• About
    • Disclosure and Disclaimer Policy
  • Blog
  • Shop Ebooks
  • Recommended Products

Pediatric Feeding News

Dedicated to up to date pediatric feeding and dysphagia information

Welcome!

Hi, I'm Krisi Brackett, MS SLP/CCC this blog is dedicated to current information on pediatric feeding and swallowing issues. Email me at feedingnewsletter@gmail.com with questions.

Read More About Me Here...
  • Feeding Flock
    Research
  • For Parents
    & Caregivers
  • View The
    Resources
  • Pediatric Feeding
    & Dysphagia Newsletter
    • Volume 1
    • Volume 2
    • Volume 3
    • Volume 4
    • Volume 5
    • Volume 6
    • Volume 7
    • Volume 8
    • Volume 9
    • Volume 10
  • Workshops &
    Presentations
  • Ask Me A
    Question
  • Links
    We Like

Feeding Therapy Thoughts

April 16, 2017 by Krisi Brackett 5 Comments

A question for feeding therapists? 

  • Are you providing feeding therapy with parents present?
  • Are you working closely with caregivers to understand their goals as well as provide teaching and training to build their feeding skills?

Each patient has the unique opportunity of teaching us something as therapists and really as human beings if we let them. As therapists, we have an interesting window into a families struggle including the depression, anxiety and stress feeding issues can create.

 

I would like to share an experience I have had with one of my patients. Our feeding team has been following a child who is  medically complex for quite some time. This patient has a history of complicated medical issues, reflux and vomiting, aspiration of all liquids on initial swallow study due to impaired vocal cord function, constipation, and developmental delay. He came to us breast feeding but aspirating and not growing. We put a feeding tube in and as a team have been able to manage reflux, constipation, and growth issues with medical and nutritional strategies. We helped  establish home feeding therapy with feeding team follow up every 2 -3 months or as needed.

 

Each time this child came to feeding team, we saw a similar pattern. He was growing and appeared more comfortable from a GI standpoint but continued to be very hypersensitive, displayed strong refusal behaviors, and was not progressing with his feeding skills. Caregivers would tell us what the home therapist was doing. I would make some suggestions for therapy and attempt therapeutic strategies. Patient would protest and become upset, caregivers would cry, and the session would end and so forth. We offered suggestions for medical, nutritional and therapeutic strategies- some were taken, many were not. Family was not willing to come to the hospital for consistent therapy. Progress was crawling along like a snail. This patient what was about 16 months at the time was taking zero to 3 bites of puree per session with all nutrition via feeding tube.

 

In some ways, I think I had given up. Then one day in clinic, patient’s mother looked at me and said “why aren’t we pushing him?”. “Why aren’t we exposing him to food?” “Why aren’t we doing everything we can?” “I have been on the internet and there are all of these things we could be doing!”

 

I must say, I was speechless for about 5 minutes. Hadn’t I been saying all of this for the last year? He was in feeding therapy although we knew he wasn’t progressing. I swallowed any feelings of defensiveness that I felt that I had not done my job. After all, this was not about me. And then I realized that I had not been providing information in a way that the caregivers could hear and understand- or maybe they were not ready to push their child and were afraid to have expectations that their child could eat?

 

I jumped right on the band wagon of this mother’s new found focus and determination. We put together a plan that included:

  • exposing patient to food experiences coupled with structured feedings using a gentle behavioral approach focusing on acceptance of purees.
  • consistent feeding therapy using new strategies at the hospital to assist with management.
  • repeating the swallow study which he passed!
  • adding in some medical management to boost appetite and gastric accommodation.
  • altering tube feeding schedule to elicit hunger and boost desire to orally feed.

 

The results have been exciting! In 2 months, this child has moved from total refusal to now accepting 3 meals of 8  ounces of a variety of types of smooth puree with minimal refusal and no gagging. He is also working on cup drinking and at our last session accepted 2 oz of slightly thickened fluid via open cup with his puree meal. Our dietitians have adjusted his tube feedings and he now only requires water and a small volume of formula  via tube  to make up caloric and protein needs.

 

Future directions include moving toward acceptance of home made purees to boost calories, flavor and nutrient profile of the purees, drinking for fluid needs and chewing.

 

What I have learned. I have learned to meet caregivers where they are, to support them, provide information and education that they need and to never give up on them or their child. I have learned not to be attached to a specific philosophy or therapy strategy or judge therapists or caregivers. Every child is unique and different and  what helps one child may not help another in the same way. My colleague likes to say we take of a bunch of unicorns, each one unique and special. We all bring different strengths and experience to the table with a united goal to help our young clients have the best quality of life possible.

Perhaps the timing must be right for the child and caregiver to make progress? And maybe most importantly, I learned of the importance of caregiver support, willingness, and acceptance of the therapeutic feeding plan. Once the caregivers expressed a strong desire to work on feeding diligently and consistently, this child began dramatic improvement! I also believe this was possible because he was in a place of good nutrition and growth including well managed GI issues.

I do believe this child is on his way to becoming a successful oral feeder.

Share this:

  • Click to share on Twitter (Opens in new window)
  • Click to share on Facebook (Opens in new window)

Related

Filed Under: Feeding Treatment Tagged With: feeding problem, feeding therapy, parents and feeding therapy, Pediatric Dysphagia, tube weaning

Comments

    Leave a Reply Cancel reply

    Your email address will not be published. Required fields are marked *

  1. Julie Kouzel says

    April 16, 2017 at 3:12 pm

    This has happened to me, more times than I can remember, with feeding as well as language and strategies for parenting! Thanks for sharing; if it can happen to you…it can happen to anyone!

    Reply
  2. Tiffany says

    April 16, 2017 at 5:04 pm

    Wow, I love this. I’m not specifically a feeding therapist, I work as a pediatric PT and primarily in early intervention. But what you wrote really hit home. Sometimes you think you’re educating a family and caregivers and meeting them where they’re at, but until they’re ready to jump on board things can feel stagnant. I’ve had similar conversations with families who are frustrated or think we haven’t been doing enough, and that’s hard. But, it helps to know someone with as much experience as you, who is clearly awesome at her job, runs into the same thing from time to time. I took your course a couple years ago out in Colorado with PPHC and I’d love to go again if you’re ever in the area, it was amazingly informative. Thanks Krisi!

    Reply
  3. Jill says

    April 16, 2017 at 6:15 pm

    I work EI. Caregiver/parent is always present and when they are comfortable they are the person feeding the child. We talk about involving the child in as many sensory experiences related to feeding as possible. I often feel like a broken record repeating these strategies. Then, all of the sudden they buy in after reading/hearing it for the first time from a Facebook group, another parent, etc.
    It’s a journey for sure!!

    Reply
  4. Krisi Brackett says

    April 16, 2017 at 7:12 pm

    Thanks for the thoughtful and encouraging comments!

    Reply
  5. Tanya says

    April 17, 2017 at 4:23 am

    As a fellow feeding therapist, I totally agree! Meeting families where they are at is SO important! Thank you for sharing!

    Reply

Cart

Products

  • When Your Child Can't Or Won't Eat
    Rated 1.00 out of 5
    $10.00

Recent Posts

  • Happy New Year 2023!
  • Baby-Led Bottle Feeding – Free Ebook Promotion for 4 Days
  • UNC Feeding Team presents:  Avoiding Mealtime Stress in Pediatric Feeding Disorders:  Interdisciplinary Approaches to Address Food Selectivity, Oral Aversion and Food Refusal
  • A Formula Shortage How Policy, Societal Pressure Impact Babies & Parents
  • Feeding Research: Looking for Parents of 6-12 month olds

Recent Comments

  • Kelsey on Hypersensitive Gag Reflex and Pediatric Feeding Delays By Donna Scarborough Ph.D., CCC-SLP, BCS-S Miami University, Oxford, OH scarbod@muohio.edu
  • Elaine Egbert on Aversive Feeding Behavior: Getting full mouth opening for the spoon and why it’s worth the trouble
  • Krisi Brackett on Feeding Flock – Feeding Assessment Tools
  • prabha on Feeding Flock – Feeding Assessment Tools
  • Abigail Wilson on Happy New Year 2023!

search

Categories

Archives

My Account | Shop | Shopping Cart
Copyright ©2023, Pediatric Feeding News. All Rights Reserved. Custom design by Pixel Me Designs
 

Loading Comments...