Advancing excellence in Promouvoir l’excellence
occupational therapy en ergothérapie
CAOT Position Statement:
Feeding, eating and swallowing and occupational therapy (2010)
The Canadian Association of Occupational Therapists
(CAOT) acknowledges the knowledge, skills and expertise
that occupational therapists have to fulfill their roles in
providing client services regarding feeding, eating and
swallowing. CAOT also recognizes occupational thera-
pists’ skills and abilities to fulfill leadership roles in the
planning, organization and functioning of eating, feed-
ing and swallowing services.
Occupational therapy services enable people to
engage in everyday living through occupation (Townsend
& Polatajko, 2007). Ingestion is an essential occupation
of daily life which includes the actions of feeding, eat-
ing and swallowing. Having an understanding of the
relationship among the person, occupation, and envi-
ronment uniquely positions occupational therapists to
provide evidence-based services that enhance a person’s
ability to engage in the occupation of ingestion.
Recommendations for occupational
therapists:
1. Occupational therapists advocate for their role in
feeding, eating and swallowing management.
2. Occupational therapists collaborate with stakehold-
ers at national and regional levels to promote and
engage in research to further our understanding of
the impact the occupation of ingestion has on our
health and well being.
3. Occupational therapists collaborate with stakehold-
ers at national and regional levels to promote and
engage in research to further best practices in all
areas of feeding, eating and swallowing including
dysphagia assessment and management.
4. Occupational therapists continue to develop
consensus regarding interprofessional standards,
assessment and management protocols for feeding,
eating and swallowing.
5. Occupational therapists engage in continuing
professional development to enhance their skills,
knowledge and expertise in the areas of feeding,
eating and swallowing.
6. Occupational therapists, working in the true spirit
of interprofessional collaboration, recognize, respect
and understand the scope, roles and contributions
of all professional groups.
7. Occupational therapists recognize individual exper-
tise, skills and knowledge of team members.
8. Occupational therapists utilize mentorship oppor-
tunities to share expertise, build workforce capacity
and develop best practices.
9. Occupational therapists provide direct care, or care
through the supervision of support personnel (e.g.
occupational therapy assistants or personal care
assistants), to enable the occupation of ingestion.
10. Occupational therapists seek out opportunities for
leadership within the practice context (e.g. case
management).
CAOT Initiatives
To enable occupational therapists to develop and
deliver quality services regarding feeding, eating and
swallowing, CAOT will:
1. Work in collaboration with the profession and stake-
holders that have a direct interest in the advance-
ment of quality services.
2. Provide occupational therapists with access to
research-based evidence and resources (e.g. McGill
Ingestive Skills Assessment (Lambert et al., 2006a, b)
to support implementation of best practice.
3. Foster opportunities for mentorship such as the
mentoring gateway available at www.caot.ca.
4. Offer continuing education opportunities on the
assessment and management of eating, feeding and
swallowing disorders.
5. Promote leadership within the field of feeding,
eating and swallowing.
Background
The Canadian Association of Occupational Therapists
is the national not-for-profit voluntary organization
that provides resources and services to develop excel-
lence in occupational therapy services. Occupational
therapists are graduates of university programs with
baccalaureate or Master level degree and are regulated
health professionals in all 10 provinces.
Occupational therapists work with individuals, fami-
lies, groups, communities, organizations and popula-
tions; with people of all ages, and levels of
ability to promote health, well-being and justice
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 through occupation. Occupations are groups of activi-
ties and tasks of everyday life that people are engaged
in such as work, volunteerism, school, leisure and
personal care.
Occupational therapists provide quality services in
health care organizations, community services, schools
and industry in both the public and private sectors. An
evidence-based, client- centred approach is central to
occupational therapy service delivery (Canadian
Association of Occupational Therapists, the Associa-
tion of Canadian Occupational Therapy University
Programs, the Association of Canadian Occupational
Therapy Regulatory Organizations , and the Presidents’
Advisory Committee, 1999). Occupational therapists
utilize key enablement skills: adapt, advocate, coach,
collaborate, consult, coordinate, design/build, educate,
engage and specialize (Townsend & Polatajko, 2007).
The acquisition of sufficient nutrition and hydra-
tion is essential to life. Difficulties with nutrition and
hydration have a pervasive impact on health and well-
being. Occupational therapists have been enabling
clients to meet their nutritional needs, in a reasonable
amount of time, safely and with pleasure (Owens &
Robertson, 1990) since the middle of the 20th century
(Holser-Bueler, 1966). Occupational therapists regard
feeding, eating and swallowing as a dynamic interac-
tion between the person, environment and occupation.
Occupational therapy intervention may include, but is
not limited to:
• Adapting , environments, equipment, feeding sched-
ules/routines or modifying food/liquid textures and
consistencies
• Advocating for client rights to self-feeding.
• Coaching clients to progress in oral feeding and/or
transition from tube feeding
• Collaborating with other professions in the develop-
ment of client-centred care plans for feeding and/or
alternate forms of nutrition
• Consulting to establish institutional practices for
individuals with feeding, eating and swallowing
problems.
• Coordinating service delivery and prioritization of care.
• Designing/building specialized equipment in the
physical environment to support feeding or design
behavioural modifications to manage sensory/
behavioral feeding difficulties.
• Educating client, families, caregivers, support person-
nel, teachers and other health professionals in food
selection (including appropriate liquid/food consis-
tencies) and preparation, appropriate feeding tech-
niques, positioning for feeding, feeding schedules
• Engaging clients in psychosocial aspects of feeding.
2
• Specializing in the administration of instrumental
assessment (e.g. videofluoroscopic swallow studies ,
Fiberoptic Endoscopic Evaluation of Swallow (FEES),
auscultation,) or treatment strategies to strengthen
musculature and to reduce effects of abnormal
muscle tone and sensory responsiveness.
Occupational therapists in Canada use a client-centred,
process-based approach in the evaluation and man-
agement of feeding, eating and swallowing. They
receive entry-level education which provides the knowl-
edge and skills to be evidence-based practitioners. This
education includes anatomy, physiology, neurology,
pathology, human behavior and development across
the lifespan, as well as profession-specific content
related to professional reasoning, activity analysis,
evaluation, intervention strategies, therapeutic activi-
ties, equipment adaptations and outcome measures.
Occupational therapists have a responsibility to main-
tain an awareness of current developments in the field
and may further their expertise by seeking out mentor-
ship, continuing education and research opportunities.
The occupational therapy practice is a context sensi-
tive, dynamic collaborative process. Occupational thera-
pists incorporate client’s hopes, dreams, values into this
process; client - therapist collaboration is essential to
both process and outcome. Eating and feeding are
occupations that are client driven. The approach to
a difficulty with eating, feeding and swallowing will
depend on the beliefs and values of the client, and
the inclusion of culturally appropriate or meaningful
habits, traditions and foods. The occupational therapist
will enable a client’s participation in this primordial
occupation through negotiation of risk, power sharing
and vision of possibilities for the client.
Glossary
Client-centred practice: is based on enablement
foundations and employs enablement skills in a
collaborative relationship with clients to advance
a vision of health, well-being, and justice through
occupation. (Townsend & Polatajko, 2007) Client-
centered occupational therapists demonstrate re-
spect for clients, involve clients in decision making,
advocate with and for clients’ needs, and otherwise
recognize clients’ experience and knowledge (CAOT,
1997; 2002a)
Deglutition: act of swallowing (Jacobs & Jacobs, 2009)
Dysphagia: difficulty in swallowing, (CAOT, 2009,
Jacobs & Jacobs, 2009)
Eating: “the ability to keep and manipulate food or
fluid in the mouth and swallow it; eating and
swallowing are often used interchangeably” (AOTA,
2007)
Evidence-based occupational therapy: includes
experiential, qualitative, and quantitative evidence.
“The occupational therapist provides knowledge
of client, environment and occupational factors
relevant to enabling occupation. Ideally, this
evidence is derived from a critical review of the
research literature, expert consensus and
professional experience” (CAOT, ACOTUP, ACOTRO,
& PAC, 1999, p. 267).
Enabling occupation: The process of facilitating, guid-
ing, coaching, educating, prompting, listening,
reflecting, encouraging, or otherwise collaborating
with people so that they may choose, organize and
perform those tasks and activities of everyday life
which they find useful and meaningful in their
environment (CAOT, 1997; 2002a).
Feeding: “the process of setting up, arranging, and
bringing food [or fluid] from the plate or cup to
the mouth; sometimes called self- feeding”
(AOTA, 2007)
Ingestion: A construct of skills surrounding the tak-
ing of food into the body, described by a five-stage
process: pre-oral (anticipatory), preparatory, lingual,
pharyngeal, and esophageal. The first stage consid-
ers the interaction of pre-oral motor, cognitive,
psychosocial, and somataesthetic elements engen-
dered by the meal. (Leopold and Kagel, 1997)
Occupational therapy: is the art and science of
enabling engagement in everyday living, through
occupation; of enabling people to perform the
occupations that foster health and well-being; and
of enabling a just and inclusive society so that all
people may participate to their potential in the daily
occupations of life. (Townsend & Polatajko, 2007)
Swallowing: involves a complicated act in which
food, fluid, medication, or saliva is moved from the
mouth through the pharynx and esophagus into
the stomach (AOTA, 2007)
Position statements are on political, ethical and social issues that impact on client welfare, the profession of
occupational therapy or CAOT. If they are to be distributed past two years of the publication date, please contact
the Director of Professional Practice, CAOT National Office, CTTC Building, 3400-1125 Colonel By Drive, Ottawa, ON.
K1S 5R1. Tel. (613) 523-2268 or e-mail: practice@caot.ca.
Resources:
Alberta College of Occupational Therapists. (2009).
Position statement: Occupational therapists role in
feeding, eating and swallowing available at
http://www.acot.ca/files/Position_Stement_FES.pdf
Ordre des ergothérapeutes du Québec. (2006).
Au-delà de la dysphagie, la personne avant tout : Rôle
de l’ergothérapeute auprès des personnes présentant
des difficultés à s’alimenter ou à être alimentées
http://www.oeq.org/userfiles/File/Publica-
tions/Doc_professionnels/Dysphagie-doc_
gestionnaires%28sept06%29.pdf
References
American Occupational Therapy Association (2007). Specialize
knowledge and skills in feeding, eating, and swallowing:for
occupational therapy practice. American Journal of Occupa-
tional Therapy. 61, 686-700.
Canadian Association of Occupational Therapists. (1997; 2002).
Enabling occupation: An occupational therapy perspective
(1st. Ed.). Ottawa, ON: CAOT Publications ACE.
Canadian Association of Occupational Therapists (CAOT), the
Association of Canadian Occupational Therapy University
Programs (ACOTUP), the Association of Canadian Occupa-
tional Therapy Regulatory Organizations (ACOTRO), and the
Presidents’ Advisory Committee (PAC) (1999). Joint position
statement on evidence-based practice. Retrieved on October
27, 2003 from http://www.caot.ca/default.asp?pageid=156
Canadian Association of Occupational Therapists (2009). hOT
topic: Dyspahgia. Ottawa, ON: CAOT Publications ACE
Holser Beuler, P. (1966). The Blanchard method of feeding the
cerebral palsied. American Journal of Occupational Therapy.
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Jacobs, K. & Jacobs, L. (2009). Quick refence dictionary for occupa-
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Lambert, H.C., Gisel, E.G., Groher, M.E., Abrahamowicz, M. &
Wood-Dauphinee, S. (2006) The McGill Ingestive Skills
Assessment. Test Manual and Evaluation Forms. Canadian
Association of Occupational Therapists: Ottawa, ON.
Lambert, H.C., Gisel, E.G., Groher, M.E., Abrahamowicz, M. &
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