Universal Aspects in Feeding Intervention

Let’s talk about universal aspects in feeding intervention

This is any idea I have been playing around with for awhile now. We all know that there are different strategies and philosophies in feeding treatment. This is a good thing– we need many options to help our kids with PFD (pediatric feeding disorder). And this can be hard to sort out as a feeding therapist especially if you’re new to the field, but keep an open mind!  I will save that for another post. 

What are aspects of care in feeding treatment that we all must address, no matter what type of feeding therapy we prefer to use? This is what I came up with- I will call these universal aspects of feeding treatment

• Positioning for feeding
• Motivation to particulate in therapy and feeding
• Caregiver training
• Mealtime structure
• Positive meal time experiences and pleasure with food and family
• Medical and nutritional management to support feeding and growth
• Driving appetite and hunger, desire to eat
• Team work

Now let’s dig into these a bit more deeply- these are not in order of importance and that will depend on on the individual needs of the child and family. 

• Positioning for feeding: Children benefit from supportive seating with postural alignment when eating to support stability in oral motor function, swallowing, and digestion. Some children need special seating systems while others can achieve stability in a high chair or regular kitchen chair. If you’re not sure what I mean, look up at the ceiling and swallow. Feels awkward, right? We help find the best and safest positioning for mealtime.

• Motivation to particulate in therapy and feeding: How we do motivate children to participate in something they don’t want to do? We make therapy fun and engaging, build report, and use structure to the session. This could include hunger, a visual schedule, worksheet, game /activity, or clear indication of expectations of the therapy task and activity.

• Mealtime structure: We help families figure out appropriate meal time structure to improve eating. We may recommend reduction of grazing, changing the way a supplement or tube feeding (with medical team) is used, establishing clear eating and non-eating times, or limiting snacking. Hopefully, these suggestion improve intake at mealtimes.
• Caregiver training: How do we help caregivers feed their hard to feed child? We want to support our parents and caregivers by giving them the tools to successfully feed their children. I do this by having parents feed with me and coaching them during our sessions. I also provide support and resources because we know this is an incredibly stressful issue for families. I consider this my main job as a feeding therapist.
• Positive mealtime experiences and pleasure with food and family: How do we create positive experiences at mealtimes? I do not like to recommend therapy activities during a family meal. Instead, I often recommend the child sit with the family. Perhaps the child has preferred food or a plate of the family foods for exposure, child led interaction with the food, observation of family members eating, or a portion foods we have been practicing in therapy. My goal with family meal is low stress, family enjoyment, and social  interaction. This may look different depending on the needs of the child.

• Medical and nutritional management to support feeding and growth: I believe many pediatric feeding disorders have a medical and nutritional component.  It is often hard to determine what is a medical issue versus a behavioral problem versus a sensory issue. As a therapist who works on an interdisciplinary team, I see a lot of children who are not progressing with feeding skills in good feeding therapy due to a variety of medical and nutritional barriers. Simply put, children eat better when they feel better. They respond to therapy better when they feel better and this includes treating underlying medical issues and helping a child to get the proper calories and nutrients for growth and development.

• Driving appetite and hunger, desire to eat: How do we encourage appetite and hunger in our kids? Many children with PFD do not experience a typical hunger drive. This is something that is not easy to measure but explored through caregiver discussion and intake patterns. In my practice, we approach this from different angles. Meal time scheduling, limiting snacking, and spending out supplements can help. Creating opportunity to feed! In addition, in some cases adding an appetite stimulant medication can be very helpful. The most common medication used is cyproheptidine (brand name periactin). We find that over time with correct use of the appetite stimulant, it builds hunger, comfort with more volume of food, and a habit of eating. Children then transition off the medication without difficulty and continue eating. Adding: promoting more autonomy w feeding vs caregiver regulation of volume and calorie concentration and high calorie drinks, which preclude hunger drive and often cause that gut discomfort.(From Ann Marie Presberg MS, CCC-SLP-CCC)

• Team work: Last but not least, one of my favorite topics, team work. It is very hard to remediate pediatric feeding problems as a therapist by yourself. That is because they are often complicated and multifactorial. The Goday et al. (2019) definition of PFD explores the 4 domains of PFD and helps to illustrate the complex nature of PFD. this is an open access article and anyone providing feeding treatment should read this!  https://pmc.ncbi.nlm.nih.gov/articles/PMC6314510/ . Most of us do not work on feeding team but I encourage therapists to identify other providers (medical, nutritional, therapeutic, psychological) in your local area who can support you in the care of children with PFD. 
• Adding:The Sensory Environment and Feeding:  We really can’t talk about the motor aspects of the whole body without talking about sensory initiation and feedback for comfort, food acceptance and guidance of movement.  Sensory regulation and processing: sensory information in the external and internal environment can be overwhelming or not detected adequately.  This affects oral movement as much as poor motor function and positioning for feeding and is a major driver of food rejection.(From Suzanne Evans Morris, PhD, CCC-SLP)

If you want to explore these ideas further, please consider joining me in my CAN-EAT Approach© workshop. https://www.motivationsceu.com/product-page/306-can-eat-approach-using-medical-motor-behavioral-strategies