OTS 201: School Lunch Struggles and Sensory Processing in School-Based OT
- 3 days ago
- 37 min read
Updated: 1 day ago
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Welcome to the show notes for Episode 201 of the OT Schoolhouse Podcast.
When a student refuses to eat at school, it affects everything—academic performance, regulation, social interactions, and the afternoon meltdown that follows.
In this episode, Jayson Davies sits down with Alisha Grogan, MOT, OTR/L, founder of Your Kid's Table, to talk about feeding challenges in school-based OT. Alisha brings over 20 years of experience working with extreme picky eaters and shares what school-based practitioners need to know about supporting students who struggle with lunch and snacks.
You'll learn how to identify when picky eating crosses into extreme territory, why the cafeteria environment can be so overwhelming for sensory-sensitive students, and what accommodations actually help. Alisha also clarifies the often-confusing scope question: what can school-based OTPs reasonably address versus what requires outside support?
Whether you're freezing up when feeding comes up in an IEP or wondering how to support a student who won't eat at school, this conversation offers practical, realistic guidance grounded in both clinical expertise and respect for the school setting.
Listen now to learn how to make lunchtime less stressful and more successful for the students on your caseload.
Learning Objectives
Learners will identify the clinical indicators that distinguish extreme picky eating from typical developmental selectivity.
Learners will identify and address environmental barriers in the cafeteria that prevent students from eating at school—and implement appropriate accommodations.
Learners will identify scope of practice for feeding intervention in schools by understanding what is appropriate for school-based OT versus what requires outside clinic-based or medical feeding therapy.
Guest Bio
Alisha Grogan, MOT, OTR/L is a licensed pediatric occupational therapist and the founder of Your Kid’s Table, a platform providing education and resources on sensory processing, primitive reflex integration, executive functioning, and feeding challenges to parents and pediatric therapists.
She has over 20 years of OT experience working with children with developmental delays, autism spectrum disorder, ADHD, and a wide range of sensory and regulatory difficulties across a variety of settings including school-based, early intervention, and private practice. Alisha also founded and runs a unique week-long sensory summer camp in Pittsburgh.
Quotes
"At school, the number one goal is just them getting the nutrition that they need."
— Alisha Grogan
"School is one of the things that always comes up for parents. Often kids will not eat at school, even if a parent is sending their preferred items."
— Alisha Grogan
"I don't know that I agree that it's a school-based therapist's job to improve the variety of foods that they're eating, but it is their job to help them have a successful meal, lunch, snack time with what they are eating."
— Alisha Grogan
"It's nice to hear you say some of this because we all want to support the kids as best as we can... but if we don't have the tools at our disposal, we maybe don't have the training... it gets tricky."
— Jayson Davies
Resources
👉Mealtime Works (Affiliate Link)
Episode Transcript
Expand to view episode transcript
Jayson Davies
Hey there, and welcome to episode 201 of the OT Schools podcast. All right, you already saw the title of this episode, and you clicked play anyways. Therefore, you definitely already know that today's topic is a hot one in the schools. My goal for today's episode is to help you see just how dynamic all of the feeding concerns that you may come across in school-based OT, actually are, and to help you understand how you might support some of your students in that sensory intense cafeteria on your campus. To do that, we are diving into feeding challenges in school-based OT with someone who has been a trusted voice in the pediatric feeding space for over 14 years, Alisha Grogan is a fellow occupational therapist and the founder of Your Kids Table, where she's helped countless families and therapists, both in the clinic and in the schools, navigate extreme picky eating, sensory processing challenges, and feeding difficulties. In this episode, we are getting real about what school-based OT practitioners can and should address when it comes to feeding. We'll talk about why some kids refuse to eat in the cafeteria. We'll talk about simple accommodations that you can implement tomorrow in the schools, and we'll also discuss where you can draw the line between school support and clinic level intervention when it comes to feeding. This conversation will give you the confidence and clarity that you need to support those picky eaters that you have on campus, as well as explain the intricacies of feeding on campus in those tough IEP meetings. So, let's go ahead and get started with Alisha Grogan.
Amazing Narrator
Hello, and welcome to the OT School House Podcast, your source for school-based occupational therapy tips, interviews, and professional development. Now to get the conversation started, here is your host, Jayson Davies. Class is officially in session.
Jayson Davies
Alisha, welcome to the OT School House podcast. Thank you so much for being here today. And how are you doing?
Alisha Grogan
I'm, I'm doing great, and I'm so happy to be here with you, and talking to your, your people. It's great.
Jayson Davies
I can't say my people, because I believe that my people are your people, your people are my people, especially in this online space.
Alisha Grogan
That's true, that is very true. It's a small OT world that we live in, right? Yeah.
Jayson Davies
Yeah, yeah, and you have so many wonderful resources. I really appreciate them. And you know, I, as we were kind of talking a little bit before this, you know, when you really got started with your online blog and everything that you're doing, it was really early on, and you were one of the few out there.
Alisha Grogan
Yeah, it was 2012 early 2012 when I started, and so, yeah, actually, just this past month we hit 14 years, which is kind of crazy, and there just wasn't a lot of people, any really, there was just very few therapists present, any type of kind of specialties online, there was a lot of mommy bloggers, and so I was also, they were very, very popular at the time, people were following them every single day, kind of this was the precursor to social media, and I was cringing sometimes at at the well-meaning but misguided advice that was often being given because you know we know the complexities of development, and you know sometimes there was just, gosh, you know, I just read through these comments and I would just think, oh my gosh, there's so much we're not talking about here, and I, at the time, I really did feel this like kind of call to just like I need to be a voice pouring into stuff that's going to really help parents, or you know, there are all of these other challenges that this well-meaning blogger is, that is a parent, is meaning to cover from their own personal experience with their child, who is likely pretty typically developing, and doesn't have extra challenges, so the suggestions and the strategies are not going to probably be effective for another child that maybe has a diagnosis or has more complexities, or and families feel really unseen in that, yeah, you know, so that was such a big reason that I started in the first place.
Jayson Davies
Absolutely, as an occupational therapist who graduated right around that time, I really appreciate it, because I know there wasn't. I looked for podcasts and they weren't there, and even I think it was you and Kara, Kara Kosinski.
Alisha Grogan
Who actually graduated at my site. We went to the same university in Pittsburgh, which is crazy. Yes,
Jayson Davies
yeah, that's awesome. And the two of you, so helpful to all of us, you know, OT practitioners that were just kind of getting into the space at that time, because you're really too, like, the only ones out there to really look for, you know, other than research, which is a lot more difficult to read. Then the nice friendly blogs that you all write, so we appreciate that, but you know what, let's take a step back, you know, before 2012 and I just want to kind of let you share and ask you, like, what drew you into pediatrics, and maybe even more specifically into feeding.
Alisha Grogan
Yeah, that's a, that's a great question. When I was in high school. This is the mid to late 90s, and this was when inclusion became became a new method for teaching children of different disabilities, and I sat in my ninth grade classroom, and they came and gave a presentation about the kids that were our peers that had special needs, and how what it would look like for us to have friendships with them, and I was so moved by this presentation, and I got involved with the special needs classroom, and just ended up spending a lot of time there, I found it just so meaningful, and so it was really my work, and they were my peers, really, at the time, but I just, I fell in love with that work in that kind of population, and so when I headed to OT school, so you know, a couple years later, I had several people suggesting to me, have you thought about being an occupational therapist, because they saw what I was doing with these kids, and so when I went to OT school, I really knew that I wanted to work in pediatrics, and I know a lot of people say that, you know, you talk to most, I feel like a lot of OTs, in you know, in their first couple years, say they want to work in pediatrics, but I really knew in my heart that I would, yeah, yeah.
Jayson Davies
And then, so you began working in the pediatrics, what did you go straight to clinic schools contract gig? What was that? Out of school.
Alisha Grogan
I had the most amazing first job in Washington, DC, at a private practice. The owner was in semi-retirement, Lynn Israel. Shout out to her, I'm sure she's enjoying retirement. She's.. she was California-based at the time, but she was one of Jean Eyre's apprentices, and so I had just such an incredible experience there. There was just a mentorship program set up. We had trainings every single week. I was immediately put into an environment where I was completely supported and got this really deep foundation in sensory processing and reflex integration that truly became a lens that I looked at the rest of my career through, and still I still is so foundational to me, and how I look at everything with kids. I then ended up moving back to Pittsburgh, and worked in private school, and actually, in that private practice, we, we ran a summer camp, we worked in private schools, we ran the clinic, so I was in a variety of settings within that one practice, which was really awesome and unique. So, I, my days looked different, you know, depending on what day of the week it was, which was great. When I moved back to Pittsburgh, I was in an approved private school. I shortly started early intervention on the side, home-based care, zero to three. Eventually, that became my full-time gig, and when I moved to early intervention, my caseload became full of picky eaters, and so, because, yeah, because speech therapy, I mean, so many kids from zero to three need speech therapist for speech, so they were completely out of capacity to treat feeding at all, and so they never, and I mean never treated speech unless it was like a really specific swallowing issue, and so it was completely on OTs, and many OTs, myself included, did not have training in feeding, you know, it was a, it was one class in my pediatric, in my pediatric course in grad school, that I think we talked about a nook brush, like I don't know, I mean, I was like super vague, and I had a little bit of exposure with feeding, for sure, in my approved private school, we were working with kids that had significant physical disabilities, so the feeding looked different there, it was more of a mechanical type of feeding that I was helping them with, more of a self-care skill, also not this kind of picky eating where my kid is literally eating two foods, and if I don't drive to McDonald's and get him this food, he is not going to eat a single thing, and the parents, yeah, I'm like showing up at their house and they're looking at me like they're not taking weight. Yeah, well, we, yeah, like, what? Like, tell me what to do. Tell me what to do. And so I had to figure it out. And so I just, I started reading the research, or reading the books, started talking to mentors, I started taking every feeding course I could take, and I just kept. I kept trying everything until it, like, and then it became distilled down to a system where I could just see, you know, this kind of pattern emerge of what was really effective, what what really was helping kids, and so once I started, once I once I started getting results with these kids, my caseload soon became full of them, because then, of course, every feeding kid was put on my caseload. So, but there's a huge, the way that I treat feeding, there's a huge sensory component, obviously, that often goes along with that, and so there's, yeah, there's a really big sensory component to most of my treatment with feeding,
Jayson Davies
Wow, and at the time, this is, I'm assuming, kind of like the early 2000s mid 2000s ish.
Alisha Grogan
Mid mid to late 2000s yeah. I graduated in 2004
Jayson Davies
Okay, so then at that time, I mean, were there OT lead feeding type of intervention courses? Is that kind of what you, what you went to, or did you have to go kind of go outside the world of OT to get some training? What did that look like?
Alisha Grogan
Well, it was, it was shifting, and that's when SOS came out. That was that was the course that really shifted everything for me, which, of course, is taught by Kay Toomey, who comes from a psych background, but, but she very much valued the role of OT and speech, and she really saw a team approach. So, I'm sure many of your listeners have taken SOS. It is, it is as, as many therapists should. I recommend that to any therapist that is, that is really doing a lot of work in feeding. SOS is just one of the, the best, the best comprehensive courses that you can take, particularly if you're in a clinic or a home-based setting. Little tricky in a school setting to implement SOS approach, but she really was multidisciplinary, and so she had such a solid understanding in this, she pulled a ton of sensory stuff in, hence, like, you know, sequential oral sensory is what SOS stands for, so the oral piece, you know, she's seen the kind of the speech end, and even just the mature end that you know OTs can cover as well, but then also this huge sensory component that was going on for so many of these kids, and so even within the even within the niche of feeding, I really became, you know, and what I, what I often use is the term, you know, extreme picky eating, or very picky eater, or because you know, obviously feeding itself can even be a pretty wide umbrella with all of the challenges, yeah, that kids can have, so you know, I wasn't really treating, although, of course, those kids would end up on my caseload from time to time, kids with cerebral palsy that had significant difficulties with chewing and coordination. Most of the kids that I were treating, although they sometimes, for sure, had oral motor stuff going on. Many of the kids that I've worked with, in person, in real life, and the families that I have serviced around the world through your kids table, have been families that these kids kind of look quote unquote typical, or they have some neurodivergence going on, you know? Maybe they have autism, maybe they have ADHD. There's no diagnosis, there's all this sensory stuff going on, and their eating is stressful, they're eating very little, they're highly specific, and there's a ton of anxiety around food, though. That's kind of that, like, is my niche within the niche. So, oh yeah.
Jayson Davies
Good deal. And now I think you know a lot of people, we think of feeding, we think of that clinical side of things, and you just kind of talked a little bit about that clinical side, but I'm actually interested to hear from you a little bit. When you talk to the parents, maybe even when you talk to students, do they talk about school? Do they talk about school being difficult because of this and that? And what have you heard?
Alisha Grogan
Oh, 100% School, school is one of the things that always comes up for parents. Often kids will not eat at school, so even if a parent is sending their preferred items, a child is not eating. This, this comes up so often, and that you know, and there are a variety of reasons that that happens. We can kind of talk through those if you want, but then also sometimes parents don't even know what to send, so sometimes that's an issue, like my kid is so inconsistent, and at home I'm standing in front of the pantry and saying, do you want this or this or this, so when I pick in the morning and I send it, I I'm guessing at that moment if that's going to be what they feel like eating and if they. Don't they're not eating all afternoon, so their academic performance goes down. They're getting dysregulated, so in social interactions are suffering. They're coming home often, having a meltdown, because they're pushed past their capacity, because they literally have not eaten, and so this becomes a significant stressor for parents, because they're worried about their school performance, understandably, and this really difficult transition that can happen when they get home, because they're now starving, and then the other element that happens is they're starving, so you have to, they're coming home, they're not having a snack, they need, they need a meal, and so now they're eating a whole meal at maybe 330 or 4o'clock when they get home from school, and then dinner is sabotaged because now they've just eaten this entire meal, and so now one of the, you know, one of the principles that I teach is sitting down to eat together, which is a huge step for a lot of families, and there's a lot of ways that I break that down into smaller steps and help families get there, or just focus on it for certain nights, if that feels like an overwhelming task, but then we're like totally missing out on any opportunity for dinner, so you're having like this, you know, weird after school huge meal, and then, and then they're hungry before bed again, you're trying to get them ready for bed, it just, it like throws off the whole cycle, so.
Jayson Davies
Yeah.
Alisha Grogan
This comes up quite a bit, I think, for these parents with kiddos that are struggling to eat a variety of food.
Jayson Davies
Yeah, absolutely. And I'm sure you've had a lot of, you know, parents reach out to you. I guess what, trying to figure out how to word this one. My kid, right? I have a four year old, he is typically very good with food, but every now and then he gets a little picky and stuff, and then you obviously have the population that you've been talking about a little bit. Have you ever had parents like come to you, I guess, and say, "My kid is really picky? And then, to a degree, to yourself, you're kind of like, "You're no, your kid might be picky, but not in this way. Like, I guess what I'm trying to allude to, or get to, is like, how do you determine, like, really what is more of a concern versus what is a kid who, yeah, it's picky every now and then, but maybe not as much of a concern.
Alisha Grogan
Yeah, I mean, this is this is something that we teach all the time, because picky eating is a subjective term that is used very easily in our culture. It's also very common. It is, it is a, it is a typical part of development for kids to be more selective from around the time they are one until usually around three and a half, and even up to five years old, where you kind of will just see some of this natural pickiness, and there's all kinds of reasons for that, like their taste buds enhance at that point, you know, when we think about what's happening with them developmentally, and they're starting to see themselves as their own entity, they're exerting some sense of control of, hey, look, I can say no to this. I'm not just, you know, passively taking this in, and what happens if I say no? And there's all.. there's all these cognitive and developmental aspects that are going into that. When a child is kind of just in a natural picky eater stage as a toddler or preschooler, when we look at kids that are more extreme picky eaters, we're really looking at this as having a significant impact on their life, either on their nutrition, on their health, on their quality of life, either for themselves or for their families, that there's sometimes a financial stress, you know, if your kid is only eating from McDonald's, and you have to pay for McDonald's every day, instead of being able to use a house, you have to get in the car, you have to use gas, you have to do all these things, you can start to feel really trapped by that, so when, when all of those, when those elements are in play, we really start to look at this as tipping more towards extreme picky eating, and there are some diagnoses now that sometimes kids get if it is in the severe state. I would say that these diagnoses are still not kind of culturally known, you know, so I still think we're still kind of generally saying picky eating, but what I'm really looking at, and this, this actually goes back to Kay Toomey's guidelines, and I have, I have used this for years, and it's when a child is eating less than 20 foods in their diet, and that does mean everything, because sometimes parents will say, well, okay, I'm counting cheese as one thing, but they eat five different types of cheese. Now, I would probably count five different types of cheese if they're eating, you know, if they take American cheese, if they take mozzarella string cheese, like those are different foods, so if we're looking at 20 foods or less, where. Looking at trying to control the food, and that you're going to see that there's a, there's distress if they do not have a food that feels safe or like something that they can eat, and you will usually see when they're in this extreme picky eating category, where it's like, hey, you know what? Maybe we need to get more help with this. We need to start approaching this from a different standpoint. You are usually going to see again some kind of gagging, shuddering, extreme anxiety when food is sometimes put on the table for some kids, like it could just be on the table and they're just looking at it. For other kids, they have to taste or touch it to get that reaction, but if, if you're, you know, if you're seeing a kiddo and they gag at foods, I mean, if there's, if there's one food, you know, like, I mean, there, we do kind of all have, you know, these unique sensory systems, and for some of us, there's a, there's a food that just really is like, oh, that, like, nails down the chalkboard, I'm talking like you're seeing this pretty much with like anything outside of their safe foods.
Jayson Davies
Yeah, gotcha. Thanks for sharing that. We're going to take a quick break, but when we come back, we're going to start to talk more about feeding in the school-based OT room. So, stay tuned. All right, Alicia, I want to start talking more specifically about school-based OT. I know you've worked in the private schools, but you also mentioned, you know, really you've worked with all the kids, obviously the kids go to school, and you mentioned school-based. You also mentioned some reasons, maybe why kids might go to school with their preferred food but still not eat. I'd love to hear a little bit more about that.
Alisha Grogan
Yeah, so what commonly comes up for kids when they have their preferred foods and they're still not eating is that they are super overwhelmed in the cafeteria environment. So that can come from a couple different places, and so obviously, as OTs, it's our job to figure out what, where is the overwhelm coming from. Number one is this a light and sound type of situation, which it absolutely can be. I have certainly worked with kids where it's just, it's so over stimulating in the cafeteria from a noise standpoint that they're getting very dysregulated, they're getting very agitated, and you know, once we get so dysregulated, our appetite shuts off, so even if you have not eaten well, you, you lose your appetite, and so it sometimes is just the noise, sometimes it's the lights, sometimes it's peers, you know, bumping into you. Some kids, they're just so dysregulated by the time they get to lunch from everything they've been doing all morning that they're just kind of shutting down, and now they're kind of in this chaotic environment, on top of everything. There's just.. there's not a chance for them to kind of calm and to be able to eat. Another big factor, though, is a lot of these kiddos that are struggling with this, you know, again, we'll call quote unquote extreme picky eating, which again in itself is kind of just an umbrella category, because they may have, you know, this diagnosis of ARFID or PFD, which is pediatric feeding disorder. If they have one of those diagnoses, and maybe, maybe they don't, they are likely to be disgusted by other kids' foods, and so even just seeing other kids, and especially if there's kids at the table that are encouraging them to try something, or maybe making fun of the food that they're eating, that also happens sometimes, because sometimes the things that they're eating are a little bit unusual, or they're eating the same exact thing every day, and kids are just going to comment on that, and so when another child, when that child is really sensitive to it, or feels like they're being watched or seen, there's just a lot of anxiety around eating, and so it just becomes a lot easier to just not eat, and to close that, to close that lunch box.
Jayson Davies
Yeah, and there are a ton of smells, and the cafeteria, it often kind of mushes together into this really weird smell, but a lot of kids are more sensitive to smells than I am, so.
Alisha Grogan
Yeah, right, absolutely, absolutely,
Jayson Davies
Yeah. So I kind of want to walk through this process where we talk a little bit about what you've done from kind of the clinic side to support these students at school, and then our work kind of work our way up to like what you feel would be the best thing ever for like for feeding and school based OT, but like I said, I want to start with kind of what you've done. So, what are just some of the popular things, the more common things that you've done with some of your students, not as a school-based OT, but to support them at school?
Alisha Grogan
Right, so we talk about having a plan with the child, so even though it's the morning, and we have to take into consideration, too, if the morning is chaotic and hard for these kids. Again, a lot of times these kids are sensory kids, they're neurodivergent kids. So going through the routine in the morning has all these it. Own stressors, like getting that arousal level up in the morning, is hard, and so we do a lot of talk about regulating in the morning, so that they're starting the day from a really regulated standpoint. Now, of course, if there is a school-based OT that is working with that kid, if I know that there's a sensory room at that school, if I know that there's bandwidth, if there's an aid, if there's somebody that's able to get them to the sensory room to start off their day, that's definitely becomes part of the plan. I would say more often than not, that is not what I'm working with. So I'm working with a family to say, even if we have five more minutes, how can, like, how can we use that time well to help get your kid regulated, so now we're talking about sensory strategies, you know, we're talking about, you know, crossing midline activities, really just getting getting the brain in a regulated place when they leave, which can actually have an impact on lunch. If they're regulated, they can also help make a choice about what they're going to eat for lunch now, that that can work the night before too, and for some families that does that. We're making a plan. Hey, this is what's going to go in your lunch. What options do you do you want to have? This is one time. Normally, I, my goal is, is that at every meal for kids that are so sensitive to these foods is that we're working towards, or they already have at least one food on their plate that they don't typically eat, so that they're getting comfortable with it, they're getting used to it. That might be a bowl that's like sitting halfway across the table at first, that might be one pea on their plate in a divided plate, where it's sure not to touch anything else. But yeah, but this at school, that is all off the table, like there's just no point, like there's no point in like making sure, so this is the one place I tell parents, like don't try to send the peas to school, like at least at this point there is definitely benefit for that as you're making progress, and then it's and then it becomes a point where it's helpful for a child, even if they're not going to eat it, to say, oh yeah, those are in here, and that's okay, and I can still eat my lunch, and you know, maybe working towards that, but for school, what I always tell parents is that the number one goal is just them getting the nutrition that they need, so that they can do what they need to at school, so whatever that is right now, that's what we need to start with, and we just start with them having a plan. We also do other things, like putting notes in, you know, if a kid is old enough to read, like something really encouraging, a joke that's going to make them laugh, that's on the, that's on the really low end of support, of like this is, this is like basically what we're doing, then if that's still like we still need more support, then I'm looking into, are there things that we can do and that are appropriate, and the child is going to respond to, like, our noise canceling headphones a good option right now? Is that going, are they are they missing out on peer interactions, or are they so upset that they're not interacting anyways, and at least this is going to allow them to be calm, and they're still with their peers, and they can, you know, eat here. Is it a weighted lap pad that's going to help them? Do they just need a fidget in their other hand that they can just kind of squeeze while they're focusing on eating? So we look at some of those supports, if it's still in a really difficult place, I have worked with parents to help them have it added to the 504 plan to have the teacher get on board, the school basically get on board with them having a quiet room to eat, and so some schools have done this where they pick a friend to go eat with them in the quiet space. There's a ton of social dynamics, and this varies so much from school to school, like what faculty is willing to do. There's, there's obviously such a concern, and even as I say it, the last, you know, like, they're just, gosh, we don't want them eating by themselves, we don't want to like pull them out, it's this social experience. This is supposed to be a fun time, but if a child is not eating and they're totally stressed, sometimes as a temporary measure to help them reset and start getting comfortable eating at school, that can be a really good solution. Or maybe they're staying and eating in the classroom, you know, they're staying in eating classroom teachers in their eating, or they're just kind of hanging out. It's just not so overwhelming. And then we start working up to them being able to tolerate it. Now, of course, if they're in feeding therapy, or they're using a home program, and they're working on these kind of underlying sensory processing sensitivities, they're following a program, this isn't life sentence. This is okay. This is where we are right now. We know that it takes time, especially with feeding, to see progress, and so as that progress is unfolding, we have hope and expectation that this lunch situation is going to get better. Also.
Jayson Davies
Yeah.
Alisha Grogan
Yeah.
Jayson Davies
Wow, yeah. I mean, it's amazing how much you can actually do without even technically being in the schools, but that then also leads me to wonder, because I am sure in the last 14 years you have heard from many school-based OT practitioners, and you've probably heard similar things that I've heard, like A, I want to address feeding. I don't know how. B feeding doesn't belong in school-based OT, and countless others, I am sure. And so I'm wondering, from all you know, from all the things that you've heard, and you know it's probably changed in the last 14 years. What are you seeing as current practices? What are OTs coming to you and saying, like, this is what I'm already doing or not doing as a school-based therapist.
Alisha Grogan
Yeah, I do. I mean, again, in my world, I'm fortunate because you know I have people taking our picky eating program, which is called Mealtime Works, and so when they come into Meal Time Works as therapists, even we've had many school-based therapists, they're open and willing and wanting to learn, so I think I do hear more often from the therapists that are wanting to help and.
Jayson Davies
Optimistic.
Alisha Grogan
Yes, optimistic, wanting to help support, they always want support in how do I make this work in this school environment, because a lot of the suggestions that I make have to happen at home too, and the thing with feeding is, oh, it is tricky, because I did early intervention for such a long time, so I was in the home, and when you're this is so different than when you're working on fine motor skills, or you're working on handwriting, or you're working on sensory processing. It's kind of like this isolated thing that this kid is going through, and the family is coming along and supporting them. Eating is very personal to people, the way that they eat, how they eat as a family. Do they eat in front of the TV? Do they eat together at all? Do they have these homemade recipes that we're making when we look at different cultures and the types of foods that they're eating, the expectations that are there. So, when we start coming in and saying, hey, it might be good to sit at the table when we eat, that can be unbelievably difficult for some families, and if you're not working with the family on an ongoing basis, like in a home setting or in a clinic setting, where you're really having a lot of that contact to support them, you really can feel like you're hitting a wall there. And I think that's where a lot of school-based therapists come, because they start learning strategies, and some of these things that I'm talking about, you know, we teach a five-step system, and so, like, our first two steps are really structure routine to just start forming this foundation. It's like steps three and four are when we get into the sensory pieces, the feeding techniques, but for most kids they really just need this foundation. And so I think for school-based therapists, as they start learning these strategies, it's like, okay, I can work on the sensory stuff as a prep activity, and like, have this be dual purpose. I can incorporate fine motor into that and make it like align with my goals, but how the heck do I start having a family start to eat together, serve non-preferred foods, you know? And I would say there's a significant.. there's a hurdle there, but I think every one of us, even if you're in the home or you're in the clinic, you're feeling that because you're you're up against an individual family's culture, and you have to be a respectful of that, and b show them the benefits of why maybe working towards some of these changes would be are really going to help their child start eating more food, which is what they're really looking for, and so I bend rules, my own quote unquote rules, all the time, because they need to work for people, they need to, you know, it can't be a totally rigid system that it's like when something is stressful that I'm asking a family to do, they're not going to do it, so for school-based therapists, and what we teach in our program is, you know, I mean, we just, we have a lot of handouts, we have a lot of visuals, we have a lot of clear step by step, so that parents feel supported in that on the on the home front. Now, I would agree with their, I mean, I agree and disagree with therapists that say feeding isn't school-based, ot it's not appropriate. Well, it is because they eat lunch there, unless they're not eating lunch. It is one of their activities,
Jayson Davies
Or even snack time.
Alisha Grogan
Right? If they're eating at all there, it is. It is part of it, but but that is way different than trying to have an impact on all of their eating throughout the, you know, 40 meals that they're eating every week, that is, you know, I think for school-based therapists, if you have a family that is motivated and is looking to you for guidance and you're able to provide. Um, handouts and visuals to them to help get them started, that that's appropriate, but it does become beyond the scope to try to make significant change in the home environment when you know, because of what you're seeing at school, and so I think that the supports, like, have to, I think I hope that it gives the school-based therapists that are listening to this, a little sigh of relief in that if you're addressing it at the school-based level and you've offered some resources to the parents, that I think you're doing an amazing job, because that's what's appropriate for your role in that setting. Did I answer that all the way?
Jayson Davies
I think so. I mean, my only.. I guess my follow-up would be, you know, there are some times where we get asked by the parent or by the IEP team to further address the issue inside the cafeteria, and you know, earlier you, you mentioned a few different things about the cafeteria, right? The smells, the sights, the sounds, all of that. Let's kind of frame it this way, like in your perfect world, how could a school-based OT practitioner have an impact in the cafeteria, maybe directly with a student in the perfect school-based OT feeding world.
Alisha Grogan
Yeah, and so for me that's number one, are identifying what the triggers are in that environment, you know. Again, we talked through all those, like, which, what is going on there, you know. We tend to see patterns, I mean, it can vary from day to day, you know. Maybe, you know, whatever, the triggers could look a little different, but if a kid is really struggling with smell, they're probably going to be really struggling with that smell most days, you know. And maybe they cook something that day that's particularly stinky, that isn't always in there, that's a little bit more triggering, but again, for the most part, you know, you're going to see a pattern, and I think that's where, you know, we need to come in and really look through that sensory lens of, and just really overall nervous system regulation, what is going on that is making it really hard for this kid to eat, and I think I think that's where we, we use our clinical reasoning assessment skills to just say, look, this is this is what I think is going on, let's try out some of these supports and to see how we can help this child eat. I don't know that I agree with that. It's a school-based therapist's job to improve the variety of foods that they're eating, but that it's, it is their job to help them have a successful meal, lunch, snack time with what they, with what they are eating. So I think that that may also mean having conversations with the parents, maybe the parents are saying, I mean, most parents are not doing this, quite frankly. When you have a child that's in this extreme picky eating category, they know that their kid is not going to eat anything out. Else, you know, parents that try, they'll wait it out and see, which is what some doctors, unfortunately, still say, oh, well, you're just giving in, you're giving them whatever they want, just wait it out, they'll get hungry enough, and they will eat. That is false. Kids that are in this extreme picky eating category, because this is like they are having serious anxiety, sensory processing difficulties with this food, or oral motor challenges, maybe even physical challenges. There are so many kids that have undiagnosed physical stuff going on that like reflux and EOE and all of this stuff that is.
Jayson Davies
Worth the hunger.
Alisha Grogan
Yeah, yeah. And so you're gonna, you're gonna, you don't give me what I can eat, fine, like I'm not gonna eat, and they will not eat. I have had countless families who have followed that advice, who have ended up in the ER because their kid was like at the point of passing out, and they're on like day two, you know? I mean, the parents always end up caving because they can see this isn't working, like this is not, this is not working, like we are trying to wait it out and see. And so that would be the only thing, if you had a, if a therapist listening right now is like, oh my gosh, I have a family that is just insistent that they're not sending the x, y, or z foods that their kid really likes, then that's an education piece. I would say again, look, it's at school, this is so important, after school time to work on this, but right now we just need them to eat, and let's start here. So, I think that that's where the therapist speaks into that. I think it can be an appropriate goal if a child is significantly struggling with lunch. You know, this is an ADL. It's happening in this setting, so it is very appropriate to say to help that child eat lunch. So, again, yeah. Then, what are the supports? Does that mean we're taking a break? Am I doing therapy while during lunchtime? If that's, if that's a primary goal, or we're I'm rotating through, you know, maybe every third session is we're one on one at lunch, and I'm assessing, and I'm trying to, I'm testing different supports and strategies, so that this child. Feels more comfortable and is able to eat the food that is being sent.
Jayson Davies
Yeah, I feel like in the past, for me, a lot of our quote unquote feeding goals that we would sometimes address would be more access related to the food. To be honest, it's kind of a fine motor skill, right? So, like, to open up the bag, so that they can get to the carrots to open up a milk carton to be able to put the straw into a juice box, something like that. To me, I honestly, a lot of times, froze up when it went a little bit further than that, like I didn't always have a plan, and, and it's kind of honestly a little nice to hear you say, right, that education piece is, to a degree a lot of what we can do and what we should be doing at schools, and kind of not putting necessarily the onus on us to try to expand food, because that is definitely something that does come up in IEPs, and sometimes parents are comfortable sharing that, other times they're not. I think, like you mentioned, food eating is such a personal experience in every culture, every person does it a little bit differently, but it's nice to hear some of the things that you're saying. You know that for some things we need to have more than what we can do in a cafeteria, and I appreciate that, and I'm sure other school-based OTs appreciate that as well, a little bit. So, thank you.
Alisha Grogan
Good. Yeah,
Jayson Davies
I want to switch the subject a little bit. I'm going to be a little selfish here, because I just talked a little bit about some of the difficulties that I had when I would freeze up when it came to eating, but there was one other kid, and I can see him vividly in my mind - third grade at the time when I was working with him. I still see him around town. You see those kids, right? We also, well, you all see our kids outside, okay. Anyways, he seems to be doing good when I see him, but this always made me feel uncomfortable again. And it was more along the pica world, and I don't know how familiar you are with that, but this was a kid, he, he had picky eating, and on the flip side, he would come to school, and I don't know if he had a formal diagnosis of pica, but he would eat erasers, he would eat glue, other odds, and in school, and I just want to pick your brain on that, and kind of what you have experienced, what you've, what you know about it.
Alisha Grogan
Yeah, I mean, clinically I probably have a few families online I have worked with that have pica, but clinically I have, and especially in approved private schools with kids that have often multiple diagnoses and multiple things going on. Yeah, it's, it's really, it's really tricky, and I do think that there is something neurological going on with it, in just terms of that it always feels very neurological to me, as in, like, there is some confusion around what is edible and what is not, and like, legitimate, like, confusion around that, and also that there is a, there's a huge sensory component, I think, also, so with, with texture, with, you know, gosh, if you think of, like, you know, if I think of a kid chewing an eraser, you know, I think of a dense amount of proprioceptive input that they're getting from that, that might be pretty, pretty rewarding, and make a kid want, make a kid want to do that, you know. We emphasize, like, whenever I'm working with a kid with pica, I do work on sensory integration a lot. We're doing a lot of deep work in texture play. I have a, like, I have a protocol, because I think earlier in my career, you know, you just like, "Oh, play in a sensory bin, and I did that for a long time, and it's good. It's so good, like, I'm not saying don't play in a sensor bin, play in a sensory bin, it's so good. I think there's so many ways to adapt it. I think we should be doing it with so many older kids, because so many kids have texture sensitivities. I think kids now more than ever don't get their hands dirty, and it totally affects all their sensory processing and all of that stuff. But I do think we need to get kids in deep textures, they need to get their feet in the textures, they need to, they need to play in the textures for a while, and they need to be in like gritty textures that are helping kind of their tactile system start to process sensations more than they even need messy textures, they need gritty textures like sand and bird seed and rice to really be playing in deep bins to kind of help their brain start to process the sensory input better, and also, you know, and then that's pulling in even sensory integration, because again, you know, I couldn't say like what pathways are particularly activated, but when I start working on sensory integration and reflex integration, and I can get to some like deep neurological stuff. We can, I have seen the needle move with some of these kind of odd challenges, that it's like, what is going on, like what is going on here?
Jayson Davies
Yeah, yeah. Thank you for taking on that, that question. I know that it was not an easy one, and it's not one that I prepped you for, so I appreciate that, and I completely agree, and it is really like we were really kind of at a loss, and this IEP team, you know, we would meet, gosh, probably three times, if not four times a year, because this was always coming up, and it was really hard to, like, I just felt like we continue to try to use cognitive behavioral strategies and.
Alisha Grogan
That's great too.
Jayson Davies
Yeah, but it's just so limited, like you're limited in what you can do, right? Like, especially, you know, this was a third grade. I also worked with him in fourth grade, I believe, and there's only so much time that you have eyes on a third grader and a fourth grader, right? Like, this isn't a small preschool program where you're constantly, you know, teacher has eyes on the kid all the time. I mean, he would sneak off into the cabinet in the classroom, and no one would even notice that he got it until later in the day, like it was just really hard, and you know, not, you know, you mentioned sensory integration, and you know, this is a big topic in school-based, obviously, you know, we, we don't have all that in the schools, and so that makes it more tricky as well, and, like, I don't know, part of the reason I bring this up too is just to share with all the practitioners out there, like, these are not things that happen overnight, and these are not things that we can always address as the school-based OT, and sometimes we need support outside. Sometimes we need to, in a very crafty way, suggest support from outside occupational therapy in a way that's not going to put the district really mad at you. Like, these things happen, and it's tough. And so that's why I like having these tough conversations a little bit, right?
Alisha Grogan
Yeah, absolutely, because it's not, it's yeah, like, if you don't have, gosh, if you don't have the equipment and the ability to treat, it's, I mean, some, yes, some of these, some of these challenges are beyond the scope of school-based practice, it just is, you know, and that's, but like you said, I know that there's a lot of politics behind kind of, kind of saying that in, in a setting, and unfortunately, I do think sometimes school-based therapists are looked at as, well, you're no tea here, so just, you know, fix it, yeah, like, yeah.
Jayson Davies
Yeah, another topic, another day, another podcast. We've had that topic on the podcast before. I'm sure we'll have it again. It's a tricky one, and again, like I said earlier, it's a little comforting to hear you say some of this, because we all want to support the kids as best as we can, and we all, like, we think the same way that you just kind of said, right, we're OTs, we want to be able to support these things, but if we don't have the tools at our disposal, we maybe don't have the training, we don't have a classroom full of rice bins and all the fun stuff, it gets tricky. So, Alicia, I think we're going to wrap up today, but I really appreciate your time. I really appreciate you willing to have some, some real tough conversations. I know it's not always easy, but we always appreciate, appreciate it here on the podcast. Really quickly, you did mention your course. I would love to let you share where everyone can go to learn more about that.
Alisha Grogan
Yeah, absolutely. So, we do. We have several courses. We have Meal Time Works, is our picky eating program. So we do go a little deeper in there, you know. It focuses on these kiddos with extreme picky eating, but it is a plan. It is a program. We have dozens and dozens and dozens of handouts in there that are all written for parents that are beautifully designed, visually appealing, that you get to use forever with your caseload, so they're yours, like when you become a student. But yeah, it's a.. if you're looking to get more help on feeding and want to feel like you have some training in it, I would definitely suggest trying that out. You can find it at your kids table.com you can just kind of click on classes, or yeah, I'm sure that'll be in the show notes, at least the website, yeah, so yeah.
Jayson Davies
Yep, we will link to that, we'll also link to the SOS program, as well as some of the other resources that you've mentioned, and make sure to make it super easy for everybody to find, and yeah, Alicia, thank you so much. I hope we get to do this again sometime, because it was really great learning from you.
Alisha Grogan
Yeah, it was great to be here. Thanks so much, Jayson.
Jayson Davies
All right, and that is a wrap on episode 201 Alicia, thank you so much for joining us today and sharing your incredible expertise on feeding challenges in school-based OT as well. Was in the clinic from all the school-based OT practitioners, in fact, all the pediatric OT practitioners who have had to learn a little bit about feeding. We greatly appreciate all the tools that you have put out for all of us at YourKids table.com If you want to dive more into feeding and helping picky eaters, be sure to check out Alicia's Mealtime Works program over at Your Kids table.com And, of course, to you, thank you so much for being here. Really appreciate all the work that you are doing, and all the work that you're putting in to supporting your students more. You definitely don't have to spend your time listening to an OT-related podcast, you could be listening to Serial, a true crime podcast. Maybe you like to watch the news or listen to the news via podcast, but you were here today learning about feeding, learning about improving yourself as an OT practitioner, and I really appreciate that. If you're looking for more resources, more professional development, and more mentorship to support your school-based practice. I would love to invite you to join us over at the OT School House's school-based OT collaborative. Inside the collaborative, you'll get access to our full library of resources, professional development sessions, as well as a community of school-based OT practitioners who get exactly what you're going through and are ready to support you. Check it out at OT schoolhouse.com/collab That's OT schoolhouse.com/collab Until next time, keep making a difference in all the students that you serve in their lives, and take care.
Amazing Narrator
Thank you for listening to the OT School House podcast. For more ways to help you and your students succeed. Right now, head on over to OT School house.com Until next time, class is dismissed.
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