaky hands, phobic reactions to foods, or appearing "out of control" during mealtimes and is affecting their nutritional status, a behavioral psychologist is here to help. A behavioral psychologist can administer as many tests and measure a young person’s intellectual health to determine a child’s psychological health if the medical factors are ruled out and feeding/swallowing activities are still impacted.

  • Allergists/Immunologists: Allergists and immunologists determine allergies and food intolerances that may be causing the child internal discomfort or pain in the GI tract. Internal discomfort or pain leads to children not wanting to eat, having irregular bowel movements, difficulty with digestion, and frequent vomiting. When experiencing these symptoms, no one would want to explore foods.

  • Cardiologist: Children with cardiac issues tend to fatigue quicker, and eating takes energy; therefore, the child may not receive the proper nutrition. Cardiologists can determine underlying factors and solutions to increase energy in a child’s daily life.

  • Dentist: The dentist can determine if any cavities or pain are causing the child to refuse to eat or be defensive about their mouth when eating or brushing their teeth.

  • Endocrinologists: An imbalance in hormones can cause the child to be malnourished due to the body’s inability to process certain nutrients. Endocrinologists can help control the child’s metabolism, nutrition, growth, and energy.

  • Nurse: “Neonatal nurses are the frontline practitioners who judge preterm infants’ risk for aspiration during oral feeding and determine readiness for oral feeding. They use their clinical judgment to determine when preterm infants are physiologically stable, ready to initiate oral feeding, and feeding adequately” (Ferguson & Estis, 2018).

  • Teacher: The teacher of the child has an important role since they are in the child's everyday life during the school week. The teacher will be able to observe the child's behaviors and tolerance regarding eating in a noisy and busy environment: the cafeteria. Teachers can help advocate for the child's eating by informing parents or other therapists on how they are eating, what they are eating, and how they are interacting with their environment during lunch or snack time.


Other Important Roles to Consider

  • The Child: The child is the most important person to listen to and observe when addressing their eating difficulties. There is a reason why they are having difficulties eating in the first place!

  • The Parent: The parent(s) are the primary feeders for the child. Parents are very aware of how their child behaves/interacts with foods during all meal intakes. Parents are key; therefore, it is important to listen to their concerns about what has been working, what has not been working, their relationship with their child, and their culture/beliefs regarding eating.


References

Blayden, C. M., Holland, K., Hughes, S., & Nicol, J. (2021). Feeding difficulties in children: A

guide for allied health professionals an evaluation report. Internet Journal of Allied

Health Sciences & Practice, 19(3), 1–8.

Feeding matters. (n.d.). Feeding skill. https://www.feedingmatters.org/what-is-pfd/feeding-

skill/

Ferguson, N. F., & Estis, J. M. (2018). Training students to evaluate preterm infant feeding

safety using a video-recorded patient simulation approach. American Journal of

Speech-Language Pathology, 27(2), 566–573. https://doi.org/10.1044/2017_AJSLP-

16-0107

Fraker, C., Fishbein, M., Cox, S., Walbert, L. (2007, November 2). Food chaining: The proven

6-step plan to stop picky eating, solve feeding problems, and expand your child’s diet.

Hachette Books.

Gettier, M. (2022, June 1). Children with problematic feeding, selective restrictive eating: A

pilot program.

Aota.org. https://www.aota.org/publications/ot-practice/ot-practice-issues

/2022/problematic-feeding-selective-restrictive-eating

Haiao, E. Y. (2014). Gastrointestinal issues in autism spectrum disorder. Harvard Review of

Psychiatry., 22(2), 104–111. doi:10.1097/HRP.0000000000000029

Marcus, S., & Breton, S. (Eds.). (2022). Infant and child feeding and swallowing: Occupational

therapy assessment and intervention (2nd ed.) AOTA Press.

McComish, C., Brackett, K., Kelly, M., Hall, C., Wallace, S., & Powell, V. (2016).

Interdisciplinary feeding team: A medical, motor, behavioral approach to complex

pediatric feeding problems. MCN. The American Journal of Maternal Child Nursing,

41(4), 230–236. https://doi.org/10.1097/NMC.0000000000000252

Morris, S. M., & Klein M. D. (2000, January 1). Pre-feeding skills: A comprehensive resource

for mealtime development. Pro-ed International Publisher.

Petrozelle, D., & Moll C. M. (2020). Sibling-supported feeding intervention: Sibling

participation leads to growth in food repertoire and generalization of positive habits to

home. OT Practice, 25(2), 10–13.


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