PFD

Affects up to 1 in __ children under the age of 5

37

Often co-occurs with

Autism or developmental delays

what can PFD impact?

health, development, behavior and parent-child relationships

Define Pediatric Feeding Disorder (PFD)

“Pediatric Feeding Disorder is impaired oral intake that is not age-appropriate, and is associated with medical, nutritional, feeding skill, and/or psychosocial dysfunction.”

what could a feeding problem look like?

• Only eats beige foods

• Refuses to sit at the table

• Choking or gagging on solids

• Very slow eater

• G-tube

• Parents report each meal is stressful

4-domain model

1. Medical

2. Nutritional

3. Feeding Skill

4. Psychosocial

GERD, prematurity, airway anomalies, neurological conditions

which domain?

medical

Faltering growth, iron deficiency, dependence on supplements

which domain?

nutritional

Poor suck-swallow-breathe coordination, inefficient chewing, aspiration

which domain?

feeding skill

Parent-child conflict, feeding refusal, trauma, anxiety around meals

which domain?

psychosocial

Eats only purees and formula

which domain?

feeding skill

Gags when offered textured foods

which domain?

feeding skill or psychosocial

History of reflux as an infant

which domain?

medical

Mealtimes last over an hour & are very stressful

which domain?

psychosocial

Growth has dropped 25th to 5th percentile

which domain?

nutrition

who monitors growth, coordinates referrals, tracks feeding concerns over time?

Pediatrician or Developmental Pediatrician

who manages reflux, constipation, EoE, feeding tube decisions?

Gastroenterologist (GI)

who evaluates airway, structural issues, laryngeal cleft, laryngomalacia, aspiration risk?

Otolaryngologist (ENT)

who manages chronic lung disease, recurrent aspiration, pneumonias, O2?

pulmonologist

who evaluates and diagnose syndromes affecting feeding, growth, tone, metabolism?

Geneticist/Metabolic MD

who identifies food allergies, EoE, non-IgE mediated reactions?

allergist

who performs imaging: MBSS, Upper GI, Esophagram?

radiologist

Why is a team-based approach recommended for PFD?

Because most children with PFD experience overlapping challenges across multiple domains, requiring interdisciplinary collaboration.

Name medical contributors to PFD.

GERD, eosinophilic esophagitis, cleft palate, cerebral palsy, CHD, prematurity, medications.

What are signs of nutritional dysfunction in PFD?

Faltering growth, reliance on supplements, vitamin deficiencies, poor caloric/fluid intake

What are indicators of feeding skill dysfunction?

Poor suck-swallow-breathe coordination, delayed textures progression, fatigue with meals, aspiration.

What psychosocial factors contribute to PFD?

Feeding-related trauma, family conflict, caregiver stress, rigid routines, and mealtime anxiety.

How do SLPs assess PFD?

Through case history, observation, oral motor exam, instrumental studies, and collaboration with other disciplines.

What are common treatment frameworks used by SLPs for PFD?

• Food Chaining

• SOS Approach

• Get Permission

• AEIOU

• Responsive Feeding Therapy

• Trauma-Informed Care

What is the SOS Approach to Feeding?

• A play-based (food play), structured approach involving 32 steps:

  • tolerance → interaction→ tasting→ eating

• emphasizing child exploration and reduced anxiety.

What is Food Chaining?

• Expand diet variety using sensory bridges

• Progression: Known → Similar →New

• Used with: Sensory-based avoidance, extreme picky eaters

What is the Get Permission Approach?

A relationship-based approach that supports autonomy, trust, and emotional safety in feeding. feed in response to child’s cues

“Just Right Challenge”=

meeting the child where they are (apart of get permission approach)

AEIOU stands for:

Acceptance

Exposure

Independence

Observation

Understanding

key principles of AEIOU approach

• Developmental and sensory-informed approach

• Emphasis on caregiver-child interaction

• Layered exploration to support skill development

What are core principles of Responsive Feeding Therapy?

Feeding based on cues, caregiver-child co-regulation, avoiding pressure, and positive mealtimes.

Who are key medical professionals involved in PFD care?

Pediatricians, GIs, ENTs, pulmonologists, dietitians, allergists, geneticists, radiologists.

What role do Registered Dietitians (RDs) play in PFD?

Assessing nutrition, recommending supplements and feeding schedules, and supporting oral transitions.

What should SLPs do if they don’t have a feeding team?

Build partnerships with local providers, create shared care plans, and maintain regular communication with caregivers.

What is the main takeaway regarding therapy for PFD?

There is no one-size-fits-all approach; therapy should be individualized; Clinical reasoning + caregiver partnership= effective therapy

why does trauma-formed care matter?

Many children with PFD have experienced:

• Painful medical conditions or procedures

• Forced feeding or mealtime stress

• Tube dependence

core principles of trauma-informed care

• Safety

• Trustworthiness

• Empowerment

• Collaboration

• Cultural humility