What Specialty Performs Behavioral Feeding Therapy
Behavioral feeding therapy is delivered by an interdisciplinary team, with speech-language pathologists and occupational therapists serving as the primary feeding therapists, coordinated alongside physicians (typically gastroenterologists or developmental pediatricians), registered dietitians, and behavioral psychologists. 1, 2
Core Team Members
The interdisciplinary feeding team requires specific professionals working collaboratively:
Speech-language pathologists provide oral-motor assessment, evaluate swallowing function, and deliver feeding therapy focused on oral sensory-motor stimulation and safe oral feeding strategies 3
Occupational therapists address sensory integration issues, fine motor skills related to self-feeding, and positioning concerns that impact feeding 3, 1
Physical therapists manage gross motor delays and positioning strategies, particularly important when hypotonia affects feeding 3
Gastroenterologists serve as the medical lead for children with underlying gastrointestinal disorders, reflux, or malabsorption 3, 2
Registered dietitians optimize nutritional intake, caloric density, and growth parameters 1, 4
Behavioral psychologists implement behavioral modification strategies to address learned maladaptive feeding patterns and parent-child feeding interactions 2, 5
When Behavioral Feeding Therapy Is Indicated
Referral for feeding therapy evaluation should occur when:
Feeding difficulties are present with poor growth, failure to thrive, or prolonged feeding times exceeding 20 minutes per session 3, 6
Oral-motor dysfunction manifests as difficulty with sucking, swallowing, or transitioning between food textures 3
Behavioral feeding problems develop, including food refusal, limited food repertoire, or disruptive mealtime behaviors 3
Medical conditions such as cardio-facio-cutaneous syndrome, Prader-Willi syndrome, congenital heart disease, or developmental delays create feeding challenges 3, 6
The Medical-Motor-Behavioral Framework
Assessment and treatment must address all three domains simultaneously rather than treating them as separate issues 1, 2:
Medical factors: Gastroesophageal reflux, structural abnormalities, cardiac insufficiency, respiratory compromise 3, 6
Motor factors: Oral-motor coordination, swallowing mechanics, positioning, muscle tone 3
Behavioral factors: Learned feeding aversions, parent-child interaction patterns, anxiety around mealtimes 2, 5
Critical Coordination Points
The team must function as an integrated unit, not as separate consultants, with regular communication and unified treatment plans 1, 4:
Initial comprehensive assessment by all team members occurs before treatment begins 2, 4
Treatment goals are established collaboratively with measurable outcomes 7
Parent education and training in feeding techniques is provided by all disciplines 2, 5
Regular team meetings ensure consistency in recommendations and prevent conflicting advice 1
Common Pitfalls to Avoid
Do not refer to only one discipline when feeding problems are multifactorial—25% of typically developing children and 80% of developmentally delayed children experience feeding disorders requiring comprehensive interdisciplinary care 2
Avoid exclusive tube feeding without concurrent oral feeding therapy, as this creates iatrogenic feeding problems and delays oral skill development 2
Do not delay referral until failure to thrive is severe—early intervention within the first year prevents entrenched behavioral patterns and optimizes developmental outcomes 3, 7
Recognize that most feeding disorders have both organic and behavioral components existing on a continuum, requiring simultaneous medical and behavioral intervention rather than sequential treatment 2, 4