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Resources for Feeding, Eating, Drinking, Speech, and Mouth/Airway Function


Hot Topic Blog - Feeding, Eating, & Drinking


Julia Fisher, MA, CCC-SLP in New York City

March 2014


I work in early intervention in New York City where I go into children’s homes to provide services. There are an estimated 300 cultures or nationalities living in New York City. Each culture has not only its own utensils and menus but also its own cultural response to feeding changes suggested by an outsider with authority. Many of my families do not speak English, and many of the mothers have little formal education. Here are some of my ideas for working in a multicultural environment. I hope they will be helpful to you.

There is an expression that one must “give time time,” and that is what I do when I enter a new home. I ask permission to:

  • Observe a typical meal preparation
  • Observe the mother and child share a meal
  • Participate in a family mealtime

I also ask the families to record a 4-day feeding log. Then, I ask them to tell me about the dishes in the log.

We, as therapists, often become accustomed to living in our own little corners of the universe and forget that all people don’t view the world in the same way we do. So, I may ask the same questions I asked on my first visit again on my 2nd or my 5th visit as the mother and I begin to understand each other’s cultures and needs. It’s a 2-way street and partnership. I help parents understand the process, so we can become an active team of problem solvers. For example, if a parent doesn’t understand why questions are being asked, then the answers may be tailored to why they think the information is being asked. We all do this in any interview process, and we must remember this in our daily therapy.

Many parents have expressed the notion that a mother should innately know how to feed her child which is not necessarily true with the complexities of modern life. A mother may also think that if someone tells her she is not “doing it the right way,” she has failed in being a good mother. Therapists can help families move beyond these limiting ideas, because a breakdown in the basic mother-child bonding experience can have many levels of emotional overlay that may impact feeding therapy.

So in New York City and other places where a variety of cultures coincide, therapists will often encounter cultural differences that are unique from their own. These differences may include:

  • A different culture,
  • A different language,
  • Different foods,
  • Different utensils,
  • Different ways of preparing foods,
  • Different cultural norms for when a child is transitioned to new foods,
  • Different socioeconomic levels,
  • Different levels of parental education, and
  • Different types of mothers. 

I have found that a good way to approach treatment is to observe the mother-child interaction and the whole family at mealtime to assess the family’s norms. A family of 13 children treats mealtime very differently than a family with one child. It’s critical that we, as therapists, take the time to learn about each individual household.

Once my assessment is completed, I ask a parent’s permission to buy some food for the child to try. Many of my families have never eaten graham crackers or other things we might view as "typical" toddler foods. Many of the staples we use as transition foods in feeding therapy don’t exist in other cultures. If a family has more than one child, I bring new foods for everyone to share. I try to bring healthy snacks, and we have a Snackfest. If a child is in need of a more restrictive diet, I use the knowledge I have gained through the sharing of family time to come up with a variety of activities and menus that the family can utilize.

As therapists, we have our favorite toys, utensils, recipes, etc. I like to give the parent and child choices, so they can develop their own favorites and styles. If a parent does not feel at ease and empowered during feeding therapy, follow-through will be minimal. I have found that working as a team is most effective in moving a child and family forward in feeding treatment.

Thank you for reading my thoughts and ideas on this topic. As you can tell, I am passionate about my work. Please feel free to email me with your thoughts, ideas, or questions. My email is