Possible barriers to improvement of Jack’s feeding might include:

• Parents don’t agree with strategies e.g. may not want Jack to ‘Give up’ the bottle. 
• Parents don’t believe or trust that strategies will work e.g.
• Overriding concern that growth will slow if milk is reduced and Jack doesn’t eat.  Then what will they do?
• Continued belief that there is a medical cause for Jack’s feeding problems.
• Difficulty implementing strategies consistently.
• Personal or cultural beliefs about feeding children e.g. belief that parent is responsible for all aspects of feeding or letting a child go hungry is not good parenting.  Differing beliefs and expectations of others involved in Jack’s care such as grandparents or extended family could be impacting consistent implementation of chosen strategies.
• Changes in social circumstances.   

Options for management of barriers might include:

• Modify strategies to help improve compliance.  Aim for strategies to be implemented in smaller steps.
• Tactfully challenge parents beliefs to create a shift in thinking.  Depending on the issue consider asking: 
• What do you think would happen if......? 
• What would need to change for mealtimes to become enjoyable for you and Jack?
• Re assess possible contributors to Jack’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 Jack’s current feeding difficulties.
• Dietitian referral for assessment of nutritional adequacy of Jack’s diet, advice on mealtime environments and food requirements for a two year old or reassurance regarding growth.
• Speech Pathology referral if concerns regarding food textures are contributing to parental anxiety.

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