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If you've ever wondered when to call psych, or whether a psychologist would even understand the nuances of pediatric feeding disorder, this episode is for you. I sat down with Dr. Laura Austin, a pediatric psychologist who spent 21 years working in an intensive inpatient feeding program in Dallas alongside speech therapy, occupational therapy, dieticians, and physicians. She now sees families in private practice and is one of a very small number of psychologists in the country with true specialty-level training in PFD.
Dr. Austin opened by naming something most of us already feel: psychology is almost impossible to find in the feeding world. The training simply doesn't exist unless you land in an intensive program, and even then, many psychologists who do have some experience come from programs that are heavily behavior-forward in ways that don't always align with how we understand PFD today.
Her framing of the disorder itself is one I'd encourage every provider to sit with: PFD is a physical problem. The cause is rooted in difficulty with strength, sensitivity, coordination, and self-regulation in the mouth and body — often compounded by medical factors. When eating is painful, difficult, or scary, fear and anxiety follow. The psychological piece is real and significant, but it's an effect, not a cause. And almost every family, she noted, is accidentally engaging in maladaptive feeding patterns — not because of bad parenting, but because their child's feeding difficulties shaped their parenting.
So where does psychology fit? Dr. Austin described three broad entry points. First, nearly every family could benefit from support processing the grief, isolation, and unrelenting stress that comes with raising a child with PFD — most of them have never even heard the term before walking into a feeding therapist's office. Second, when a child is doing things in the clinic but won't do them at home, psychology can help identify what's blocking carryover and partner with the feeding therapy team to close that gap. Third, when a child is stuck in therapy and progress has stalled, psychology can help the team ask: what are we missing?
We also worked through three questions submitted by Coral Care providers — on navigating ABA and feeding, using food as a motivator, and what to do when a child can complete every step of the SOS hierarchy except actually chewing and swallowing. Dr. Austin's answers were nuanced and practical, and her consistent first move — rule out medical before assuming psychology or behavior — is worth internalizing.
One thread that ran through the whole conversation was the importance of the reset. Before a child can learn to approach food differently, the family's entire experience of food has to shift. That means starting with no pressure, leaning into curiosity over judgment, and accepting that this work is slow. Lightning fast, in Dr. Austin's world, is six months. Most families are looking at a year or two.
Dr. Austin will be joining Coral Care providers for a live Office Hours session soon — a chance to bring your specific cases and questions directly to her. She also offers free consultations for families and loves provider partnering. You can reach her at drlauraaustin@gmail.com or at austinpetriepsychology.com. And if you haven't explored Feeding Matters yet, they have a remarkable amount of content for families and providers alike.
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