Conducting Successful Feeding Therapy over Telehealth: 9 Recommendations

As many as 25 percent of children worldwide have a feeding problem,¹ and it comes as no surprise that parents of these children report nutrition as one of their most worrying concerns. Adding to their worry, the COVID-19 pandemic has left service providers scrambling with minimal preparation for mastering the art of using teletherapy.

While the transition to telehealth presents significant new challenges, it also presents an opportunity for parents to become more involved in their child’s feeding journey.

Can Feeding Therapy Be Conducted via Telehealth?

A feeding therapist must evaluate numerous factors and formulate a plan before conducting a feeding session via teletherapy:

• Do parents have access to computers?
• Can families manage technical aspects of teletherapy while using feeding strategies?
• Will the child get distracted by the screen and not focus on eating?
• How can providers address the lack of modeling and hands-on aspects of feeding intervention?
• How do we reduce the emotional barriers and exacerbated behavioral difficulties parents experience in feeding their children?

Coordination between the provider and parents can maximize the client’s progress and improve active parent participation in therapy. Although the use of telehealth has not previously been at the forefront of feeding services, it is now serving as a stabilizing factor in maintaining consistent services.

9 Recommendations for a Successful Telehealth Feeding Therapy Session

Based on our experience, these steps will help create a successful feeding therapy session via teletherapy:

1. Plan ahead—with flexibility.

Due to limited access to certain food items, it is vital for providers and parents to discuss in advance the food items they will use for the session to effectively plan activities and target skills during a telehealth session. Attempt to have the same or similar food available to model the activity for the child. Research shows that when a child sees another person eating the targeted food, they will be more willing to try it.²

2. Time your session properly.

There is a fine line between hungry and starving. Remember, our goal is successful feeding; try to avoid any emotional outbursts because the child is overly hungry. Conduct your session at an appropriate time to reduce any negative experiences.

3. Ensure a safe and secure seating system.

Optimal seating and positioning are necessary for successful feeding therapy. A simple discussion about the rationale and importance of appropriate seating has helped many families.

Clinicians could use teletherapy as an opportunity to provide recommendations to ensure a safe and secure seating system at home. You may need to help the parent by being creative, for example, using rolled towels as lateral supports.

4. Communicate with other professionals.

The child you are working with might be receiving other related services such as nutrition, occupational therapy, and physical therapy. An interdisciplinary approach must be adopted to maximize effectiveness.

5. Educate parents.

Parent competence in utilizing and transferring skills is crucial. Professionals must disseminate therapeutic information using easy-to-understand language. Parents need to relate to the information they are receiving without the barriers of technical jargon. MedBridge’s Patient Education library includes resources for education on feeding therapy.

Discuss and demonstrate specific goals and strategies for children who exhibit emotional reactions or anxiety toward food. Consider all confounding variables that may affect your planned session, such as presence of other children in the home, parent commitment, scheduling issues, parent anxiety and preparedness, and the expectations and limitations of teletherapy.

6. Follow UNICEF recommendations.

Parents should always wash their hands with soap and water frequently, including before and after contact with an infant. Routinely clean high-contact surfaces around the home with soap and water. If the caregiver is experiencing respiratory symptoms, the use of a face mask during feeding or caregiving is recommended. If necessary, locally available or adaptive face masks can be used as an alternative.

Use evidence-based online resources to obtain needed information and clarification about feeding. Recommendations also include educating caregivers on the availability of videos, such as UNICEF’s first foods video series. This video series can be downloaded on mobile phones and applications like WhatsApp, which are used in developing countries.

7. Set simple and achievable goals.

Create simple steps to help parents and children acclimate to new online routines. Establish weekly goals to monitor progress. Provide sample videos and other resources beforehand to describe the strategies and activities you intend to use. Parents will feel more comfortable if they know the plan in advance.

8. Practice active listening.

Actively listening to parents’ concerns and feedback can strengthen the planning and execution of the session. Use parents’ knowledge of the environment, child, resources, and limitations, and then plan accordingly.

9. Provide compassion, support, and positive reinforcement.

Any new learning takes time. Just like everyone else, parents of children with feeding needs are going through a difficult, unplanned transitional time. A compassionate and supportive approach helps everyone during this unpredictable pandemic. Regular positive reinforcement will help parents learn and support the delivery of feeding services.

The authors of this article are clinical educators and professors at New York Medical College, which offers the Advanced Certificate in Pediatric Dysphagia post-Masters program.