This will be an unusual post for my blog- usually I stick to informational type posts, however, I would like to tag onto to a vibe that I have been feeling lately in some of the face books groups and list serves I belong too and that is one of collaboration.
I want to say some special thank you’s to clinicians for being gracious and collegial. I’ll start with a thank you to Melanie Potock for always being so respectful and kind in posts and highlighting this concept. We need to work together as clinicians and not against each other, even if we come from different philosophical sides.
Pediatric feeding disorders are complicated and usually multi-factorial in nature. They effect children from birth to adulthood and come in all shapes and sizes and different severity levels. This is why they are so challenging to treat. There is no single way to treat a child with a feeding problem. The truth is there are many techniques and strategies to choose from. Not every technique will work all of the time. What we don’t know is what type of feeding problem will respond best to which technique. Therefore, it is a good thing that there are different options available.
Unfortunately, the research we have is scarce. We do not have solid research studies that back up many of the techniques we use on a daily basis- from medical management, to evaluation techniques, or the therapeutic interventions we employ. We don’t even have common language to talk about feeding problems across disciplines. So what most therapists do is rely on their anecdotal experience in making clinical decisions. Experience, research, reading, information gathered from workshops, lectures and books, and collaboration all go into our recommendations.
Last year, I presented my CAN-EAT course in Tuscon, AZ for Mealtime Connections. I was admittedly a little nervous to be presenting for Marsha Dunn Klein, one of the most experienced therapists in our field. I often think of something that she said to me as I apologetically said I don’t use traditional sensory approaches. I am paraphrasing now but she said “you use the techniques that have worked for you and that you’ve had success with”. Thank you Marsha for your acceptance and kind words, so simple but so true.
I work on a hospital based feeding team that uses medical, nutritional and behavioral strategies in an out patient clinic. Not many children start with a feeding team. The reality is that we are often called upon for second and third opinions. We see many children who have failed or had poor progress with their local feeding therapy. Most often, it is the local therapist who is sending the child to us to assist with medical and nutritional strategies or further evaluation and therapy strategies to help the child progress. So I see a fairly complicated type of feeding patient and one that often comes to me having tried various techniques and interventions prior to our evaluation. I also see many children who are medically complex that are referred from the clinics in the hospital. All of this influences my view on feeding problems and intervention. If someone asked me why children have trouble progressing in feeding therapy, I would say for many children it is because they don’t feel good when they eat. Most of the children who come to see us have underlying GI issues, food intolerances, or diagnoses that interfere with their ability to progress with oral feeding.
I want to help encourage collaboration and open mindedness where we listen to each other and learn from one another. I learn every day from parents, colleagues, and our kids! If you email me for advice I will always do my best to support you as a clinician and give you honest advice. This is not an exact science. After all, the point of all of this is to help a child feed successfully and reach their best function possible in the easiest and most successful way.
Melanie Van Noy says
A great blog! Well said, and thanks for putting this out there!
Susan Harper says
Thank you so much. As a parent, of a child with a G-tube who seems to be developmentally okay with the exception of her medical needs, I find that I am the one doing the coordinating because the specialists are in different offices and don’t necessarily consult each other regarding my child’s needs. I do a lot of reading and research on my own, bring in suggestions and they are rubber stamped as the plan. I would like more collaboration and coordination of medical/feeding issues. Any suggestions? I know that it may be that I need all the specialist in one office and stop trying to get practitioners in two different communities to talk with one another. I am about at the point where I’m ready to do that.
Nannette Martin says
I commend you for the hard work you are doing for your daughter. It is not uncommon to see parents of children with feeding issues functioning as “case managers”. It takes so much time to get everyone on the same page.
It certainly does help when your child is seen in a larger hospital where all of their sub-specialists practice. I would often schedule a child’s gi appointment on the same day that they were seeing another specialist (like neurology or pulmonary). That way I could confer with that provider immediately. When I was at UNC -Chapel Hill with Krisi, we had an Aero-digestive team coordinator who managed all of the appointments. What a luxury that was!
If you cannot coordinate appointments on the same day, I would encourage you to keep the summaries of your visits with you to share with each specialist in case they cannot access these records. I have had some providers who are willing to email parents along with other specialists. That may be an option for you as well. Thank you for this post!
Lori Nachtigal Rothschild says
This is awesome. Thanks. One thing I love about melanie Potok and Diane Bahr is they are on the blogs and respond. So amazing to see you being so open too! I am an administer on a Facebook feeding page . It’s called slpfeedingtherapy. Feel free to post or comment. We would love it. The site is slp’s and parents with feeding issues
As a grandparent of a 3 1/2 year old grandson, the colaborative approach we have experienced at Krisi’s clinic is amazing! The compassion and support given to families dealing with this overwhelming condition is so comforting, especially at a time when you are struggling and don’t know what the future holds. Understanding that you are working with children with different diagnoses and underlying causes and families who have different strengths, concerns and levels of understanding is the biggest strength of this team. Thanks to Krisi and her team for your knowledge, support, strategies and willingness to see my grandson as a child with feeding issues not a feeding issue in a child.
Brandi Watts says
Thank you for this post! I, too, work in a medical setting with very medically complex children and while I absolutely take sensory concerns and considerations into account with food, techniques and environmental components, I do not use an SOS approach. I have often felt judged and criticized. I applaud anyone who dives into the world of pediatric feeding, regardless of philosophy, because there are too few practitioners in the field. Live and let live, there is more than one way to treat children. I feel sad that Ms. Bracket felt the need to defend herself at all.
Krisi Brackett says
Thank you for the nice comments and the support of this amazing community! While I have tried to develop a blog that represents all sides of feeding, you have given me the confidence to be more open about my “opinions” on the blog and to share my experience. Thank you! Krisi
Suzanne Ducharme says
Thank you, Krissi, for putting this out there. I too have noticed a lot of negativity and attacks on clinicians like Melanie Potock because there are not RCTs for everything that we do. If that were the only standard, there would be very little that we could do in our practices! I am also a feeding therapist with many years of experience, and have found that my techniques have evolved over the years, as have my clients and their needs. I would like to see less bashing of clinical experience and more respectful discussion about how experience and the results that have come from it have shaped the field and how they help children and families every day.
Nancy Calamusa says
BRAVO!!! Well said and I am so happy you wrote this! I could not agree more!
Marget Wincent, OTR says
Collaboration and respect for each other’s work, I believe, are the foundation for what we bring to each interaction- with our patients, their families and teams. This important topic that was recently touched on by Melanie Potock at a recent workshop in Dallas. Thanks Krisi for bringing this to your blog.
Catherine S Shaker, MS/CCC-SLP, BCS-S, C/NDT says
I agree, Krisi. We are all life long learners I hope and as we know better, we do better. Those of us blessed to have been mentored by some amazing colleagues and to be in an environment that brings both challenging patients and supportive professional colleagues, have an obligation to share, to support and to guide kindly and with respect. When I offer thoughts to problem-solve a patient whether a tiny preterm or an 18 year old post-head injury, that idea is foremost in my mind.
The levels of evidence- base include professional wisdom; while it is the lowest level of evidence it is as you say Krisi, a valid tool. Our challenge is to combine professional wisdom, the higher levels of evidence-base and critical thinking to assure our approach and plan of care does no harm and is carefully titrated each session with each patient. We owe our families that commitment, and in doing so, we grow in our clinical reasoning.
Nannette Martin says
Great post! I totally agree that collaboration is critical. I have learned so much from shadowing at different feeding centers, attending conferences and conferring with colleagues. We all come with different backgrounds and experiences. Our patients benefit most when we work together. Well said, my friend! Nannette