Evaluation & Treatment

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Authored by:
Amy L. Delaney, PhD, CCC-SLP, Erika Gisel, PhD, OTR, erg, and Feeding Matters

Pediatric feeding disorders are complex. They originate from any single problem or any combination involving your child's medical status, issues with growth and nutrition, or limited skills and abilities as well as the parent–child interaction. When you seek services, your child’s evaluation needs to be comprehensive so that treatment can be customized to his or her individual capabilities.

A shortage of specialists, limited resources, and a lack of coordinated support can cause stress and frustration that affect the whole family. It is normal to feel overwhelmed or have a sense of helplessness. Feeding Matters will help provide the knowledge that empowers you to foster meaningful and collaborative relationships with your child’s providers. Click through the interactive service flowchart below to learn more about the evaluation and treatment options.

Feeding Matters promotes a Coordination of Care Model that addresses all aspects of pediatric feeding disorders. This collaborative approach to care consists of two or more disciplines working together in a formalized relationship. This model of care is represented by the middle, streamlined track above.

A parent with concerns initiates a visit with the primary care physician (PCP)

  • Below is a sample of warning signs associated with pediatric feeding disorders. You may share this list with your child’s physician. For a more comprehensive list, based on your child’s age, please visit our Infant and Child Feeding Questionnaire©.
  • Child refuses, cries, chokes, or vomits during feeding
  • Child take too little or too much time to eat
  • Child eats a limited variety of foods
  • Child shows no interest in food at mealtimes
  • Child isn’t growing or gaining weight

Primary care physician (PCP) will evaluate and/or make a referral

  • Identifies red flags by using our Infant and Child Feeding Questionnaire
  • Monitors height and weight
  • Modifies the child’s diet
  • Orders diagnostic tests or prescribes medications

A medical specialist performs further evaluation

  • Gastroenterologist, Otolaryngologist (ENT), Pulmonologist, Cardiology, Allergist, Nurse, Immunologist
    • May order various diagnostic tests
    • May be in or out of the hospital
    • May be referred to an allied healthcare specialist/therapist for further evaluation

A team of medical specialists and allied healthcare specialists/therapists perform further evaluation

  • Obtains complete medical and feeding history
    • Growth and Nutrition - Nutritional assessment with food diary
    • Skill and Ability - Observes and assess the child’s sensory and oral-motor skills during a meal
    • Medical - Necessary medical testing, such as swallow studies and/or endoscopies
    • Family & Behavior Psychology - Observes and assess parent-child relationship and effect on mealtime behaviors
  • Write recommendations and suggests core members of treatment team
    • May be in or out of the hospital
    • May recommend additional testing, procedures, and surgeries
    • May recommend regular sessions of therapeutic treatment

An allied healthcare specialist/therapist performs further evaluation

  • An allied healthcare specialist/therapist is Speech-Language Therapists, Occupational Therapists, Behavior Psychologists, and/or Registered Dietitians
    • In a 1:1 session not in conjunction with another specialist
    • Evaluates and develops treatment goals
    • May be done at a home, in a clinic, or hospital
    • May be referred to a medical specialist for further evaluation

Medical treatment

  • May recommend procedures, surgeries, and/or medication
  • May need ongoing follow-up from medical specialist
  • May need ongoing follow-up from allied healthcare professional/therapist in addition to treatment

Treatment is received by a team of medical specialists and allied healthcare specialists/therapists

  • Working on achieving goals set by evaluation team, such as:
    • Oral-motor strengthening and coordination
    • Optimal positioning to increase safety
    • Decreasing oral defensiveness and aversion
    • Diet modifications
    • Medical and nutritional monitoring
  • Progress should be monitored and evaluated regularly
    • May recommend additional testing, procedures, and surgeries
    • May recommend regular sessions of therapeutic treatment

Outpatient therapy treatment

  • Carrying out treatment goals and recommendations from evaluation
    • Occur only once a day (or less often)
    • Provided at home, in the community or in a clinic
  • Continually reevaluating and adjusting treatment goals as necessary
  • May need ongoing follow up from other allied healthcare professionals/therapists
  • May refer to a medical specialist for further evaluation

Enter an inpatient or outpatient intensive feeding program

  • The child is accepted to and discharged from the program
  • Occurs for a set period of time such as 2, 4, 6, or 8 weeks
  • Treatment is more intensive than traditional outpatient therapy
  • Intensive outpatient vs. intensive inpatient options
    • Intensive outpatient treatment typically occurs 1 or more times a day, 3-5 days a week, usually 7 days a week
    • Intensive inpatient treatment typically requires an overnight stay; feeding sessions occur multiple times a day, 7 days a week

The child is released from a feeding program or medical/therapeutic treatment

  • Referred back to primary care specialist, medical specialist, or allied healthcare specialist/therapist for ongoing care

The Coordination of Care Model

We promote coordinated care that examines the complexities of a child’s feeding disorders because it significantly impacts a child’s lifelong well-being. This model encourages a collaborative approach to care that focuses on four key areas: medical diagnosis; growth and nutrition; skills and abilities; and family and behavioral psychology. Hover over each section below to learn more about the specialists who may be on your child's team.

This model address all aspects of pediatric feeding disorders. Click the model to learn more.