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Referral Criteria

Who to refer for infant specialty care.

We see infants birth through 12 months across five areas of specialty care: feeding and swallowing, lactation, infant occupational therapy and development, nutrition and growth, and NICU transition and follow-up. The categories below reflect the clinical presentations we evaluate and treat most frequently in each. If your patient's presentation is not listed here, contact us directly to discuss appropriateness for referral.

Feeding & Swallowing

Clinical presentations appropriate for feeding evaluation.

Bottle Feeding Difficulty

  • Disorganized or inefficient suck pattern
  • Poor suck-swallow-breathe coordination
  • Feeding fatigue or physiologic instability during feeds
  • Prolonged feeding duration outside expected norms
  • Inability to sustain or complete feeds consistently
  • Caregiver report of feeding as consistently effortful or stressful

Inadequate Intake & Growth Concerns

  • Insufficient daily oral volume relative to age and weight
  • Poor weight gain trajectory with feeding function as a contributing factor
  • Inconsistent intake across the day or across caregivers
  • Infant unable to meet nutritional needs through oral feeding alone

Oral Motor & Swallowing Concerns

  • Suspected or confirmed oral motor dysfunction
  • Clinical signs consistent with pharyngeal dysphagia
  • History of aspiration or aspiration risk by clinical presentation
  • Structural or tonal concerns affecting feeding function
  • Coughing, choking, or desaturation during feeds
  • Wet or gurgly vocal quality during or after feeding

NICU Graduate & Post-Discharge Follow-Up

  • Premature infants requiring continued outpatient feeding monitoring after discharge
  • Medically complex infants with ongoing feeding concerns post-discharge
  • Infants transitioning from NG or gavage feeding to full oral feeding at home
  • Families needing structured support and education for home feeding routines
  • Concerns about feeding progression, pacing, or intake at NICU follow-up

Breast and Bottle Feeding Transitions

  • Infants having difficulty transitioning between breast and bottle
  • Bottle refusal in exclusively or primarily breastfed infants
  • Oral function concerns impacting latch quality or transfer efficiency
  • Lactation consultant referral when oral motor concerns are identified
  • Families navigating combined feeding methods with clinical complexity

Bottle Refusal & Feeding Aversion

  • Infant who previously accepted bottles but has stopped
  • Infant who has never consistently accepted bottle feeding
  • Behavioral or aversive responses to bottle presentation
  • Feeding refusal associated with negative sensory or physiologic experience
  • Significant mealtime disruption or caregiver distress related to refusal

Solid Food Progression Concerns

  • Significant delay in introduction or acceptance of purees or textured foods
  • Difficulty progressing through food textures appropriate to developmental age
  • Oral sensory concerns affecting food acceptance
  • Prolonged texture refusal or extreme selectivity
  • Mealtime behaviors significantly impacting family function

Lactation

Clinical presentations appropriate for lactation support.

Breastfeeding, Latch & Transfer Concerns

  • Painful or inconsistent latch
  • Uncertainty about milk transfer or intake at breast
  • Positioning difficulty affecting nursing sessions
  • Caregiver-reported nursing distress not clearly linked to oral function

Mixed Feeding & Bottle Transitions

  • Families combining breast and bottle without a clear plan
  • Questions about introducing or reducing bottle feeds
  • Need for practical guidance that fits the family's routine
  • Requests for additional support alongside existing lactation consultant care

Developmental & Occupational Therapy

Clinical presentations appropriate for developmental evaluation.

Motor & Milestone Concerns

  • Delayed rolling, sitting, or crawling
  • Low or high muscle tone
  • Parental concern about movement that "just looks different"
  • Developmental follow-up after prematurity or a NICU stay

Sensory Regulation & Play

  • Difficulty tolerating tummy time
  • Over- or under-responsiveness to touch, movement, or sound
  • Limited engagement with age-appropriate play
  • Caregiver uncertainty about what's typical versus worth addressing

Torticollis, Head Preference & Motor Asymmetry

Clinical presentations appropriate for torticollis and positioning evaluation.

Head-Turning Preference & Torticollis

  • Persistent preference for turning the head one direction
  • Neck tightness or resistance to midline positioning
  • Suspected or diagnosed torticollis
  • Asymmetric tolerance of tummy time or side-lying

Plagiocephaly & Positioning

  • Flat spots or asymmetric head shape
  • Positional preference during sleep or holding
  • Well-visit finding warranting a positioning and movement assessment
  • Family questions about repositioning strategies at home
View the torticollis service →

Nutrition & Growth

Clinical presentations appropriate for nutrition and growth evaluation.

Weight Gain & Growth Trajectory

  • Slow, plateaued, or "falling off the curve" weight gain
  • Prematurity-related growth tracking
  • Growth concerns not clearly tied to feeding function
  • Need for dietitian-level review of growth trends

Formula, Fortification & Tolerance

  • Questions about formula selection or changes
  • Fortification of breast milk or formula
  • Possible milk or formula intolerance
  • Nutritional needs specific to medically complex infants

NICU Transition & Post-Discharge

Clinical presentations appropriate for NICU follow-up.

NICU Discharge Planning

  • Premature or medically complex infants approaching discharge
  • Families who will need coordinated outpatient follow-up across feeding, growth, or development
  • Early coordination requested by NICU or follow-up clinic teams

Post-Discharge Follow-Up

  • New or ongoing concerns identified after a NICU stay
  • Families wanting a team that already understands their baby's history
  • Concerns spanning more than one area: feeding, growth, and development together

Not Sure?

When in doubt, contact us to discuss the patient.

If your patient's presentation does not clearly fit the categories above, reach out before or instead of formally referring. We can help determine whether an evaluation is appropriate, which specialty is the right fit, what information would be useful, and what the next step might look like.

Referral does not require a formal diagnosis. Functional feeding concerns, developmental or movement concerns, growth or nutrition questions, lactation difficulty, caregiver-reported difficulty, or a clinical presentation suggesting any of our specialties may benefit the patient are all valid reasons to contact us.

Contact Our Team How Referral Works

Referral Does Not Require

  • A confirmed diagnosis
  • Prior instrumental swallow study
  • Imaging or lab results
  • A defined number of failed feeding interventions

Referral Is Strengthened By

  • Relevant history for the concern being referred (feeding, growth, development, etc.)
  • Relevant medical and birth history
  • Specific caregiver concerns or observed behaviors
  • Prior interventions or provider guidance related to the concern
  • Other providers currently involved in the patient's care

Ready to Refer

Refer a patient or discuss a clinical question.

To initiate a referral or discuss whether a patient may benefit from feeding, lactation, developmental, nutrition, or NICU follow-up services, call our team or submit through our secure online referral tool. Please don't email clinical information. We welcome provider-to-provider conversations at any stage of the referral process.

Submit a Referral Back to Practitioner Overview