Feeding interventions that support family relationships enhance children’s daily participation in meaningful occupations at home. A critical review of the literature yielded several premises that support the development of a relationship-based feeding framework. The proposed theoretical framework, based on the Biopsychosocial Model of Pediatric Feeding (Berlin, Davies, Lobato, & Silverman, 2009) and the Ecological Model of Occupation (Dunn, Brown, & Youngstrom, 2003), is presented to guide feeding interventions for children with significant feeding difficulties. A case example that illustrates the practical application of this framework is provided. Further development of relationship-based feeding theory and research is recommended to improve the occupational performance and quality-of-life outcomes for children and their families.