Mealtime is an essential occupation that occurs daily in the school setting for all learners. This study explored how school occupational therapy practitioners address mealtime challenges using a one-group, convergent mixed methods design. Participants were school occupational therapy practitioners who service pre-K to 5th-grade students. Data were collected using an electronic survey (n = 195) and semi-structured interviews (n = 11) to gain an in-depth understanding of therapeutic processes and practitioner experiences regarding mealtime challenges. Survey results indicated that 41% of practitioners evaluate mealtime using non-standardized methods like clinical observations (88%) and teacher interviews (78%). The most common mealtime interventions and outcomes reported by practitioners were self-feeding (73%) and independence with mealtime routines (37%). Interview themes revealed the informal processes practitioners use to address mealtime challenges and feelings of apprehension about supporting students with complex mealtime needs. Formal documentation and more frequent coordination between parents, school staff, and community providers are target areas for improvement. The development of clear practice guidelines at the local, state, and national level are critical tasks to empower this change.