Hey Reader,

I recently spoke with a colleague about an OT who had inherited a few IEP goals related to feeding.

And naturally, that led to some important discussion around:

• What are school-based OT services actually responsible for related to feeding concerns?
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• Is expanding food variety a school-based OT goal?
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• And how do we know when a feeding concern belongs in the school setting versus a medical or clinic-based setting?

These are some questions I think we all fear needing to really consider. We just hope that feeding won't come up at an IEP.

I left that conversation feeling like I needed to do some digging, so I did.

I started with AOTA documents. Then I looked to what ASHA had to say. Eventually I even went down the yellow brick road of court cases.

And when you do that, things only get more interesting. Rarely do I find the answer I am looking for from case law, but I ALWAYS learn something worth pondering.

Here are my 3 conclusions from that deep dive

1. As much as you might like to confidently say "feeding is not a school-based OT concern," nothing is inherently “off limits” when it comes to feeding goals in IEPs. This includes complex oral motor and food variety goals.
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2. Not every school-based OT has the necessary training to support these types of goals. In some states, like California, you are even required to have specialty or advanced training to address these types of goals.
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3. Like most IEP-related concerns, this is not just an OT specific problem. Supporting student access to food and mealtime participation should include the teachers, paraprofessionals, nurse, and meal prep staff.

All that said, here is how I have approached feeding-related concerns.

School-based OTPs can absolutely help to identify barriers, recommend accommodations, and support mealtime participation. Adapting the environment, coaching those who support the student, and introducing adapted tools are all fair game.

But I am cautious when asked to work on oral motor, swallowing, or even food texture and variety goals.

Schools must ensure access and participation in food and mealtimes, not ensure that students can/will eat cafeteria food.

So the question becomes, how do we respond to questions about feeding, and what can we do to support mealtimes?

As you might expect, there is a lot of nuance and “what ifs” to this topic. So, I put together a new article exploring what school-based OTPs can support during mealtimes.

I also include a quick reference sheet you can print and hang on your wall for when feeding questions come up. You can find the handout in the article.

Inside, we look more closely at educational relevance, inherited IEP goals, mealtime observations, collaboration, and where our school-based role may begin and end.

​Check out the full article here ↗​

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Yes, a student can have feeding goals on their IEP. But that doesn't mean they should have one. If you have ever been in a meeting where someone turns to you and asks, "Can OT help with feeding?" you have probably felt the unmistakable tension that follows. You want to support the student in front of you, but you also know the cafeteria is not an outpatient feeding clinic, and you may not have advanced training in feeding or swallowing. So, what do you do? Let's talk about what we can support, how to think through feeding goals on an IEP, where the boundaries are, and how to explain all of that clearly to your team. Keep reading ↗

CONTINUING EDUCATION 🎓

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RESEARCH 🧪

Oral Feeding Management in the School Setting: A Scoping Review

This review examined the available research on occupational therapy’s role in oral feeding management at school.

The authors identified four primary areas:

• Collaborating with a multidisciplinary team
• Using formal and informal assessment approaches
• Providing various intervention strategies
• Developing clearer policies for addressing feeding goals at school

The review suggests that we are well positioned to support feeding in schools. However, evidence for specific interventions remains limited.

The article outlines a need for clearer guidance around assessment, service delivery, and feeding goals within the IEP process.

In other words, there is support for our involvement, but that involvement still needs to be tied to school participation, approached collaboratively, and kept within our individual competence. (Sound familiar?)

​View the full article in the AJOT →​

LAST WORD 👋​
​Have a “fun story” about feeding goals in school-based OT?

I think we all do.

It’s one of those things we secretly hope never comes up in an IEP.

But the OT Practice Framework makes it clear that we do address feeding, and IDEA doesn't rule it out. So now, you and your district need to decide where to draw the line when it comes up.

Have a plan before you need to use it.

​This article and the handout will help.​

In the meantime, share your feeding goals story with me. I’d love to hear how you have handled that situation.

Until next time,

👋 Jayson

Jayson Davies, MA, OTR/L
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