Incorporating complementary Traditional Chinese Medicine into a Multidisciplinary Feeding Program
by Dr. Mitchell Katz, MD
At CHOC Children’s Hospital in Orange, California, we approach the evaluation and treatment of children with feeding problems with an individualized and multidisciplinary approach. Children enter our intensive inpatient program with a common concern; they will not eat a typical diet in a typical fashion. Whether they are dependent on tube feedings or restricted in their food choices or demonstrate aversive behaviors in and around feeding opportunities, children arrive at that point by many different pathways. Likewise the treatment of these children needs to be individualized to address the cause of the feeding challenges and the effects with which they are dealing.
As the child enters the intensive feeding program, a plan is developed to utilize the expertise of the various members of the program. The program is comprised of a physician and nurse practitioner who monitor the medical aspects of the child during the parent and child’s stay in the Program, occupational and speech therapists who provide the feeding therapy, a psychologist and a social worker who provide assistance in management of developmental, behavioral and parenting concerns that are identified, and dietitians who monitor intake and provide education regarding the proper dietary composition and portions that the child should be offered. Additionally, a child life specialist assists in gearing playtime towards sensory play when needed or food related play.
At CHOC Children’s we have also utilized the services of a practitioner of Traditional Chinese Medicine (TCM) in the treatment of some of our patients. CHOC Children’s has a practitioner of TCM on staff and we have come to realize that through collaboration between practitioners of “western medicine” and “eastern medicine” we can provide a more holistic approach that has generated benefits.
TCM has been developed over the past 2500 years and includes herbal medicine, acupuncture, massage, exercise and dietary therapy. Despite its ancient origins, TCM continues to be actively practiced in Asia, has had developing acceptance in Western countries and is used as a complementary mode of therapy in multiple medical conditions and situations. Although widely used, TCM has not been studied in controlled trials and acceptance has been variable by the medical community.
TCM complements the typical “western” approach to the treatment of children with feeding challenges through multiple avenues. With the use of interventions we find that treatment given prior to a therapeutic feeding session can result in the reduction of anxiety experienced by the child prior to and/or during the feeding session. Anxiety surrounding meals could be behavioral or sensory based. Children treated by our program have significant negative associations with eating and, as a result, with food itself. This anxiety serves as an obstructer to making advances in the child’s relationship with food. The ability to lower anxiety as the child approaches therapy and the food serves to allow therapists a better chance of success during the feeding session. Better cooperation is achieved and the classical feeding therapeutic techniques then utilized have a better chance for success. The TCM practitioner uses a combination of acupressure, acupuncture, massage, placement of seeds and oral tinctures and herbs in order to reduce anxiety. As with everything that we do, the prescription for the child is individualized. In older children, the TCM practitioner has been able to teach techniques that would lessen anxiety much like psychologists and other therapists use techniques such as biofeedback and guided imagery. In addition to the work by the practitioner directly with the child, the parent is also taught techniques to apply once the child is discharged. This could include massage techniques and the use of certain herbs.
The TCM practitioner has used herbs in our patients. Herbs are plant-based products that seem to have medicinal or pharmacological benefits. In our patients the TCM practitioner has used ping wei san for several reasons. Clinically, ping wei san has been found to help reduce retching associated with feeding. The mechanism is not clear but a child with postprandial retching that is not due to an identifiable organic cause has, at times, responded to the use of ping wei san. Also, ping wei san has resulted in increased appetite in some patients. We have used it in conjunction with cyproheptadine or alone, especially when side effects from the cyproheptadine have occurred. To address generalized or focused anxiety that could interfere with conventional approaches to feeding therapy the TCM practitioner has used an herbal product called zizyphus, a genus in the buckthorn family. To the TCM practitioner, it is believed to calm the spirit. It is used to treat irritability, insomnia and heart palpitations. There has been concern expressed by western medicine practitioners regarding the potential toxic side effects of some of the herbs used in TCM however we have found no negative side effects in the herbs that have been used in our patients.
Children with feeding problems present with varied challenges that serve to interfere with their achieving typical feeding behavior. The Multidisciplinary Feeding Program at CHOC Children’s appreciates this fact and individualizes the therapeutic approach to a child’s feeding problems. In the appropriate scenario, TCM provides us with a complementary modality to be utilized in our treatment plan.
Learn more about the CHOC Children’s Multidisciplinary Feeding Program, Children’s Hospital of Orange County, CA