[00:00:01] Speaker A: Presented by Feeding Matters with host Jacqueline Peterson and Dr. Hailey Estrom.
Feeding does matter.
Welcome to Feeding Does Matter, a podcast about all things feeding and eating in Pediatrics, hosted by Feeding Matters. I'm Jacqueline Peterson and I'm joined by my host, Dr. Haley Estrom. Haley, how are you doing today?
[00:00:28] Speaker B: I'm doing fantastic. Jacqueline, how are you?
[00:00:31] Speaker A: I'm doing well. We've both got vacations coming up, so I think we're starting to get a little bit vacation mode and a little sloppy happy, but it's good. Yeah. And it's especially good because we're talking to our close friend and colleague Kyler Romeo today about the feeding skill domain. So, Kyler, thank you for joining us.
[00:00:51] Speaker C: Oh, I'm so happy to be here. There's nothing more than I love talking about than feeding, feeding families.
[00:00:58] Speaker A: My two feeding and families. Yep.
[00:01:01] Speaker B: Yep.
[00:01:02] Speaker A: Well, tell us a little bit about yourself.
[00:01:05] Speaker C: Well, I am an occupational therapist by clinical trade and I'm board certified in feeding, eating and swallowing. And I have the pleasure of working for Feeding Matters as the director of strategic initiatives. And then I also maintain my clinical skill by working with families in the neonatal intensive care unit. So I get the best of both worlds.
[00:01:27] Speaker A: Perfect.
[00:01:28] Speaker C: Okay, so today I'm hoping to have a discussion about what is functional feeding and what do our current screening practices look like. We're going to dive a little bit deeper and talk about the diagnostic features of feeding scale delay and dysfunction and how that impacts our overall function in our view of health and disability. And then we're going to talk about a pathway that we can offer more support and talk about factors that really influence how our kids are able to be successful at their meal times.
[00:02:05] Speaker A: And the feeding skill is a piece that not many people know about. But from your perspective, how do you kind of even think about feeding skills?
[00:02:15] Speaker C: Oh, I view feeding as so much more than just putting food in your mouth and getting enough food to grow.
Feeding and eating is truly a vital human occupation. And there comes, in my occupational therapy lens, mealtimes are an opportunity to teach children not only how to eat, but also how to communicate, how do they care for themselves, how do they care for other people, and how to socially connect. So while when we think of that word feeding skill, we think of perhaps how to put food in our mouth, how to chew and how to swallow, and then how the body processes food, it truly is so much more than just eating.
[00:02:55] Speaker B: Yeah. And when you talk about it being like a cultural activity, that really brings it into that family centered piece too, because it Happens within that setting. Right.
So it so often happens, at least with a dyad.
So children start out being fed by a caregiver.
[00:03:20] Speaker C: Right. And that may be the term. Dyad may be a new word to some people because it's not something that we say just in common language.
So what a. First we'll kind of talk about what a dyad actually is. A dyad is a word to describe an intimate relationship where you have two people that are mutually dependent on each other. And that is a good way of describing feeding, because as humans, when we're born, we're completely dependent on our caregivers in order to provide us nourishment. But that relationship does not exist in isolation. It's not just about the caregiver's interaction with the child. The child then responds to the caregiver, and the caregiver receives that communication and that guides their next step of how they respond to the child. So it's like this beautiful dance in between the caregiver and child. And if there's anything that disrupts how that child can respond based on how they're feeling, how they're medical, you know, are they medically. Well, do they have the skill to respond and do they know how to respond, that affects how the parent acts towards the child as well. So when we're looking at feeding, it is within a relationship, and we have to look at both people, both parts of the dyad, if we're going to provide them any sort of help or support.
[00:04:52] Speaker B: Right. Because that occupation for them, it's not an independent occupation.
[00:05:01] Speaker C: No, it's completely dependent on the other. And that can be a positive. And in my viewpoint, it is very positive. But it also can be challenging if one side is having trouble because it takes so much skill to identify that there's something going wrong and then knowing what to do is the next step.
Yeah.
Interestingly, if we better understand how our child's role and responsibilities are associated with mealtimes, if we understand how those roles and responsibilities change over time as they grow and develop, it really helps us as caregivers and parents know what to expect and then how to support that skill development. Which is why it's really helpful to have a big picture kind of view of what successful or typical eating looks like.
[00:06:04] Speaker A: Yeah, I think they don't really share that very easily to new parents. I think we're so used to being asked, like, are they crawling, are they walking, how many words are they sharing? But we're not comfortable with the language of feeding skill development as New parents or even as our pediatricians talking with us. Yet I think everybody kind of comes at it from a different perspective, right?
[00:06:28] Speaker C: And if we take that same lens, though, of how we look at how their motor skills changed or how their language skills change, if we apply that lens to feeding, then I think we actually know more than we think. So if we're looking at how they're. If we know that as their body structures grow and change, it gives them freedom to have new skills. If we put that same lens on with feeding, we'll see that as that child's oral structures grow, as their mouth gets larger, as their muscles develop, that helps us conceptualize or understand why they go from sucking from bottle or breast to now having more capability of taking complementary foods, another fancy word for solid foods or pureed foods. And as they continue to grow and get new motor skills, now they can feed themselves, they can touch and play with food, they can start gaining new skills, such as moving into straw and cup and utensil use as well. It follows a very similar pathway that we see with gross motor and fine motor skills.
[00:07:43] Speaker A: So as we look at feeding skill, what's kind of to be expected as children are gaining skills.
[00:07:52] Speaker C: Well within the first few days of life, an infant just has to learn how to coordinate sucking, swallowing, and breathing. And they do this at breast or at bottle. And in some other countries, they start with cup drinking at this age. But as their oral structures grow and the child has more movement options because they just have more space in the oral cavity and more muscle development, then they get to have the exciting task of starting to master new tongue and lip and jaw movements. And then that is what eventually leads to chewing. And with the introduction of solid foods, which in the US typically occurs around six months of age, being pureed food, then that older infant learns other skills. They get to learn how to open their mouth when they see the spoon, they get to learn how to touch and play with food so that they understand all the sensory properties of food, which builds their enjoyment of food. And then they just keep building and building on their skills as they go from an infant to that toddler to that preschooler. And you get to add in a whole new category of learning, which is the communication and the social and the autonomy expectations of can you learn how to sit at a table and watch others? And do you learn how to feed yourself and serve other others food and learn how to clean up after meal times? And all of those components are quite important for you to get to be the young child and the adolescent that ultimately is going to have responsibility for feeding themselves by adolescents age.
[00:09:35] Speaker A: Yeah, that makes sense.
[00:09:36] Speaker C: Now, tracking skill progression over time and knowing what to expect as that child grows older is really helpful in identifying if there's a problem that could be developing.
Our families, our pediatricians, our nurses, and people out in our community often use developmental milestone charts.
There are several versions. One is published by Child and Adult Care Food Program. These are ones that are free and available online, and they really serve as that backbone for screening.
They're also used in public education campaigns. So some families may be most familiar with these charts that show a big overview of what to expect as kids get older. But one thing to keep in mind, that while those tools do exist, often feeding skill screening is not included specifically. It's not required during wall check visits when you go and see your pediatrician. And feeding skill may not be broken down into the smaller components or sub skills, which can make it difficult to identify if there's a problem that may be existing.
[00:10:52] Speaker A: Yeah, because it's not really treated as its own developmental domain. It's kind of listed in the other domains of kind of the communication or social emotional. Like, I remember, even one of the questionnaires we were looking at was like, the only feeding question was, can they have. Do they independently hold a spoon and bring the spoon to their mouth? And there's just so much more involved in feeding skill development than are they able to independently use a spoon?
And that was even one of the first feeding questions before you even got to that point. And there's so much more that happens even before that point.
[00:11:28] Speaker C: Yeah, you're really identifying a knowledge gap, not only on the public health side, but also with our pediatricians and our medical professionals of what sort of questions should we be asking, and how can we identify when things aren't going as they should a little bit earlier?
And then also to make it even more complex, feeding skills can look very different depending on the child and the caregiver partnership. It can depend on the child's developmental stage, what skills they've already learned, and then also how meal times are set up in the home. So that just adds an additional layer of complexity when we're trying to help figure out if things are going well at home. Yeah, that kind of brings up the question that we need to ask every family individually is, what is a successful meal time?
[00:12:22] Speaker A: Yeah, and I know that that's kind of mentioned within the context of the PFD definition, but they really go into it within three kind of that safe age. Appropriate and efficient. Can you tell us more about that?
[00:12:35] Speaker C: Sure. Our three, basically, like your three primary tenants, if a meal time is successful, is one, is it safe?
Two, is it age appropriate? And then also is it efficient? And if we look at that a little bit closer, safety is really this absence of what we call adverse events. That's something that they'll often refer to in the medical community. But an adverse event is any indication that that child doesn't have the skills that they need in order to manage what's being given to them to eat, drink, or to swallow. And that can look externally, it can look like choking, coughing, trouble breathing. It may be a child that gags or vomits even on site of a food without a food even coming to their mouth. It could be that tiny baby that instantly falls asleep when they're offered bottle or breast and they're not able to take in the calories. Or it can be a bit more complex and get into the psychosocial domain. And it can be associated with food refusal or a fear response when food is shown. So that first is we need to have an absence of adverse events. These things should not be happening at safe meal times. The other thing is when we talk about the skills are as expected for their age, it's that it means that the skills have developed progressively over time that they're not missing big categories of food. They're able to drink liquids, they're able to eat solids, they're able to eat a variety of textures if it's appropriate for that person's age. And then lastly, when we talk about efficiency, this means that those skills are so functional that that child can finish a meal in an expected typical timeframe of the family, that they're not finishing meals in five minutes, causing concern that they can't get enough calories, but they're also not taking an hour to eat, where it's an excessive amount of time spent at mealtime to get in the calories they need.
[00:14:44] Speaker A: Those would be red flags.
[00:14:45] Speaker C: Exactly.
[00:14:46] Speaker A: Too short of a meal time and too long of a meal time.
[00:14:49] Speaker C: That's correct.
The meals that they need are the red flags. And if you put all that together, that means they're functional.
[00:14:58] Speaker B: So when you say finish, like so they end the meal before they've really actually finished the food.
[00:15:05] Speaker C: Right.
[00:15:05] Speaker B: It's not that they eat it all in five minutes, but they.
[00:15:09] Speaker C: Exactly.
[00:15:10] Speaker B: Before it's done.
[00:15:12] Speaker C: Right. I have a teenager at home and he can absolutely put down an entire meal in five minutes early.
[00:15:19] Speaker B: They don't really finish it in Five minutes, but they just end in five minutes.
[00:15:23] Speaker C: Very good point. That's important to clarify, especially with anyone with older children.
[00:15:29] Speaker B: Got it.
[00:15:33] Speaker C: Well, if we really want to. If we want to talk a bit more about function, there is a model that helps simplify functional presentation, or I guess it gives us a framework at looking at how a person speaks, how their health and wellness and the activities that they need to do all connect to generate this picture of can we participate in life and be functional, or do we have some areas of need and we could use a bit more support? So I just wanted to orient everyone to the International Classification of Disability and Health, which we call the icf. And this is a model that helps us understand the impact of any medical condition on our ability just to participate in life.
[00:16:23] Speaker A: Yeah, it's a really holistic look. I think that's why it was important for the authors of PFD as both a framework and the diagnosis. To think about it in these terms is it's not something that's typically done as much in the United States. I know you as an ot, are really comfortable with it, but this as a framework is a really helpful way to look holistically at what a condition does, to kind of the whole picture of our life.
[00:16:48] Speaker C: What I like, too, is that it really bring it. It brings in this medical wellness piece that we might just be looking at a child or a family, at the skills of the parent and the child. But what's going on medically? You know, is there anything happening to that child's body structures or function that is impacting whether or not that they can participate? Is there something that's impacting safety and their ability to eat efficiently?
If you take the model to help kind of guide your thought process and why problems are occurring, it gives you guidance to first check and see. Is there any health condition? Is there a potential that there's a disorder or a disease that's impacting how that child eats?
And then it helps us understand, does that health condition cause a disruption in the body function or structure? And there's lots of different examples that you can. That you can work through to describe this, how problems evolve or impact our ability to participate in meal times. And one example might be like a child with a cleft lip and palate.
Cleft lips and palates can happen because of particular disorders or differences in formation in utero. And when you have a cleft lip or a palate, that means that your body structure has changed, you have an opening in your palate, and it makes it difficult for you to drink and eat as efficiently and effectively as a person, that doesn't have that structural difference. So it impacts your activities and it can impact how you participate in drinking from the bottle and eating food. But that doesn't mean that you cannot be safe, age appropriate and efficient. Sure, you absolutely can be a functional eater. And we just need to look at what do we need to provide you from the environment side. What do we need to provide you as a person so that you can participate at the level that you want to for satisfaction?
[00:19:00] Speaker A: The ICF and pfd, we use like the term function a lot. And I think it's especially true as it relates to feeding skill and feeding skill development. What does functional kind of even mean or kind of wrap this point up about the ICF with us? You know, in what function means?
[00:19:18] Speaker C: Function is your ability to use your skills and respond. It. It's the ability to use your skills to complete activities so that you can participate in life.
That is function the measure of if something is functional, is that person able to participate in the manner that they want to?
[00:19:41] Speaker A: Yeah, I love that. I think that's a really helpful context in a feeding environment especially.
[00:19:50] Speaker C: And one thing that we have learned from the ICF is that we know that if we have a medical condition and that does cause this disruption in body function and structure which impacts our ability to perform activities, we can present with pediatric feeding disorder when it causes an inability to take an oral intake of nutrition that's inappropriate for our age and lasts for a duration of time.
[00:20:20] Speaker A: Right, sure.
[00:20:21] Speaker C: So I was hoping that we could talk about what does that mean specifically through the feeding scale lens? Because often this domain is one that our families are identifying and are in the role of communicating to their physicians that they think a problem exists. Right?
[00:20:41] Speaker A: Yeah, yeah. They see it first. And so what are the different components within that? The feeding skill domain diagnostic qualification, that feeding skill dysfunction. That would qualify a PFD diagnosis.
[00:20:52] Speaker C: Right. There's three main categories or three primary categories of signs of dysfunction. One is the need for texture modification of foods and liquids. Another is that we have to modify the child's feeding position or use special equipment. And then the third is that we are using modified feeding strategies. And those are really kind of like global terms. And it'd be helpful, I think, to talk about what those each mean specifically.
[00:21:21] Speaker A: Yeah, I think so, too. So first up, the texture modification of food or liquid, what does that mean at a deeper level?
[00:21:27] Speaker C: Right. Texture modification is when you have to take the food or the liquid and change it in some way to make it easier for that child to eat or to drink. That could look like cutting up food into very teeny, tiny, itty bitty bites. Even though the child is 9 years of age and should have the ability to chew. It could be having to puree or liquefy all food because the child doesn't have chewing skills yet. It also could be thickening liquids where you take breast milk or formula and you have to add things to it to make it thicker so it's easier for that person to swallow safely. And then on the reverse side it can actually be thinning liquids. Some people have a really difficult time swallowing thick liquids and you actually have to dilute them down in order for them to eat it safely.
[00:22:18] Speaker A: And that's where the age appropriate piece comes into play. Because we're used to our children having maybe cut up foods or pureed foods. But if they're getting older and their feeding skill development should be at a place where they should be able to chew, that's where the dysfunction and even though, like it's not a functional way to participate in life comes into play. Would that be a way to say that?
[00:22:39] Speaker C: That's an excellent way of framing that out. And one thing that comes to mind when you say that is that is the older child that's now going off to preschool or perhaps elementary school and they don't yet have the skills to drink from a cup or drink from a straw and they continue to use their bottles for nutrition. That would be a good example of that and what it looks like in real life. Another sign of dysfunction within the feeding skill domain is the model is the need for modified feeding positioning or equipment. And when we talk about modified positioning, we want to think of like, what does it typically look like to feed a child at that age? Infants we're able to hold in our arms to breastfeed or to bottle feed older children an expectation that they can sit up and they can sit at the table and sit in typical chairs. But some children have to feed in very particular positions in order to be able to get their nutrition. Some infants have to feed continuously while laying down flat. If you put them in an elevated position, they don't have enough strength to pull the liquid from the bottle. So that would qualify as a special feeding position. Some kids are only able to swallow and move the food from the front of the mouth to the back of the mouth. If they really tilt their head very far back, that's the only way they can move food back so that they can Swallow safely. And then there's other kids that need special feeding chairs. They have to sit in high chairs for periods of time that are not expected. They may be an older child, even 12, 13, 14 years of age, and have to use a special feeding chair. All of that would qualify as being modified positioning or having to use special equipment in order for that person to be safe.
[00:24:25] Speaker A: And you don't need a dysfunction in each of these deeper elements. It's just any one of these would qualify you within the feeding skill domain.
[00:24:35] Speaker C: Yes. Yes, it would. And we really highlighted the different positioning, modification of positioning. But I also wanted just to mention how we sometimes see special equipment being used to help kids learn how to eat too.
A sign of dysfunction in feeding skill domain also includes if you're having to change a typical vessel for eating and drinking. So that would qualify is if you're having to use a very fast nipple flow for bottle feeds, or the. Or the baby or the child isn't able to get the liquid in an appropriate period of time. Some families have to resort to cutting the nipple in order to get enough flow so that the baby can eat.
Some families need to use squeeze bottles or special straw cups because the baby or the child doesn't have enough strength to suck up through a straw. And then there's other children that have challenges with their movements and they need to use special spoons and forks, like weighted spoons and forks or cut spoons and forks, or they can't actually self feed. So all of those are examples of equipment changes too.
[00:25:46] Speaker B: If I've done interviews with families about their feeding and the different journeys they've been through. And I remember some mom showing me the bouquet of different spoons they've tried.
You know, like this is our cup of spoons, you know, and then they had another Ziploc bag of the. Of the other spoons that they'd gone through and tried.
Yeah. And all the different series of positioners for the high chairs and all the different chairs.
[00:26:19] Speaker A: I was like the chairs and the cups. I feel like you just often are trying to go through and find what is going to work best for your child if they are a child that has pft. And hopefully you're doing that in partnership with a healthcare professional as well.
[00:26:35] Speaker B: Right. And in part they had been. And this, some of this work had predated the PFD diagnosis and it would have been beneficial. I'm so glad this is here now. Yeah.
[00:26:52] Speaker C: You're showing how our families are true problem solvers.
[00:26:56] Speaker A: Yes. So true.
[00:26:59] Speaker C: Right. Every parent wants to feed their child. It's part of our job is to nourish our children.
And when it's not going well, they're looking for solutions. And they know that child best. And so that's why they're trying all these different things to see if they can help their child be successful, when in fact there could have been an underlying feeding disorder that they needed, that needed to be identified by the medical community so that they could, they could receive help. And so the more we all know collectively, particularly with parents, I really feel like they're going to drive change in this area of bringing help to others and getting earlier identification.
[00:27:40] Speaker A: Power of parents.
[00:27:41] Speaker C: Power of parents. Exactly, exactly. You'll also see families use different or modified feeding techniques. And this is sometimes a bit more difficult to describe because modified feeding techniques is also culturally kind of driven. It's driven by the skill set of the family, like what is the solution to the problem that they come up with. So if you're looking like deep into the literature, it's kind of difficult to identify primary categories of how solution, how families come up with solutions because they're so varied. And we really need to sit down and talk with our families and understand what are they doing to help to see if it qualifies under a modified feeding technique. I just wanted to give you a couple of examples that we see. The most commonly, we'll see families feeding a baby if they're asleep now, eating and going and getting a nice full belly and then transitioning into sleep. That is a description of a positive, successful meal time. But if a baby can only be fed when they're asleep, you have to wait for them to fall asleep and then you have to put the bottle nipple in their mouth or the breast in their mouth, or get them to swallow liquids. That's the indication that you're using a modified technique. And that's a sign that there could be a pediatric feeding disorder. You also may only feed that child certain foods or liquids because they have very strong preferences. And you know, if you offer them different foods or liquids, that they're not going to be able to accept them.
And then it can also be using tools that aren't typical for their age or having to feed your child even though they have the skills to feed themselves. That's another sign that there could be a pediatric feeding disorder.
[00:29:32] Speaker A: So how do families kind of identify PFD or how do families learn about the feeding skill domain?
[00:29:40] Speaker C: That's an excellent question.
Most often we see families enter the care continuum or enter care through medical or feeding skill domains in community settings. And if the feeding skill domain are the professionals that work with children to help them develop new feeding skills. And we'll kind of talk a little bit more in depth about who those professionals are if we want to look at it a little bit more in depth. Now, providers typically are within therapy clinics, whether that's a community therapist, an inpatient therapy clinic, or through early intervention services. Providers may include speech language pathologists, occupational therapists like myself. It can be a physical therapist or other disciplines though, who serve children with feeding skill needs.
Most often we hear that families are served by occupational therapists and speech language pathologists. But just be aware, it really depends on your area and the training that that person has and their scope of practice. So different professionals may be interacting with our families at different points in their care.
One thing for, I think that's important though for families to be aware of is that there isn't a formal pathway for education for training in feeding skill domain. And that may be a surprise to some people. You know, when you.
[00:31:11] Speaker A: I think it is a surprise to a lot of people.
[00:31:12] Speaker C: Right. If you go to a clinic or you're seeing a therapist, then you, you kind of have this, you have an expectation that they've had a certain level of training and that they have a certain amount of exposure to your child's needs. That may or may not be the case. You know, their level of expertise is really dependent on their training and then their ability to apply that training into clinical practice. There's so many factors that impact a feeding scale provider's approach to your child's care.
[00:31:45] Speaker A: Yeah.
[00:31:48] Speaker C: Overall, I think it's very important for families to know that they have rights in their care, that they have a right to the right type of care. They have a right to get care at the right time for their child's development as well as for their family life. It has to work for that parent and it has to work for the family unit. And then they also have a right to the highest level of evidence based care for their child.
So I think we're in a really unique time where families are owning their power and asking for services that really fulfill these three tenants, that they have a right to high quality and appropriate care for their child.
[00:32:39] Speaker A: I think that's beautifully said, Kyler. And I actually think that that leads us to our kind of concluding question for you, which is all about that. It's all about family centered care and what that looks like. And you know, we, we covered a little bit about what the definition of family centered care is. But for you and your perspective and your knowledge in this field, what do you think the biggest challenges are that you see in making pediatric feeding research more inclusive of family perspectives? And how do you think we can overcome them?
[00:33:11] Speaker C: Oh, gosh, that's such a good question. Because it truly is quite complex. But, you know, I'm going to go kind of with a simple answer to a complex question.
[00:33:21] Speaker A: Sometimes that's needed.
[00:33:23] Speaker C: I feel that families need to be empowered and elevated.
I think that families need the tools of demanding inclusion in their care.
When you're coming into a healthcare environment, it's extremely intimidating.
[00:33:42] Speaker A: Very.
[00:33:42] Speaker C: You have somebody that is potentially in a medical crisis that needs help and you're dependent on that person for providing you with the information you need to make decisions for your child. Yet it's not your knowledge base.
I have that experience bringing my own children to the doctor and I'm in the healthcare field.
[00:34:02] Speaker B: Right.
[00:34:03] Speaker C: So first, I think families need to understand how to insert themselves in the conversations with medical providers that they really need to understand and own their role as being the expert their child. And so what are the best, what do families need from us? That's really what I want to know. Like what sorts of education information do they need to be able to feel successful? And then what are the responsibilities on the provider side? I'm really interested.
[00:34:36] Speaker A: I was going to say, do you think that they would listen? Do you think if families were more empowered, do you think that they would be heard always?
[00:34:42] Speaker C: No, I think it needs it. I think it needs training on both sides. And where is that perfect connection? You know, what skills here and what skills here lead to those two meeting in the middle?
[00:34:53] Speaker A: Sure.
[00:34:54] Speaker C: I think that's really what it's difficult to identify at the level of research we have. I want to know where is the intersection? Where is that sweet spot of interesting tools that the providers need and tools that the families need in order to meet in the middle? Because without a clear understanding of what is happening with the child at home and what the families value and what they need, we'll be providing care that is just not applicable to what the child needs.
[00:35:23] Speaker A: Yeah, and that's what we always say in feeding. I mean, feeding is one of those conditions that is happening every few hours. So it's a family providing that intervention most of the time because you have to eat in whatever way that looks.
[00:35:38] Speaker C: Like, you know, kind of going back to what do people need? Maybe people need to start with conversations of what does a safe, age appropriate, efficient mealtime look like at home?
[00:35:51] Speaker A: What does that look like and what's.
[00:35:55] Speaker C: The continuum of that? And then how do we find out what that looks like at home as a provider? What sorts of questions do we need to ask? What do we need to see in order to fulfill our role of being the person that helps identify with families that are having like busy, intense lives?
[00:36:13] Speaker A: Yep.
[00:36:14] Speaker C: Yeah.
[00:36:15] Speaker A: So much. It's so complex, so involved. And I think that's what Haley and I are finding as we talk to everybody is and it's something we've known. But it's interesting thinking about it from this perspective. Each of these domains are incredibly complex and so making it more family centered is also a complex venture. And so we just really appreciate you being here today to talk to us in detail about the feeding skill domain and feeding skill development in children. And I know you're on the project with us for Family Centered PFD Research Consortium and where we're going to head with this project. So we'll chat more about it. But we really appreciate you being here today, Kyler, and thank you so much.
[00:36:55] Speaker C: You are very welcome. It was a wonderful conversation and I just hope we can keep talking about that perfect intersection with caregiver, the provider so that we can guide the research, so families can guide the research.
[00:37:10] Speaker A: Oh, 100%. Conversation doesn't stop here, that's for sure. Well, thank you. Bye.
[00:37:15] Speaker C: Thank you so much.
[00:37:17] Speaker A: Feeding Matters Infant and Child Feeding Questionnaire was developed as an evidence based tool to promote early identification of feeding disorders. Developed by internationally recognized feeding experts, this online questionnaire, available in both English and Spanish, can help you better understand your child's feeding differences and needs. Take it online for free
[email protected] that's questionnaire feedingmatters.org or type ICFQ in your search bar.
