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

• Parents don’t believe or trust that strategies will work.
• Personal or cultural beliefs about feeding children e.g. belief that being a good parent is measured by how well the baby feeds and grows.  
• Social circumstances. 
• Overriding concerns that growth will slow further. 

Options for management of barriers might include:

• Tactfully challenge parents beliefs to create a shift in thinking.  Depending on the issue consider asking: 
• What do you think would happen if......? 
• How do you think Nina might feel when......? 
• Nina’s mum is isolated and may benefit from assistance to increase social support networks.   
• Reassess possible contributors to Nina’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 Nina is healthy and achieving developmental milestones as expected.  Although Nina is small her growth is tracking appropriately.  Alternatively if feeding difficulties continue despite implementation of strategies consider the possibility that there may be an as yet undiagnosed underlying organic cause

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