Reference: http://www.choc.org/feedingprogram/
There's no place like CHOC Children’s Multidisciplinary Feeding Program. Started in 2003, the program is one of a handful of specialty feeding programs in the United States to offer comprehensive outpatient consultations as well as an intensive inpatient feeding treatment program that provides children and their caregivers with the confidence, skills and tools needed to make meal time a happy part of everyday life.
Children who undergo evaluation and treatment at CHOC for feeding problems and disorders have typically failed outpatient-feeding therapy and have either a G-Tube (feeding tube) or are at risk for G-Tube placement. Patients can have a range of medical problems, as well as developmental problems, including cerebral palsy, developmental disorders, seizure disorders, genetic disorders, oral motor dysfunction, short-bowel syndrome, food allergies or were premature at birth. Children may also refuse to eat many foods or have difficult behaviors that make mealtimes a struggle. Learn more about the children we treat.
Comprehensive Outpatient Feeding Evaluations
The Multidisciplinary Feeding Program offers two-hour comprehensive outpatient evaluations. During the each evaluation, our team of experts evaluate the child’s current medical status, feeding skills and parent-child relationship around eating. At the end of the evaluation, the family is given specific recommendations to help the child progress in their feeding abilities, and some children may be recommended to attend our 19-day inpatient feeding program. Learn more about what to expect at an outpatient feeding evaluation.
Individualized Inpatient Care
At CHOC Children’s, we are dedicated to providing the very best patient- and family-centered care. The goal of our 19-day inpatient feeding program is to not only teach children how to eat, but to help them and their families enjoy the mealtime experience. As part of this effort, our team is dedicated to providing patients and families with a supportive, compassionate treatment experience. The parent and child work together throughout treatment and are provided gentle encouragement and therapeutic strategies that will forever change their mealtime routines. Our goal is to advance each child’s feeding skills while also focusing on the improving the relationships within the family that can often become strained from past difficult mealtime experiences. Inpatient treatment includes structured mealtimes, intensive daily sessions with feeding therapists and a psychologist, supportive sessions with a social worker and child life specialists, ongoing medical and nutritional monitoring and weekly family conferences with the child’s entire care team. Learn more about what to expect at the inpatient CHOC Children’s Multidisciplinary Feeding Program.
Referrals
The Multidisciplinary Feeding Program at CHOC Children’s is intended to be a "first treatment" for feeding difficulties and typcially recommended after a child has received but not recovered through outpatient therapy. Children can be referred by a physician, feeding therapist or may be self-referred by a legal guardian. Referrals are accepted through email at feedingprogram@choc.org or by phone at (714)-509-4884. Learn more about the referral and eligibility process.
Children’s Hospital of Orange County
Pediatric Feeding Program
Program Description
The Pediatric Feeding Program at CHOC was established to evaluate and treat children with significant feeding problems. Children who participate in the program typically have failed outpatient feeding therapy and have either a G-Tube or are at risk for G-Tube placement. Children seen in the feeding program have a range of medical/developmental problems including cerebral palsy, developmental disorders, seizure disorders, genetic disorders, oral motor dysfunction, short-bowel syndrome, food allergies, history of prematurity and behavioral disorders. The program is designed to be multidisciplinary in nature and includes specialists from gastroenterology, speech therapy, occupational therapy, psychology, social work, and nutrition. The program can include one or all of the following components: an initial screening, outpatient feeding evaluation, psychology/behavioral consultation and an intensive inpatient feeding program. After each stage, recommendations are made to best meet you and your child’s goals for better feeding skills.
Eligibility Requirements
Child is between the ages of 2-6.
Child’s feeding problems have been evaluated by a Gastroenterologist and medical problems related to feeding have been ruled out or treated with medication or surgery.
Child’s feeding problems have resulted in significant growth problems and/or G-Tube placement and/or child is currently being considered for G-Tube placement.
Child has received outpatient or in-home feeding therapy for at least 6 months.
Child continues to have significant feeding problems or requires G-Tube feeding after outpatient therapy.
Family is willing and able to arrange for a parent to stay with the child during the inpatient hospitalization, which may last from 3-8 weeks.
Goals of Feeding Program
The Feeding Program’s outpatient evaluation allows for a thorough evaluation of the factors that typically contribute to children’s feeding problems. This multidisciplinary approach provides the team with a comprehensive view of the child’s feeding issues and allows the team to consider all aspects of the child’s behavior into the treatment program.
The outpatient evaluation also provides a method for screening to determine which children will be best served by an inpatient stay. In some cases the team may feel that a child would benefit from additional outpatient services or other interventions instead of the inpatient program.
The Inpatient Feeding Program’s multidisciplinary nature allows the team to meet multiple child and family needs during a single hospitalization. Children who are currently receiving or are eligible to receive speech, occupational therapy or physical therapy will be provided with these therapies during the hospitalization. Social work and psychological/behavioral services will be provided to meet both the child and the families’ needs.
The goal of the inpatient feeding program is to develop feeding techniques and strategies that are effective for the individual child. These skills are then taught to the child’s parents/guardians through modeling, direct coaching and informational sessions. Children learn to eat from both the therapists involved in the case and the family in order to be sure that the child will continue to make progress at home.
For children who are at risk for G-Tube placement, the goal of the feeding program is to increase food intake and prevent the child from needing to be tube fed. For those children who have a G-Tube, the goal of the feeding program is to increase oral food intake and decrease the need for tube feedings. The long-term goal of the program is to have the G-Tube removed following successful transition to oral feedings.
The initial goal of the feeding program for all children is to increase food intake to meet nutritional needs, therefore, children may initially be encouraged simply to take their daily calorie requirements using supplements such as Pediasure. A secondary goal once children are able to take all of their calories orally is to increase the quantity and types of food that the child will eat.
Program Components
Initial Screening Questionnaire/Records Review: Prior to scheduling the outpatient evaluation, families interested in the Feeding Program will be asked to submit the following paperwork to the feeding team:
Medical Records: Parents will be asked to submit complete medical records.
Previous Feeding Evaluations/Treatment: Parents should submit reports from previous evaluations and any information they have from therapists that have worked with the child on feeding issues.
Developmental/Educational Evaluations: If your child has been evaluated for any developmental delays or educational services (e.g. speech therapy, occupational therapy, physical therapy, special preschool, etc.), copies of the evaluation should be sent to the feeding team.
Screening Questionnaire: Families will be asked to complete and return the screening questionnaire.
Food Diary: Families will be asked to complete a three day food diary.
Once the team has received all the child’s records and the questionnaire the team will review the case. Initial recommendations may be made based on the records review for additional medical evaluations or treatment.
Outpatient Evaluation: Children are evaluated in our outpatient clinic, which is held on Tuesday mornings from 8:00 – 10:00 AM. Parents are asked to arrive for this visit at 7:45 to allow time to process paperwork. The parents are asked to bring a variety of foods that the child eats, as well as, foods that the child refuses to eat. Parents should also bring utensils, plates, and cups that are familiar to the child to be used during the evaluation. In order to best assess the child’s food intake, the child should not have eaten breakfast before the evaluation. During the visit the child is evaluated by the following team members:
Gastroenterology: A nurse or physician from GI will review child’s past medical history and current GI needs. The GI specialist will review medical records and speak with the family to ensure that any GI problems related to food refusal have been evaluated and/or treated. Recommendations may be made for additional medical tests or medication trials.
Speech and Language Pathologist/Occupational Therapist: The child will be evaluated jointly by both a speech therapist and occupational therapist. The evaluation will include an observed feeding by child’s parent/guardian and evaluation of the child’s oral-motor skills and sensory processing. The therapists may also attempt to feed the child using alternative feeding strategies. Recommendations may be made for additional evaluations for speech delays or motor delays.
Dietitian: A registered dietitian will review the child’s current food intake and nutritional needs. The child’s current height and weight will be measured and the child’s growth chart will be reviewed. The dietitian will also make a list of the child’s current preferred foods for use in feeding therapy. Recommendations may be made regarding ideal food intake and the use of supplements.
Psychologist: The parent-child feeding interaction is observed to determine if there are behavioral factors that are interfering with or maintaining the child’s current feeding patterns. Along with Speech and OT, determinations are made regarding the child’s difficulties with sensory processing. The child will also be evaluated for other emotional or behavioral difficulties and family factors which may be contributing to the feeding problem.
Social Worker: The social worker on the team will evaluate any family needs that may interfere with the family participating in the inpatient program and/or assist the family in gaining access to additional resources.
At the end of the outpatient evaluation the family is provided with initial recommendations which may include additional medical/developmental evaluations, outpatient feeding therapy, or the inpatient feeding program.
Psychology/Behavioral Consultation: Three appointments with a psychologist or psychology intern from the feeding team will be scheduled either prior to or after the outpatient feeding evaluation. Each appointment will last approximately one hour and will be conducted in the Health Psychology Department at CHOC. The appointments will be scheduled based on the schedule of the psychologist and the family. The purpose of the visits is to obtain additional information about the child and family including the child’s development, family interaction style, feeding behaviors, other problem behaviors and parental concerns. Developmental testing or additional assessments may be conducted during the psychology visits. The visits also serve to help prepare the family for the inpatient stay which can be difficult for families due to the intensity of the child and parental involvement in the program.
Inpatient Feeding Program: The Inpatient Feeding Program is conducted on the 5th Floor of CHOC. Children are typically admitted for a 3-8 week stay at the hospital. During this stay at the hospital, one parent must stay with the child throughout the day and night. In some families one parent will stay with the child during the day and then the other parent will spend the night with the child. The daily schedule is structured to include a range of therapies to address the feeding problem and other developmental issues. Typically either the speech therapist or occupational therapist conducts breakfast and lunch feedings with the parent observing. The dinner feeding is then conducted by the parent using the skills they have observed and been taught at breakfast and lunch. The child may also receive occupational therapy, speech therapy, physical therapy, sensory-motor integration and/or play therapy each day. Parents may also participate in family counseling/behavior management sessions. Discharge planning is done on an individual basis with input from all team members and the family.
Program Follow-up: Following discharge from the Inpatient Feeding Program, children typically continue to receive outpatient feeding therapy. The goals of continued therapy are to ensure that the child’s gains are generalized to the home setting and to continue to work with the child to expand the child’s food intake. Outpatient therapists also serve as a continued link to the inpatient team to allow early intervention if the family experiences additional feeding problems or regressions in feeding behavior.
Children’s Hospital of Orange County
Pediatric Feeding Program
Program Description
The Pediatric Feeding Program at CHOC was established to evaluate and treat children with significant feeding problems. Children who participate in the program typically have failed outpatient feeding therapy and have either a G-Tube or are at risk for G-Tube placement. Children seen in the feeding program have a range of medical/developmental problems including cerebral palsy, developmental disorders, seizure disorders, genetic disorders, oral motor dysfunction, short-bowel syndrome, food allergies, history of prematurity and behavioral disorders. The program is designed to be multidisciplinary in nature and includes specialists from gastroenterology, speech therapy, occupational therapy, psychology, social work, and nutrition. The program can include one or all of the following components: an initial screening, outpatient feeding evaluation, psychology/behavioral consultation and an intensive inpatient feeding program. After each stage, recommendations are made to best meet you and your child’s goals for better feeding skills.
Eligibility Requirements
Child is between the ages of 2-6.
Child’s feeding problems have been evaluated by a Gastroenterologist and medical problems related to feeding have been ruled out or treated with medication or surgery.
Child’s feeding problems have resulted in significant growth problems and/or G-Tube placement and/or child is currently being considered for G-Tube placement.
Child has received outpatient or in-home feeding therapy for at least 6 months.
Child continues to have significant feeding problems or requires G-Tube feeding after outpatient therapy.
Family is willing and able to arrange for a parent to stay with the child during the inpatient hospitalization, which may last from 3-8 weeks.
Goals of Feeding Program
The Feeding Program’s outpatient evaluation allows for a thorough evaluation of the factors that typically contribute to children’s feeding problems. This multidisciplinary approach provides the team with a comprehensive view of the child’s feeding issues and allows the team to consider all aspects of the child’s behavior into the treatment program.
The outpatient evaluation also provides a method for screening to determine which children will be best served by an inpatient stay. In some cases the team may feel that a child would benefit from additional outpatient services or other interventions instead of the inpatient program.
The Inpatient Feeding Program’s multidisciplinary nature allows the team to meet multiple child and family needs during a single hospitalization. Children who are currently receiving or are eligible to receive speech, occupational therapy or physical therapy will be provided with these therapies during the hospitalization. Social work and psychological/behavioral services will be provided to meet both the child and the families’ needs.
The goal of the inpatient feeding program is to develop feeding techniques and strategies that are effective for the individual child. These skills are then taught to the child’s parents/guardians through modeling, direct coaching and informational sessions. Children learn to eat from both the therapists involved in the case and the family in order to be sure that the child will continue to make progress at home.
For children who are at risk for G-Tube placement, the goal of the feeding program is to increase food intake and prevent the child from needing to be tube fed. For those children who have a G-Tube, the goal of the feeding program is to increase oral food intake and decrease the need for tube feedings. The long-term goal of the program is to have the G-Tube removed following successful transition to oral feedings.
The initial goal of the feeding program for all children is to increase food intake to meet nutritional needs, therefore, children may initially be encouraged simply to take their daily calorie requirements using supplements such as Pediasure. A secondary goal once children are able to take all of their calories orally is to increase the quantity and types of food that the child will eat.
Program Components
Initial Screening Questionnaire/Records Review: Prior to scheduling the outpatient evaluation, families interested in the Feeding Program will be asked to submit the following paperwork to the feeding team:
Medical Records: Parents will be asked to submit complete medical records.
Previous Feeding Evaluations/Treatment: Parents should submit reports from previous evaluations and any information they have from therapists that have worked with the child on feeding issues.
Developmental/Educational Evaluations: If your child has been evaluated for any developmental delays or educational services (e.g. speech therapy, occupational therapy, physical therapy, special preschool, etc.), copies of the evaluation should be sent to the feeding team.
Screening Questionnaire: Families will be asked to complete and return the screening questionnaire.
Food Diary: Families will be asked to complete a three day food diary.
Once the team has received all the child’s records and the questionnaire the team will review the case. Initial recommendations may be made based on the records review for additional medical evaluations or treatment.
Outpatient Evaluation: Children are evaluated in our outpatient clinic, which is held on Tuesday mornings from 8:00 – 10:00 AM. Parents are asked to arrive for this visit at 7:45 to allow time to process paperwork. The parents are asked to bring a variety of foods that the child eats, as well as, foods that the child refuses to eat. Parents should also bring utensils, plates, and cups that are familiar to the child to be used during the evaluation. In order to best assess the child’s food intake, the child should not have eaten breakfast before the evaluation. During the visit the child is evaluated by the following team members:
Gastroenterology: A nurse or physician from GI will review child’s past medical history and current GI needs. The GI specialist will review medical records and speak with the family to ensure that any GI problems related to food refusal have been evaluated and/or treated. Recommendations may be made for additional medical tests or medication trials.
Speech and Language Pathologist/Occupational Therapist: The child will be evaluated jointly by both a speech therapist and occupational therapist. The evaluation will include an observed feeding by child’s parent/guardian and evaluation of the child’s oral-motor skills and sensory processing. The therapists may also attempt to feed the child using alternative feeding strategies. Recommendations may be made for additional evaluations for speech delays or motor delays.
Dietitian: A registered dietitian will review the child’s current food intake and nutritional needs. The child’s current height and weight will be measured and the child’s growth chart will be reviewed. The dietitian will also make a list of the child’s current preferred foods for use in feeding therapy. Recommendations may be made regarding ideal food intake and the use of supplements.
Psychologist: The parent-child feeding interaction is observed to determine if there are behavioral factors that are interfering with or maintaining the child’s current feeding patterns. Along with Speech and OT, determinations are made regarding the child’s difficulties with sensory processing. The child will also be evaluated for other emotional or behavioral difficulties and family factors which may be contributing to the feeding problem.
Social Worker: The social worker on the team will evaluate any family needs that may interfere with the family participating in the inpatient program and/or assist the family in gaining access to additional resources.
At the end of the outpatient evaluation the family is provided with initial recommendations which may include additional medical/developmental evaluations, outpatient feeding therapy, or the inpatient feeding program.
Psychology/Behavioral Consultation: Three appointments with a psychologist or psychology intern from the feeding team will be scheduled either prior to or after the outpatient feeding evaluation. Each appointment will last approximately one hour and will be conducted in the Health Psychology Department at CHOC. The appointments will be scheduled based on the schedule of the psychologist and the family. The purpose of the visits is to obtain additional information about the child and family including the child’s development, family interaction style, feeding behaviors, other problem behaviors and parental concerns. Developmental testing or additional assessments may be conducted during the psychology visits. The visits also serve to help prepare the family for the inpatient stay which can be difficult for families due to the intensity of the child and parental involvement in the program.
Inpatient Feeding Program: The Inpatient Feeding Program is conducted on the 5th Floor of CHOC. Children are typically admitted for a 3-8 week stay at the hospital. During this stay at the hospital, one parent must stay with the child throughout the day and night. In some families one parent will stay with the child during the day and then the other parent will spend the night with the child. The daily schedule is structured to include a range of therapies to address the feeding problem and other developmental issues. Typically either the speech therapist or occupational therapist conducts breakfast and lunch feedings with the parent observing. The dinner feeding is then conducted by the parent using the skills they have observed and been taught at breakfast and lunch. The child may also receive occupational therapy, speech therapy, physical therapy, sensory-motor integration and/or play therapy each day. Parents may also participate in family counseling/behavior management sessions. Discharge planning is done on an individual basis with input from all team members and the family.
Program Follow-up: Following discharge from the Inpatient Feeding Program, children typically continue to receive outpatient feeding therapy. The goals of continued therapy are to ensure that the child’s gains are generalized to the home setting and to continue to work with the child to expand the child’s food intake. Outpatient therapists also serve as a continued link to the inpatient team to allow early intervention if the family experiences additional feeding problems or regressions in feeding behavior.
