Picky eating or problem feeding?
Pediatric feeding problems occur in 25% of the general pediatric population and up to 80% of those who have developmental delays (Estrem et. al, 2018).
If meal times are particularly tricky for you and your family, you may have a little one who falls into the pediatric feeding disorder category. Pediatric feeding disorder (PFD) is “impaired oral intake that is not age-appropriate and is associated with medical, nutritional, feeding skill, and/or psychosocial dysfunction” (Goday et al., 2019).
Over the last 12 months of working with feeding therapy clients, our team at Bumblebee found there was a need to develop a more rigorous feeding therapy program to better serve this population. Research shows that “children with feeding problems often have multiple comorbidities” and we have found that many of our families may not be aware of how multi-faceted feeding problems and feeding disorders can be (Sharp et. al, 2010).
Our program is based on the medical, motor, and behavioral approach that collaboratively targets underlying medical issues that can cause and/or impact feeding problems, treats delays in oral and gross motor skills, and addresses sensory and emotional challenges.
We know that feeding challenges can greatly impact a family’s function and child’s health.
Our goal is to decrease meal-time frustration for all members of the family while supporting the child’s continuous skill development and health.
We are now offering a multi-disciplinary evaluation that includes input from an Occupational Therapist, a Speech Language Pathologist, and a Registered Dietician. We have partnered with Brittany Shapiro, RD, LD, CNSC, CSP, founder of Capital Pediatric Nutrition.
Brittany will work with you and your child’s pediatrician to evaluate growth parameters and assess caloric and nutrient needs. Bumblebee clinicians providing these services have participated in additional continuing education courses including Sequential-Oral-Sensory (SOS) and the AEIOU Approach. We will also coordinate with your child’s pediatrician if additional specialities are required.
What to expect during the evaluation:
Prior to the in-clinic evaluation, Brittany will conduct parent interviews and gather necessary medical information to complete her assessment.
The in-clinic portion of the evaluation lasts approximately 1.5-2 hours. During this time, your child will participate in an Occupational Therapy assessment that is tailored towards the areas of development related to motor skills and sensory input necessary for proper feeding. They will also participate in an oral-motor evaluation and food trials with a Speech Language Pathologist who will determine if their feeding challenges are impacted by oral motor deficits such as immature oral motor patterns, tethered oral tissues, or coughing/choking during meals.
At the conclusion of this evaluation, the clinicians will spend up to 30 minutes collaborating to create a treatment plan. This plan will be outlined for you in broad terms on the day of the evaluation. You will then be provided with a minimum 12-week long feeding therapy plan within a week of the evaluation.
What to expect with Feeding Therapy
Based on data taken during the intake process and information gathered during the nutritional portion of the evaluation, the team may recommend additional testing such as a Modified Barium Swallow Study, Upper/Lower GI evaluation, or allergy testing.
Feeding therapy can be conducted in-clinic or in-home. This will be determined based on the results of your child’s evaluation and clinician availability. Some children report higher degrees of comfort trying new foods in a new environment; some families require in-home support to make behavioral adjustments. If in-home services are not available due to limited availability, we may offer virtual sessions to provide additional support.
Families will be required to commit to a minimum of 12-weeks of therapy to ensure that enough time has passed to demonstrate changes. During this time, they will also meet with Brittany for a minimum of 1x per month or more based on recommendations at the evaluation.
It is imperative that families participate in feeding therapy sessions because parents are the primary partners during mealtime. Parents will do feeding therapy sessions WITH the clinicians and will be taught to use the techniques and asked to practice certain skills. Parents will be provided with goals and targets at the conclusion of each session.
Who could benefit from feeding therapy?
If any of the behaviors below are affecting a child’s ability to safely eat, meet nutritional needs or enjoy the mealtime experience, the child may benefit from receiving a feeding evaluation.
Difficulty chewing foods, typically swallowing food in whole pieces.
Difficulty swallowing foods or refusing to swallow certain types of food consistencies.
Refuses to eat certain food textures or has difficulty transitioning from one texture to another texture (ex: from bottle feedings to purees, from purees to soft solids or mixed textured foods).
Gags on, avoids or is very sensitive to certain food textures, food temperatures and/or flavors.
Struggles to control and coordinate moving food around in mouth, chewing and preparing to swallow food.
Frequently coughs when eating.
Gags and chokes when eating.
Frequently vomits during or immediately after eating or drinking.
Refuses or rarely tries new foods.
Pushes food away.
Has difficulty transitioning from gastric tube (G tube) feedings to oral feedings.
Negative mealtime behaviors (infant cries, arches, pulls away from food; child refuses to eat, tantrums at mealtimes or “shuts-down” and does not engage in mealtime).
Feeding time taking longer than 30 to 40 minutes for toddlers or young children.
Known to be a “picky eater” who eats a limited variety of foods or consistencies.
We will begin scheduling evaluations in mid to late April, 2023. Please contact Alex at alex@bumblebeepediatrics.com to get started!
Sources
Estrem, H. H., Thoyre, S. M., Knafl, K. A., Frisk Pados, B., & Van Riper, M. (2018). "It's a Long-Term Process": Description of Daily Family Life When a Child Has a Feeding Disorder. Journal of pediatric health care : official publication of National Association of Pediatric Nurse Associates & Practitioners, 32(4), 340–347. https://doi.org/10.1016/j.pedhc.2017.12.002
Goday, Praveen S., Huh, Susanna Y., Silverman, Alan, Lukens, Colleen T. Dodrill, Pamela||; Cohen, Sherri S.; Delaney, Amy L.∗; Feuling, Mary B.#; Noel, Richard J.∗∗; Gisel, Erika††; Kenzer, Amy‡‡; Kessler, Daniel B.§§; Kraus de Camargo, Olaf||||; Browne, Joy¶¶; Phalen, James A.##. Pediatric Feeding Disorder: Consensus Definition and Conceptual Framework. Journal of Pediatric Gastroenterology and Nutrition 68(1):p 124-129, January 2019. | DOI: 10.1097/MPG.0000000000002188
McComish, Cara PhD, CCC-SLP; Brackett, Kristen MS, CCC-SLP; Kelly, Maureen MS, RN, CPNP; Hall, Christine MS, RD, CSP, LDN; Wallace, Sharon RD, CSP, LDN; Powell, Victoria MSN, RN, CPNP. Interdisciplinary Feeding Team: A Medical, Motor, Behavioral Approach to Complex Pediatric Feeding Problems. MCN, The American Journal of Maternal/Child Nursing 41(4):p 230-236, July/August 2016. | DOI: 10.1097/NMC.0000000000000252
Roche, W. J., Eicher, P. S., Martorana, P., Berkowitz, M., Petronchak, J., Dzioba, J., & Vitello, L. (2011). An oral, motor, medical, and behav- ioral approach to pediatric feeding and swallowing disorders: An interdisciplinary model. Perspectives on Swallowing and Swallow- ing Disorders (Dysphagia), 20, 65-74. doi:10.1044/sasd20.3.65
Sharp W, Jaquess D, Morton J, Herzinger C. Pediatric feeding disorders: A quantitative synthesis of treatment outcomes. Clinical Child and Family Psychology Review. 2010;13:348–365.