Kennedy Krieger's Specialties

Feeding Disorders

What is a Feeding Disorder?

A pediatric feeding disorder refers to a child’s inability or refusal to eat or drink sufficient quantities to maintain nutritional status. Feeding disorders often, but not always, occur in connection with other conditions such as prematurity, reactive airway disease, short bowel syndrome, cystic fibrosis, cerebral palsy, developmental delay, autism, and genetic and metabolic disorders.

Children who persistently do not consume enough calories for healthy growth, or who exclude from their diets entire food groups, put themselves at risk for nutritional deficiencies such as anemia. Feeding disorders can also prompt a variety of immediate symptoms including:

• Difficulties with different food textures
• Food selectivity
• Tantrums or crying at meal times
• Oral motor and sensory problems
• Gastrostomy  (g-tube) or naso-gastric (ng-tube) dependence
• Vomiting

When to Refer a Child

A feeding disorder is typically identified when, despite persistent attempts by parents or caregivers, a child’s behavior results in failure to eat sufficient quantity or types of foods to sustain weight, meet nutritional needs, and/or grow.  Children exhibiting these symptoms may be referred to the outpatient Evaluation Clinic at Kennedy Krieger’s Pediatric Feeding Disorders Program. Referrals may come from family members, pediatricians, or other professionals working with the child.

The Pediatric Feeding Disorders Program Team

Kennedy Krieger’s Feeding team is comprised of an interdisciplinary group of professionals who work together with families and schools to meet children’s individual needs:

Pediatric gastroenterologist and nurse practioner
Medical personnel who monitor a child’s progress and may recommend diagnostic techniques such as upper GI endoscopy, percutaneous endo-scopic gastrostomy, pH probe or esophageal/antroduodenal manometry.

Behavioral Psychologist
Conducts mealtime assessments and makes data-based decisions to develop strategies for overcoming inappropriate behaviors and increasing appropriate eating behavior.

Speech Language Therapist
Provides assessment and treatment of oral motor skills, swallowing dysfunction, and communication skills.

Occupational Therapist
Assesses swallowing function and treats oral-motor dysfunction. They also help to develop postural and fine motor skills.

Nutritionist
Helps each child achieve a safe and efficient means of nutrition to meet his or her calorie and fluid needs to support growth.

Social Worker
Supports caregivers, coordinates discharge planning and helps access community services.

Nurse
Provides direct care to patients that may include medication administration, tube feedings, treatments, procedures, and hygiene care.

What You Can Expect

We recognize how important a child’s family or caregivers are to the evaluation and treatment process, and strive to include them as active team members in their child’s therapy. Clinic team findings and recommendations are discussed individually with parents and other caregivers.

Patients new to the program are initially evaluated in the outpatient clinic. In this clinic, all members of the interdisciplinary team participate in examinations lasting up to three hours. These sessions are designed to determine each child’s underlying conditions, program eligibility, appropriate placement and reasonable goals.

Treatment options include:

Inpatient Services
Children with severe food refusal and complex medical issues may be admitted to a 24-hour, 7-day per week intensive assessment and treatment program. Patients typically remain in this program for eight weeks.

Day Program
Designed for children who do not need around-the-clock medical supervision, but require more intensive therapy than can be provided on an outpatient basis. Patients commute daily, Monday through Friday, for six to eight weeks.

Outpatient services
Appropriate for children who don’t require intensive services, but can benefit from the assistance of one of the interdisciplinary team members (e.g., behavior, occupational or speech therapist). These services can also help children discharged from the inpatient unit maintain treatment gains at home.

It is often difficult to determine a long-range prognosis for a child’s future development. Thus, follow-up services are available for up to two years. Parents and caregivers receive guidance and feedback on their ability to maintain their child’s treatment plan.