Helping Clinicians Support Children Who Face Eating Challenges
NCDHHS speech-language pathologist co-authors academic article to aid providers in treating pediatric feeding disorder (PFD)

Dr. Cara McComish, a Speech Language Pathologist at the NCDHHS' Durham Children’s Developmental Services Agency, co-authored an academic paper in March 2023 to help clinicians support children with pediatric feeding disorder (PFD). 

Head shot of Cara McComish
Dr. Cara McComish


Every parent of young children knows mealtime can be one of the most fraught times of the day. Whether your toddler’s refusing to eat anything that’s not orange, your 3-year-old has decided that the only food group they’re willing to consider is chicken nuggets, or your preschooler is on a French-fries-only kick, it can be a trying time for even the most patient parent. 

But what if it’s not a phase? When a child can’t eat, won’t eat, or maybe can’t swallow, and there’s no end in sight, parents turn to clinicians for support – clinicians who are themselves looking for treatment guidance they can share with the parents and children.

According to, one in 37 children under the age of 5 years old in the United States has a pediatric feeding disorder (PFD).

This is the life’s work of Dr. Cara McComish, a Speech Language Pathologist at the NCDHHS' Durham Children’s Developmental Services Agency, and it’s why she co-authored an article for the Special Interest Group (SIG) 13, Swallowing and Swallowing Disorders (Dysphagia) of the American Speech and Hearing Association Perspectives journal with Drs. Kelsey L. Thompson and Suzanne Thoyre

“Dynamic Systems Theory: A Primer for Pediatric Feeding Clinicians,” was published in the March 2023 issue of Perspectives of SIG 13, a publication of the American Speech-Language-Hearing Association. 

The peer-reviewed scientific item is more than an article – it’s a tutorial that was purpose-built to serve as a treatment framework for clinicians who are treating children struggling to transition to solid foods. 

A parent or clinician faced with a child struggling with PFD is likely to measure the child’s abilities against the expectations presented in the kinds of child developmental stages charts seen in popular parenting books and pamphlets. It’s the kind of comparison that can lead to guilt and frustration.

Thompson, McComish, and Thoyre’s article advocates for another approach – the use of Dynamic Systems Theory (DST). 

“DST requires clinicians to shift their thinking about their role in helping children develop. Development is not a discrete set of steps; it is a complex process in which an individual interacts with their ever-changing selves, environment, and goals,” Thompson, McComish and Thoyre write in their article. 

“When utilizing a DST framework, the clinician’s goal is not to teach a child a skill they are missing; the goal is to support the child and family’s ability to problem solve in order to gain skills that are within their current abilities.”

It allows for a dynamic approach to thinking about all the aspects of a child’s development that can impact PFD.

“The clinicians are already using many of these methods, but this article was designed as a tutorial in order to provide them with a specific framework when addressing PFD,” McComish said. 

It’s a framework that allows vital flexibility in the face of what are often complex presentations.

“Babies and toddlers don’t often grow out of these problems without support. That’s why we’re working to support the clinicians who are supporting these children,” McComish said. 

The article’s lead author, Dr. Kelsey L. Thompson recently completed her PhD in Speech and Hearing Sciences from UNC Chapel Hill. Drs. McComish & Thoyre served as research mentors and members of Dr. Thompson’s dissertation committee. Dr. Thoyre is a professor in the School of Nursing at UNC.

“Dynamic Systems Theory: A Primer for Pediatric Feeding Clinicians,” is available for purchase on the Perspectives of SIG 13 website

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