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Interventions for the Co-Occupation of Feeding: Considerations for the Experienced Clinician

Interventions for the Co-Occupation of Feeding: Considerations for the Experienced Clinician
Jennifer Pitonyak, PhD, OTR/L, SCFES, CIMI
February 12, 2014

 This text based course is a transcript of the live webinar titled, "Interventions for the Co-Occupation of Feeding: Considerations for the Experienced Clinician", presented by Jennifer Pitonyak, PhD, OTR/L, SCFES, CIMI.


>> Jennifer Pitonyak:  I am guessing that those of you who are participating are likely providing services to children who are experiencing difficulties in the area of the occupation of feeding or eating.  When I envisioned this webinar, I wanted to target clinicians who were more experienced.  I wanted to focus on feeding and mealtime as a co-occupation, and using occupation really as a means as well as an outcome.  As part of interdisciplinary teams we are evaluating and providing intervention for children with feeding difficulties.  Many times these interdisciplinary teams are situated in medical settings where it is important for us, as practitioners, to have expertise in a "bottom-up" approach. This is identifying the underlying health conditions that are related to the feeding difficulties in order for the OT to focus on specific client factors and performance skills.  For instance, we might focus on the client's tone, or look at specific body parts such as the cheeks, lips or the tongue.  We could also look at tongue mobility and chewing.  In my first five years of clinical practice I sought out continuing education for techniques that were going to help me address specific impairments mentioned above. However, I wanted to take a different slant for this webinar. 

We know that participating in meals is an essential occupation that occurs several times each day.  It not only provides children with the necessary nutritional intake, but it provides them opportunities for learning and social interaction.  We have to recognize that meals take place within specific environments and contexts that influence the social meaning of this occupation.  For instance, is it a family meal or a holiday that has very specific traditions, rituals, or routines?  Or is it a meal that is on the go, maybe in the car, going through a drive through, while traveling or running errands, or transporting children between other activities?  The context of the meal determines how the child is going to be participating.  I would like us to think about mealtime participation as a therapeutic agent rather than simply the end product of our occupational therapy services. 


One of my objectives today is to talk about the role of occupational therapy on multidisciplinary teams.  I want view this through a top-down approach.  It will help us identify our role in being occupation based in working with children who have feeding difficulties and their families.  It is not to say that we should not use bottom-up strategies.  We definitely have to have the expertise and skills to address client factors and performance skills so that we can help with impairments like poor lip closure and weak tongue movements. However, it is important to recognize that these are preparatory activities and part of a broader occupation-based approach to mealtime participation.

OT Role on Multidisciplinary Team

Feeding teams often exist in inpatient hospital settings, but also are in the community in a diversity of settings.  I have found that our role as the occupational therapist depends on a number of factors.  It will depend on that practice setting, and the severity of the child's underlying medical conditions often dictates the setting. 

jennifer pitonyak

Jennifer Pitonyak, PhD, OTR/L, SCFES, CIMI

Jennifer Pitonyak has over 14 years of clinical experience as an occupational therapist in a diversity of practice settings, including early intervention and the neonatal intensive care unit.  She holds specialty certification in feeding, eating, and swallowing from AOTA, and is a Certified Infant Massage Instructor.  She is currently on the faculty at University of the Sciences in Philadelphia, where in addition to teaching, she collaborates with community partners to develop occupational therapy programs for infants and families.  She recently completed doctoral studies in health policy with research on the social and contextual factors that impact breastfeeding duration.  Her clinical and research interests include infant and family mental health.  

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