What is a feeding disorder?

A child with a feeding disorder has difficulties related to eating or drinking. There are many different types of feeding problems, and no two children have the same problem. Sometimes, infants may demonstrate swallowing issues with decreased sensation or difficulty coordinating suck-swallow-breath, placing them at risk of aspiration and respiratory illness.  While some children simply do not eat enough quantity and are at risk to be nutritionally compromised and fail to gain weight and grow.  Other children may have more complex medical histories that placed them at high risk of aspiration or did not allow them to be fed by mouth early in life, requiring them to be fed by a feeding tube.  Others may have problems transitioning to solid foods or difficulty with chewing and swallowing with oral-motor delays and/or sensory issues with hypersensitivity or hyposensitivity leading to negative food experiences.  Finally, underlying physiological problems, such as vomiting from gastrointestinal (GI) issues related to reflux or food allergies or intolerance, may also play a role in a child's feeding problems.  Although children may have different kinds of feeding issues, all issues can lead to negative associations with feeding and swallowing, resulting in behaviors, such as crying, refusing, or throwing food that can lead to risk of failure to thrive.

Eating is a basic task and an integral part of our daily lives.  When it does not come easily to a child, it can become a daily stressful activity and can lead to parent-child power struggles.  Parents can feel very alone and stressed when it comes to their child not wanting to eat.  However, food refusal is a common problem in children. 
 

• “Statistics reveal that one in four children have some sort of feeding disorder.  Food refusal can take the form of food selectivity, G-tube (Gastrostomy tube) or NG-tube (Nasogastric Feeding tube) dependency, bottle or milk/formula dependency, texture selectivity or general poor oral intake.”
  http://www.asha.org/about/publications/leader-online/archives/2003/q4/f031021c.htm (article on feeding disorders)

Is my child a candidate for feeding therapy?

 

Yes-if some of the following are present:

• Failure to thrive with poor weight gain, weight loss or difficulty maintaining weight

• Choking, gagging, coughing or vomiting during meals

• Report of overstuffing the mouth with food and fear of choking

• Vomiting, reflux, crying/arching with feeding or other identified GI issues

• History of food allergy or intolerance with limited acceptance of foods

• History of eating & breathing coordination problems with ongoing feeding concerns or chronic respiratory issues

• Children with oral feeding skills at risk for tube feeding placement, with tube feeds or transitioning off tube feeding

• Refusal of bottle/breastfeeding, especially with report of better results with sleep feeding

• Inability to transition to baby food purees

• Inability to transition to table food solids or wean off baby purees

• Inability to transition from breast/bottle to a cup

• Aversion or avoidance of a wide repertoire of tastes, temperatures, and textures of foods

• An ongoing report of decreased appetite and limited intake with growth and/or nutrition concerns

• Food range of less than 20 foods with concerns of limited ability to meet nutritional needs

• Tolerance of only specific brands of foods and/or other rigid feeding behavior

• Family distress over food and feeding, feeding time is stressful or meals are battles

A child who exhibits these difficulties may be appropriate for a feeding evaluation. As part of the assessment, a full feeding history, including a detailed current feeding routine and any pertinent medical history or work-up, will be obtained.  The child will be observed eating a variety of preferred and some non-preferred foods and the feeding therapist will observe the child for signs of oral motor or swallowing difficulties as well as sensory defensiveness and/or hypo-responsiveness, which may contribute to the child's eating difficulties. Upon completion of the evaluation, a comprehensive assessment with findings and recommendations will be provided to the family, as well as the referring physician and other providers.  

What happens when feeding therapy is recommended?

 

Carmen will utilize oral-sensory feeding strategies based on Cue-Based Feeding and the S.O.S (Sensory-Oral-Sequential) developmental approach to feeding, along with her expertise in swallowing disorders and evidenced-based Hunger Induction Theory, to progress patients to become positive, oral feeders. Carmen will work with families through parent education/coaching and closely collaborate with patients' medical providers to develop highly individualized plans of care to accelerate patients' progress toward optimal, positive oral intake. Her success lies in her ability to address all areas of your child's feeding issues; physiological, motor, sensory, and behavioral. 

Cue-Based Feeding utilizes principles to monitor and react to the baby's signs of comfort versus stress, modifying the feeding approach based on the quality not the quantity of the feed.  The S.O.S approach uses typical feeding development as a template for increasing oral-sensory feeding skills. Carmen will utilize oral-sensory feeding strategies, along with any needed swallowing precautions for aspiration risk.  She will work with families to optimize or establish an appropriate feeding schedule to promote hunger-satiety, advance early feeding skills based on readiness, address sensory defensiveness in a non-threatening environment to build off the child’s current level of function, and advance them along the continuum of typical feeding development to optimally meet their nutrition/hydration needs as positive, oral feeders. Parent education and involvement are an integral part of a developmental feeding approach.  During feeding therapy sessions, Carmen works directly with families to teach feeding/swallowing strategies for carry over into their daily home routine. When working with children with failure to thrive or feeding tube weaning, therapy will also focus on maximizing caloric intake within current oral-sensory feeding skills. If tube weaning is targeted and readiness with strategies is established, hunger induction will be utilized with physician approval and monitoring to accelerate progress with an individualized "tube wean challenge" plan that involves rapid reduction of tube feeds by typically 50%.  Tube wean challenges require family readiness through adequate education and resources, close monitoring to assure medical stability, and problem-solving to tweak the plan and readjust tube feeds based on progress.

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Links/References:

• https://sosapproachtofeeding.com/insights-ideas/

• Shaker CS. Improving Feeding Outcomes in the NICU: Moving From Volume-Driven to Infant-Driven. Perspectives on Swallowing and Swallowing Disorders (Dysphagia) 19; 68-74; Oct 2010.

• Home-Based Feeding Tube Weaning: Outline of a New Treatment Modality for Children With Long-Term Feeding Tube Dependency Markus Wilken, PhD, Vanessa Cremer, MS, Stephan Echtermeyer, SLT First Published June 16, 2015

• Children with Feeding Tube Dependency: Treating the Whole Child, Mary Tarbell, Janet Allaire

• Gastrostomy Tube Weaning and Treatment of Severe Selective Eating in Childhood: Experience in Israel Using an Intensive Three Week Program, Tzippora Shalem, Akiva Fradkin, Marguerite Dunitz-Scheer, Tal Sadeh-Kon, Tali Goz-Gulik, Yael Fishler, Batia Weiss

• https://en.wikipedia.org/wiki/Graz_tube_weaning_model