Monday, December 29, 2014
Intensive Feeding Program
By: Dr. Michelle Mastin is a clinical psychologist and head of the new Intensive Feeding Program at Children’s of Alabama.
A new Intensive Feeding Program at Children’s of Alabama helps infants, toddlers and adolescents overcome problems feeding and drinking often associated with developmental delays or serious illness. It is the first and only program of its kind in Alabama and one of only a handful of similar programs in the U.S.
The program incorporates pediatric subspecialists, technologies and behavioral psychology into a unique and effective system for teaching both parents and children how to deal with these difficult issues. The program at Children’s is designed in a similar fashion to the one developed at Helen DeVos Children’s Hospital in Grand Rapids, Mich.
The program at Children’s of Alabama is the behavioral psychology component of the new Aerodigestive Program, which encompasses a larger mission of managing complex airway, feeding or nutritional issues. Program specialists evaluate children, develop treatment plans and provide care for a wide variety of conditions using proven, behavior modification techniques coupled with the insight and interventions of speech and language pathologists and occupational therapists.
About half of the program’s patients are expected to be feeding-tube dependent, and in many cases the team will work to normalize the child’s eating and drinking abilities. The Intensive Feeding Program is also capable of dealing with:
• Food refusal
• Oral aversion
• Inability to consume adequate volumes of food and liquid
• Transitioning to age-appropriate textures, consistencies or utensils
• Recurrent vomiting
• Restricted eating patterns
Patients should be referred to the program at Children’s after going through previous attempts to improve their feeding and drinking behaviors. The program is set up to handle tougher, more persistent cases that require multi-disciplined interventions and are often associated with conditions such as gastric esophageal reflux disease, failure to thrive, dysphagia, gastrointestinal problems, developmental disorders, including those on the autism spectrum and behavioral difficulties.
This is an intensive, outpatient program lasting six to eight weeks, five days a week, from 8 a.m. until 5 p.m. Generally, experts will spend about four weeks feeding a child all meals during the week in order to approach identified goals. Care is provided in a room equipped for unobtrusive observation by parents, other caregivers or health professionals.
After that, parents or caregivers will be provided with a small earphone and sent into the treatment room to take over the feeding and drinking interventions. Initially they will be working with their child with the help of therapists. As the caregivers progress and the child demonstrates consistent success, therapists will transition to the observation rooms where they can continue to coach caregivers. It is an effective way to improve the interaction between parents and children at mealtimes.
The results are often impressive. For example, the program at Children’s had its first graduate of the day treatment program in November 2014. This patient was born with significant complex medical challenges, including significant prematurity (born at 22 weeks gestation). The patient came into the program 100 percent dependent upon a feeding tube for nutrition, but was discharged 8 weeks later without the need for G-tube feedings.
Similar programs have been studied and found to be effective. This is a precisely targeted therapy that often succeeds in improving the quality of life for both the child and family. Children’s program is currently evaluating patients weekly and is currently admitting two patients at a time into day treatment. The goal is to expand the program to be able to treat three patients at a time in the second year of the program and four patients at a time in the third year. Referrals forms for evaluation can be found on the Children’s website at www.childrensal.org or by calling 205-638-7590.