Is feeding a school-based OT issue?
This is a great question that I see come up all the time. The answer, like many questions in school-based OT, is “it depends.”
Now, do we address the mechanics of feeding, such as utensil usage, positioning, and adaptive equipment? Absolutely, and we can especially offer powerful support to life skills teachers who are working on this every day.
But what about picky/restrictive eaters?
This answer is less clear. School-based OTs in some districts definitely are.
But consider this student.
Tan brings his lunch from home. Every day, he has a plain cheese sandwich, grapes, and water. He reports liking this food and eats lunch in the cafeteria with his friends. However, his parents are concerned about his picky eating – and want the school OT to address it.
If there are no other concerns, it would seem as if the student is technically accessing his education. He is able to participate in his entire school day in an age-appropriate fashion without becoming dysregulated. Yes, his food repertoire isn’t wide, but he is currently content with it. He’s able to eat with his friends and spends his lunchtime developing his social skills. For multiple reasons, it would be difficult to justify treatment from the school-based OT for this activity.
Before school-based OT, I worked in outpatient peds and addressed feeding and restrictive eating often. And while I loved working with this type of client, I much prefer seeing them in the outpatient setting for the following reasons:
1. In an outpatient or hospital setting, you have easier access to a medical team. This is especially important if the child needs further services like a swallow study – which many do.
2. The treatment activities themselves are much simpler to provide in a clinic setting that is set up for this type of therapy.
3. A variety of types of food are also necessary for effective feeding therapy, which can be difficult to coordinate with the school and family.
4. Direct parent communication is necessary for carryover with this type of therapy which tends to be easier in an outpatient setting where parents can attend sessions.
The other considerations I have when thinking about addressing restrictive eating at school are the other activities I’m keeping the child from. If I see the child at lunchtime, I’m taking away social skills time from them. Even if it’s only once to twice a week, that’s still a break and time with peers the student is missing out on.
If I decide to see them at a different time, I risk the student not being hungry and our session not really being successful. Plus, then you have to consider the ramifications of pulling the student from academic work.
Another thing to think about is if the school-based OT has sufficient training and experience in this area. This is an area that takes some skill and practice beyond typical entry-level OT training. And It’s possible to make things worse if the OT doesn’t know how to structure this type of therapy. However, even if the school-based OT doesn’t have experience in this area, it doesn’t necessarily mean the district doesn’t have to provide the service if it is truly impacting the student’s access to education.
In a perfect world, the student mentioned above would go to a skilled outpatient therapist for this service. But what about students in rural areas? Or students with limited insurance funding?
Now consider this student.
Angelica can’t eat in the cafeteria with her friends because she can’t handle the smells. She gags at the sight of her friend’s food. She eats lunch in the resource room alone with her teacher. Angelica gets the free school lunch but only tolerates a couple items – a slice of pizza that she scrapes the cheese off of and the potato smiles. Her behavior always seems worse after lunch and her mom reports she immediately has to eat when she gets home. The school is located in a rural area. There’s only one OT clinic in town and it’s aimed at older adults.
This is where we have to be a little flexible, because what is true in theory is not always true in practice. Despite all of the reservations I have about addressing inflexible eating in the school setting, this is a kid I would attempt to help if I could.
Now, there are some school districts that have whole feeding teams headed by OTs and SLPs that do address feeding extensively and would probably see both of the students mentioned in my examples. However, I would consider these teams to be going above and beyond what IDEA states must be provided. Which is great – but not all school districts can afford to do this.
So, the answer to this question must be decided by you each time it comes up. This is what I ask myself any time a weird situation like this comes up.
1. Is it impacting their school participation?
2. If I work on this at school, will it be safe?
3. Will it be effective?
4. Is it the best use of their time at school?
5. Is school-based OT the most appropriate service for addressing this?
6. If I don’t address this, what are the potential negative consequences?
7. Do I have the skills and training necessary to address this?
While this question doesn’t come up often, it’s always a tough call. Figuring out how to respond to unusual situations like this is an integral part of being an effective school-based OT. And while it gets easier with time and practice, sometimes it’s nice to have someone who’s been there give some feedback on how to best address it. If you’d like more resources on this, my course The Dynamic School OT has a module called Weird Situations and Hard Conversations that covers this exact type of question.
Are you addressing feeding as a school-based OT? I would love to hear how your district handles this. Feel free to join the discussion at my Facebook group.