Possible barriers to improvement in Ava’s feeding might include:

• Ava’s parents don’t believe or trust that strategies will work.  They maintain an underlying belief that there is a swallowing problem.
• Difficulty implementing strategies consistently
• Continued use of food in pouches for convenience.
• Parents too busy to provide graded experiences and allow time for self-feeding.
• Unable to tolerate mess
• Personal or cultural beliefs about feeding children e.g. feeding independence is not encouraged.  
• Changes in social circumstances.

Options for management of barriers might include:

• Aim for strategies to be implemented in smaller steps.
• Re assesses possible contributors to Ava’s feeding difficulties.
• Consider possibility that full details were not obtained or not all information was provided or taken into consideration at the initial assessment.
• Consider referral to another health professional for assessment or further opinion while you maintain your involvement e.g.
• Medical referral to confirm or reassure parents that there are no medical issues contributing to Ava’s feeding difficulties.
• Speech Pathology referral if concerns regarding a swallowing problem continue.    
• Note: Feeding difficulties may sometimes be present before other issues that may result in a diagnosis emerge.
  • Dietitian referral if growth falters while changes are being implemented.  Short term slowing of weight gains may occur while changes are being made but these are expected to be short term and will not affect height.

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