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.