Questions to ask your therapist before starting feeding therapies

I am hearing from more and more parents who are not happy with feeding therapy. Or who have "failed" feeding therapies... I wrote chapter 3 and 4 in my book, Love Me, Feed Me, particularly for families with picky or problem eaters, and for parents who feel like feeding therapy isn't helping. (It is also important to note that there is so much you can do to support healthy feeding whether you pursue therapy or not. Many parents feel the only option is therapy, or give in and serve chicken nuggets every night.)So many families are now being referred for feeding evals, and that is a mixed bag. This is an incredibly complex topic, which is why chapter 3 was the longest in my book. As a starting point, I have adapted a page of questions from my book to mull over as you consider therapy. If you are considering feeding therapy, my book may be a helpful resource, filled with stories from parents who had both good and bad experiences with formal therapy, as well as some parents who chose not to pursue therapies. As far as I know, it is the only resource of its kind, offering a "primer" of sorts, into diagnosis, treatment options, how to tell if what you are doing is helping or not. (I refer families to the book, with both biological and adopted children, since most of the content is the same for all families.)

As one mother said, "Bad therapy is worse than no therapy," and I couldn't agree more. As I hear horror stories from parents with children sobbing, gagging and vomiting daily through "therapy" tasks at the dinner table, I can only think that we have to do better.

Here is the content from a PDF you can download, which is on my resources page under PDFs. I have also added several others, from starting solids, to talking to kids about food. Feel free to print them off, share with teachers, friends, mothers-in-law...

Tell me what you think of this list of questions. Am I missing anything? What have your good or bad experiences been? Who was most or least helpful to you when dealing with your child's feeding challenges?

Questions to Ask a Feeding Therapist

The right speech therapist or feeding team evaluation can be incredibly helpful, but a poor fit can slow down your child’s progress with eating. As one mom said, “Bad therapy is worse than no therapy.” If you are experiencing challenges, identifying your child’s baseline skills with eating, including chewing and tongue lateralization (the ability to move food from the front teeth to the sides and place in the correct position for chewing with molars), can help you provide foods that are safe, help your child progress with her eating, and help you feel confident and supported at home. Here are a few questions to think about as you look for the right help for your family, which may or may not include formal therapy. Remember to trust your gut. If what your therapist is asking you to do increases conflict or anxiety at the table, leads to more gagging or vomiting, it is likely to make matters worse, not better.Qualifications/training:

• How long have you worked with feeding specifically?
• Have you completed your training and are you licensed? (I added this to the list after reading about a feeding clinic staffed entirely by OT students.)
• What extra training or certification do you have with feeding?
• Are you aware of the Trust Model of feeding, the Division of Responsibility, or Responsive Feeding?
• Are you aware of the “Get Permission” approach from Marsha Dunn Klein? (Dunn Klein is a pediatric occupational therapist, author, and founder of Meal-time Notions.)
• Were you exposed to a variety of feeding therapy approaches in your training? 
• Tell me about your training in feeding therapy? (I believe there is no standard training or certification outside of the state of California.)

Treatment Philosophies:

• How do you help families integrate your advice in the home?
• Will you separate me from my child or ask me to use my attention or lack thereof to motivate my child to eat?
• What do you consider “successful” treatment? What criteria determine when treatment is “over?”
• What resources do you recommend?
• What can you offer if “therapy” meals or other suggested techniques result in conflict or a power struggle?
• Do you show disapproval or hold food in front of the child’s mouth until she gives in?
• Do you use external rewards like stickers or toys to motivate my child to eat?
• Can I observe a treatment session or watch a video?Adapted from Rowell’s book Love Me, Feed Me. Chapter 3 focuses in detail on feeding challenges, sensory issues, and how to find the right help for your family. Chapter 4 goes into supporting eating in the home, or if your child has “failed” feeding therapies...

Katja Rowell M.D. 2012 www.thefeedingdoctor.com