Full Course Description

Picky Eaters vs Problem Feeders vs Avoidant/Restrictive Food Intake Disorder 

Program Information

Target Audience

  • Psychologists 
  • Social Workers
  • Counselors
  • Pediatric Occupational Therapists
  • Pediatric Speech Pathologists
  • Pediatric Feeding Specialists
  • Physicians and/or Psychiatrists
  • Registered Dietitians
  • Day Care Providers
  • Teachers/Educators
  • Nurses


  1. Determine physical, motor, sensory, oral-motor, environmental, nutritional and behavior factors necessary to consider, to properly assess feeding problems.
  2. Distinguish differential criteria for determining a child’s diagnosis as a typical eater, picky eater, problem feeder or a child with ARFID.
  3. Evaluate the diagnosis of ARFID to discover sensory sensitivity, fear of aversive consequences and/or apparent lack of interest in eating or food.
  4. Utilize practical treatment strategies to advance children’s feeding skills, improve family meal routines and increase children’s intake of more nutritious foods.
  5. Conduct more thorough and accurate diagnoses, to implement the right treatment approaches for the distinct types of feeding/eating problems.
  6. Discriminate when a child needs additional evaluation and intervention by specialists for more intense treatment.


Prevalence of the Problem

  • Picky eating
  • Problem feeding

The Complexity of Feeding/Eating

  • 7 areas of human function
  • How children learn to eat (or not)

How to Complete a Comprehensive Feeding Assessment

  • Medical/organs
  • Oral-motor skills
  • Sensory-motor skills
  • Postural and motor skills
  • Nutrition
  • Learning/cognition
  • Environment

Differential Diagnoses Criteria, Research and Limitations

Picky eating

  • Able to tolerate new foods on plate
  • Decreased range or variety of foods that will eat
  • Frequently eats a different set of foods than the rest of the family

Problem feeding

  • Restricted range or variety of foods
  • Refuses entire categories of food textures
  • Cries and “falls apart” when presented with new foods


  • Accept a limited diet in relation to sensory features
  • Food refusal is related to aversive or fear-based experiences
  • Extreme pickiness; distractible and forgetful

Treatment Approaches – Align Treatment w/ Diagnosis

  • Systematic desensitization
  • Flooding/escape extinction
  • Eating disorders

Case Studies: When Assessments Go Well, and When They Don’t

Picky eating –

  • Case 1 = 2 ½ year old male with limited number of accepted foods he will eat, variable eating from one day to next, issues staying at the table
  • Case 2 = 2 ½ year old female with restricted food range, over reliance on liquids for calories and swallowing assistance
  • Case 3 = 9 year, 8-month-old male with lack of healthly proteins per parents, and no vegetables in his food range

Problem feeding –

  • Case 1 = 3 year, 10-month-old female with a G-tube, born at 26 weeks gestation, complicated medical history
  • Case 2 = 4.25-year-old female born with congenital Rubella, poor weight gain, restricted food range, episodes of gagging and coughing, episodes of refusing to eat


  • Case 1 = 15-year-old male with chronic “chok-y” sensation, significant weight loss, hospitalized in an Eating Disorders program
  • Case 2 = 13-year-old male with difficulties eating food at school, restricted food range per parental report, refusal to eat vegetables

Practical Feeding Strategies for Pediatric Feeding Disorder

Routines and environmental supports

Matching foods to a child’s skillset


Management of maladaptive behaviors

When to Refer

Red Flags

Picky Eater vs Problem Feeder criteria

Copyright : 10/26/2018

Breathing, Digestion and Swallowing - Best Practices in Dysphagia Management

Program Information

Target Audience

Speech-Language Pathologists, Speech-Language Pathology Assistants, Occupational Therapists, Occupational Therapy Assistants, Respiratory Therapists, Nurses, Nursing Assistants , Restorative Nursing Staff, Dietitians, Dietary Managers, Long-Term Care Professionals


  1. Analyze the development and interrelationships between the respiratory and gastroesophageal systems
  2. Determine the impact of respiratory and gastrointestinal functioning on swallowing
  3. Analyze respiratory and gastroesophageal disease processes for which dysphagia is a symptom
  4. Analyze the evidence to support various diagnostic tools such as reflex cough testing, pulse oximetry, and clinical and instrumental swallowing assessment
  5. Evaluate common indicators of reflux and how they impact the treatment process
  6. Determine which patients are most at risk for developing aspiration pneumonia



  • Overview of systems - anatomy/physiology
  • Breathing/Swallowing coordination
  • The apneic signal
  • The relationship of coordination to aspiration
  • Laryngeal Chemical Responses (LCRs)
  • Reflexive cough
  • esophageal function 
  • Barriers to reflux
  • Saliva swallows
  • Digestive acids
  • Reflux mechanisms  
  • Relationship to feeding disorders  
  • GERD signs and symptoms u
  • When does GER become GERD?
  • Reflux, feeding and swallowing behaviors
  •  Relationship to dysphagia
  • Pressure relationships and their effect u
  • Asthma/gastroesophageal reflux connection
  • Laryngopharyngeal Reflux (LPR)
  • Pulmonary Clearance Mechanisms
  • Aspiration in infancy
  • How much is too much?
  • Predictors of pneumonia in various populations
  • Aspiration and oral hygiene
  • Infant Respiratory Distress Syndrome (IRDS)
  • Bronchopulmonary Dysplasia (BPD)
  • Respiratory Synctial Virus (RSV)
  • Congenital Heart defects
  • Obstructive Sleep Apnea (OSA) and dysphagia
  • Congestive Heart Failure (CHF)
  • Obstructive Conditions
  • Restrictive Conditions
  • Pneumonia vs Pneumonitis
  • Community Acquired Pneumonia
  • Healthcare Acquired Pneumonia
  • Aspiration Pneumonia
  • Non-invasive positive pressure ventilation
  • High flow nasal cannula
  • Intubation
  • Post-extubation dysphagia
  • Tracheostomies
  • Physiological changes associated with tracheotomy
  • Clinical assessment – what are we looking for?
  • Cognitive assessment
  • Pitch elevation
  • Serial swallows
  • Oral mechanism
  • Respiratory factors
  • Cough
  • Respiratory muscle strength
  • Instrumental assessment
  • Modified Barium Swallow studies
  • Fiberoptic Endoscopic Evaluation of Swallowing
  • 3 ounce water tests
  • Understanding lab values
  • Diet modifications
  • Implications of dietary changes
  • Compliance issues
  • Thick liquids
  • Complicating factors associated with thickening
  • Water protocols
  • Compensatory strategies
  • Sensory interventions
  • Principles of exercise physiology
  • Lingual strengthening
  • Effortful swallow
  • Mendolsohn maneuver
  • Masako maneuver
  • Shaker head lift
  • Chin tuck against resistance
  • Head extension exercise
  • Jaw opening exercise
  • Tongue pull back
  • Effortful pitch glide
  • Expiratory muscle strength training
  • Upper GI studies
  • Ph Monitoring
  • Esophagoscopy
  • Scintigraphy
  • Lifestyle modifications
  • Positioning
  • Diet modifications
  • Medications
  • Effects of acid suppression
  • Surgical interventions
  • New directions in reflux management
  • Endoscopic procedures
  • Melatonin
  • Acupuncture
  • Magnetic Sphincter Augmentation

Copyright : 07/26/2018

Eating with Ease: Managing Complex Feeding & Swallowing Problems in Children

Program Information



  • Autism
  • Down syndrome
  • Cerebral Palsy
  • Development of the respiratory system
    • respiration vs. ventilation
    • coordination of breathing and swallowing
    • homeostasis
    • pulmonary clearance mechanism
  • Aspiration and aspiration pneumonia
  • Assessment
    • respiratory rate
    • dyspnea
    • breathing/swallowing coordination
    • cough
    • stress behaviors
  • Interventions
    • compensations
    • positioning
    • respiratory control
    • exercise
  • Clinical assessment
  • Instrumental assessment
  • Interventions
    • diet modification
    • thick liquids pros/cons
    • strategies and compensations
    • oral hygiene
  • Development
  • Disorders of the GI system
    • reflux and reflux disease
    • constipation
    • eosinophilic esophagitis
  • GI/Respiration inter-relationships
  • Assessment
  • Interventions
    • dietary modifications
    • medications
    • positioning for sleep
  • Potential treatment strategies for real life scenarios
  • Development of the oral motor system
  • Postural stability
  • Assessment
  • Interventions
    • the role of exercise
    • muscle tone interventions
  • Development of the sensory system
  • State regulation
  • Taste and smell
  • Assessment
  • Interventions
  • Assessment
  • Interventions
    • the feeding environment
    • hunger manipulation
    • reinforcement
    • shaping
    • family education/involvement
  • Transition from tube feeding  to oral feeding
  • Potential treatment strategies for real life scenarios
  • Special diets
  • Use of supplements


  1. Examine the interplay between oral-motor, gastrointestinal, and respiratory systems and their impact on food refusal in children in order to expand volume and variety of intake.
  2. Analyze the signs and symptoms of pharyngeal dysphagia in children to prevent aspiration associated illnesses.
  3. Evaluate advantages and challenges associated with dietary modifications and use of thickened liquids with a goal of increasing safe oral intake.
  4. Apply rationale for various dietary recommendations currently being implemented with children in order to separate fact from fiction about special diets.
  5. Determine the pros and cons of various oral-motor & sensory treatment approaches to maximize safe, pleasurable eating and drinking in children.
  6. Develop a behavioral treatment plan to address problem feeding behaviors including food refusal, limited food repertoire, low volume of intake, and rigidity around foods and utensils.

Target Audience

  • Speech Language Pathologists
  • Occupational Therapists
  • Certified Occupational Therapy Assistants
  • Dietitians
  • Nurses
  • Pediatric Nurses
  • Pediatric Nurse Practitioners
  • Early Intervention Staff
  • Respiratory Therapists
  • Educators

Copyright : 04/27/2018