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

• Parents don’t believe strategies will work.  May feel they have tried it before.
• Loss of motivation by parents to achieve change.  Progress is often slow and parents may find it difficult to maintain strategies when results are not obvious. 
• Difficulty implementing strategies consistently.  Parental conflict regarding management of mealtimes.
• Personal or cultural beliefs about feeding children e.g. belief that parent needs to provide food that their child will eat.  Fear that child will starve if they don’t eat all meals.
• Other needs for Max take priority. 
• Changes in social circumstances.

Options for management of barriers might include:

• Ensure expectations for achieving changes are realistic.  Look for small positive changes.
• Modify strategies to make them more realistic or achievable.  Aim for strategies to be implemented in smaller steps.  
• Reassess possible contributors to Max’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 e.g. Max has chronic constipation contributing to reduced appetite.
• Link mealtime strategies to other interventions for Max e.g. learning to make and understand consequences of choices or understanding and following routines.
• Consider referral to another health professional for assessment or further opinion while you maintain your involvement e.g.
• Psychology referral for behaviour management strategies.
• Dietitian referral for assessment of nutritional adequacy.  Despite high consumption of ‘junk foods’ all food groups are included Max’s diet. If diet is assessed to be adequate in micro nutrients this may help reduce parental anxiety.  Alternatively if indicated advice regarding a suitable children’s multi vitamin may also reduce anxiety.
• Occupational Therapy referral for support with managing any sensory issues.

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