There are many children within the school environment that have feeding difficulties. For these children, the task of eating lunch and snack at school is a daunting one. However, lunch and snack time can present the perfect opportunity for addressing feeding difficulties if given the necessary attention and intervention.

A team collaboration framework is necessary for the design and implementation of a successful feeding therapy program within the schools, with many people and steps involved.

1. Who is involved?

a. The child is the primary person involved.

b. The student's family is a key player in the success of the program.

c. The school based speech/language pathologist or occupational therapist is typically the person responsible for designing and overseeing the feeding therapy program.

d. Teachers and paraprofessionals play a major role in the direct implementation of the program.

e. There may be other school personnel involved for each individual child and his/her needs, such as an autism teacher consultant, school social worker, special education teacher, principal, and/or cooks in the cafeteria.

f. Outside team members may include the child's physician, nutritionist, psychologist, speech/language pathologist and/or occupational therapist.

2. What steps are involved in setting up a feeding therapy program?

a. The first order of business is to identify the children who could benefit from feeding therapy. This can sometimes be a difficult task; but observant teachers or cafeteria workers can assist in determining those children who eat the same thing day after day, or who refuse to eat anything but graham crackers for snack every day. These are the children for whom feeding therapy may be appropriate.

b. The team that will be collaborating on each child's plan needs to be established. Once the team is in place, a meeting should be held to discuss the child's needs.

c. The school based speech/language pathologist or occupational therapist conducts an evaluation to determine the child's specific needs. This evaluation will look at the child's sensory and oral motor abilities, as well as what the child will and will not eat.

d. A feeding therapy plan will be developed based on the results of the evaluation and will include a sensory diet and a baseline feeding continuum which will be updated throughout the year.

e. Training for the specific individuals who will be implementing the program will be held. Typically, paraprofessionals would be responsible for implementing the program.

f. Written documentation will be used during each feeding therapy session, and periodic evaluation will be conducted to measure progress or need for adaptation.

3. What would a sample feeding therapy program look like?

(The list that follows is meant only as a general guideline, and should not be implemented without appropriate training.)

a. Each session would begin with a sensory time specifically designed to meet the needs of each individual child. Some children need activities to arouse their system, such as jumping on a trampoline; while other children need activities to quiet their system, such as swinging.

b. A mealtime routine would be established, such as preparing the table.

c. The adult implementing the program would then begin introducing the foods planned for that day, beginning with a preferred food. Several new foods would be tried at each session. Foods would be similar in size, shape, color, or texture.

d. The session ends with cleaning up the leftover food, and washing the table.

These programs may be carried out individually or in small groups, depending on the needs of each individual child. These sessions may be implemented 1-2 times per week or every day, depending on scheduling. While daily implementation is ideal, consistency is really most important for success. Paraprofessionals usually carry out the programs, but the entire team is involved in ensuring its success. Parents should be involved in the sessions as much as possible hopefully to assist in carry over within the home setting. Continued team meetings will also be important in making sure that all of the child's needs are being met by the plan.

Feeding difficulties can be very complex, requiring the need for a team approach and a comprehensive understanding of what is truly involved for each individual child. A commitment on the part of the whole team is necessary for the expansion of a child's feeding repertoire.