Date of Award

2026

Document Type

Scholarly Project

Degree Name

Doctor of Occupational Therapy (OTD)

Department

Occupational Therapy

First Advisor

Dr. Sclinda Janssen

Abstract

Background: Pediatric feeding participation is influenced by complex interactions among sensory processing, motor coordination, emotional regulation, caregiver routines, and environmental conditions. When feeding challenges occur, the impact extends beyond nutrition and may limit participation in family routines, school environments, and community activities (St. John et al., 2026; St. John & Ausderau, 2024). Access to specialized feeding services can be particularly limited in rural communities where healthcare workforce shortages and geographic barriers reduce the availability of pediatric rehabilitation services (Tak et al., 2022). Occupational therapy practitioners are uniquely positioned to address feeding participation because occupational therapy practice examines the interaction among the person, the task, and the surrounding context when supporting participation in everyday occupations (Dunn, 2017; Dunn et al., 1994). However, therapists in rural communities frequently provide services across multiple systems, including outpatient clinics, early intervention programs, and school-based settings, each of which presents distinct environmental structures, resources, and service expectations. These contextual differences may contribute to fragmentation in feeding intervention approaches across service environments.

Methodology: This scholarly project employed a qualitative, practice-based methodology to guide the development of a clinical resource. A contextual needs assessment was conducted through clinical observation, review of clinical workflows, informal practitioner consultation, and environmental analysis across outpatient, early intervention, and school-based therapy contexts. Findings from the needs assessment were integrated with a focused literature review examining pediatric feeding intervention and contextual influences on occupational therapy service delivery. The Ecology of Human Performance model served as the theoretical framework guiding interpretation of findings and product development (Dunn, 2017; Dunn et al., 1994).

Results: The product of this scholarly project is Feed in Context, a clinician-focused pediatric feeding guide designed to support occupational therapy practitioners delivering services across outpatient, early intervention, and school-based systems. The guide integrates the Ecology of Human Performance model with conceptual principles informed by the Sequential Oral Sensory approach to feeding to support context-responsive clinical reasoning (Dunn, 2017; Dunn et al., 1994; Toomey & Ross, 2011; Toomey & Associates, Inc., 2025a, 2025b, 2025c; Toomey & Associates, Inc., & Dodrill, 2025). By organizing feeding intervention considerations across service environments, the guide supports therapists in adapting intervention strategies to the contextual realities of rural practice while promoting continuity of pediatric feeding services across care systems.

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