Abstract
Pediatric feeding disorders are common and are often associated with chronic medical conditions and developmental disorders. A multidisciplinary treatment approach may be offered through outpatient or intensive programs. Benefit has been demonstrated with intensive programs, but there is little data regarding outpatient approaches. We described outcomes from a well-established outpatient feeding assessment program related to the referral base and program outcomes. Study packets collecting demographics and self-reported feeding skills were distributed to the referral population and redistributed three months later. Standardized surveys implemented included Montreal Children’s Hospital Feeding Scale (MCH-FS) and parenting stress index (PSI-SF). One hundred and ninety-eight subjects completed the initial packet. MCH-FS was elevated in all subjects indicating a broad range of feeding concerns. PSI elevation was present in a broad range of comorbidities compared to group without comorbidities. At 3 months (n = 55), MCH-FS and feeding skills improved without change in PSI-SF. The quality of therapy overall was deemed excellent to above average by most subjects. A multidisciplinary outpatient program has a role in managing infants and children with feeding disorders regardless of comorbidity. Severely affected individuals may benefit from more intensive programs and/or may require long-term care to effect significant change.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Data Availability
The data that support the findings of this study are available from the corresponding author, MF, upon reasonable request.
References
Abidin, R. R. (1995). Parenting stress index: Professional manual. Psychological Assessment Resources.
Arvedson, J. C. (2008). Assessment of pediatric dysphagia and feeding disorders: Clinical and instrumental approaches. Developmental Disabilities Research Reviews, 14(2), 118–127. https://doi.org/10.1002/ddrr.17
Arvedson, J. C. (2013). Feeding children with cerebral palsy and swallowing difficulties. European Journal of Clinical Nutrition, 67(2), S9–S12. https://doi.org/10.1038/ejcn.2013.224
Babbitt, R. L., Hoch, T. A., Coe, D. A., Cataldo, M. F., Kelly, K. J., Stackhouse, C., & Perman, J. A. (1994). Behavioral assessment and treatment of pediatric feeding disorders. Journal of Developmental and Behavioral Pediatrics, 15(4), 278–291. Retrieved June 20, 2021, from https://www.ncbi.nlm.nih.gov/pubmed/7798374
Bandstra, N. F., Crist, W. B., Napier-Phillips, A., & Flowerdew, G. (2011). The impact of behavioral feeding intervention on health care utilization. Children’s Health Care, 40(4), 282–296. https://doi.org/10.1080/02739615.2011.617233
Benson, J. D., Parke, C. S., Gannon, C., & Muñoz, D. (2013). A retrospective analysis of the sequential oral sensory feeding approach in children with feeding difficulties. Journal of Occupational Therapy, Schools, & Early Intervention, 6(4), 289–300. https://doi.org/10.1080/19411243.2013.860758
Benton, K., Swenny, C., Cox, S., Fraker, C., & Fishbein, M. (2015). Pediatric outpatient feeding clinic: If you build it, who will come? Journal of Parenteral and Enteral Nutrition, 39(7), 855–859. https://doi.org/10.1177/0148607114537072
Birkhäuer, J., Gaab, J., Kossowsky, J., Hasler, S., Krummenacher, P., Werner, C., & Gerger, H. (2017). Trust in the health care professional and health outcome: A meta-analysis. PloS ONE, 12(2), e0170988.
Cermak, S. A., Curtin, C., & Bandini, L. G. (2010). Food selectivity and sensory sensitivity in children with autism spectrum disorders. Journal of the American Dietetic Association, 110(2), 238–246. https://doi.org/10.1016/j.jada.2009.10.032
Chatoor, I. (2002). Feeding disorders in infants and toddlers: Diagnosis and treatment. Child and Adolescent Psychiatric Clinics of North America, 11(2), 163–183. https://doi.org/10.1016/s1056-4993(01)00002-5
Chatoor, I. (2009). Sensory food aversions in infants and toddlers. Zero to Three, 29(3), 44–49. Retrieved June 20, 2021, from http://www.zerotothree.org/site/PageServer?pagename=est_journal_index_archives
Chistol, L. T., Bandini, L. G., Must, A., Phillips, S., Cermak, S. A., & Curtin, C. (2018). Sensory sensitivity and food selectivity in children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 48(2), 583–591. https://doi.org/10.1007/s10803-017-3340-9
Cowpe, E., Hanson, B., & Smith, C. H. (2014). What do parents of children with dysphagia think about their MDT? A qualitative study. BMJ Open, 4(10), e005934. https://doi.org/10.1136/bmjopen-2014-005934
Curtin, C., Hubbard, K., Anderson, S. E., Mick, E., Must, A., & Bandini, L. G. (2015). Food selectivity, mealtime behavior problems, spousal stress, and family food choices in children with and without autism spectrum disorder. Journal of Autism and Developmental Disorders, 45(10), 3308–3315. https://doi.org/10.1007/s10803-015-2490-x
Fishbein, M., Benton, K., & Struthers, W. (2016). Mealtime disruption and caregiver stress in referrals to an outpatient feeding clinic. Journal of Parenteral and Enteral Nutrition, 40(5), 636–645. https://doi.org/10.1177/0148607114543832
Fishbein, M., Branham, C., Fraker, C., Walbert, L., Cox, S., & Scarborough, D. (2013). The incidence of oropharyngeal dysphagia in infants with GERD-like symptoms. Journal of Parenteral and Enteral Nutrition, 37(5), 667–673. https://doi.org/10.1177/0148607112460683
Fishbein, M., Cox, S., Swenny, C., Mogren, C., Walbert, L., & Fraker, C. (2006). Food chaining: A systematic approach for the treatment of children with feeding aversion. Nutrition in Clinical Practice, 21(2), 182–184. https://doi.org/10.1177/0115426506021002182
Fishbein, M. H., Kronberg, J., Alvarado, S., Bohm, D., Ideran, P., & Scarborough, D. R. (2023). A multidisciplinary approach to infants with GERD-like symptoms: A new paradigm. Journal of Pediatric Gastroenterology and Nutrition, 77(1), 39–46. https://doi.org/10.1097/MPG.0000000000003802
Fraker, C., Fishbein, M., Cox, S., & Walbert, L. (2009). Food chaining: The proven 6-step plan to stop picky eating, solve feeding problems, and expand your child's diet. Hachette Books. Retrieved April 18, 2019, from https://books.google.com/books?id=UcYYRNmZZycC
Fuls, N., Kruger, E., & van der Linde, J. (2020). Feeding characteristics of infants in a lower-middle-income country. Journal of Paediatrics and Child Health, 56(7), 1083–1089. https://doi.org/10.1111/jpc.14823
Garro, A., Thurman, S. K., Kerwin, M. E., & Ducette, J. P. (2005). Parent/caregiver stress during pediatric hospitalization for chronic feeding problems. Journal of Pediatric Nursing, 20(4), 268–275. https://doi.org/10.1016/j.pedn.2005.02.015
Goday, P. S., Huh, S. Y., Silverman, A., Lukens, C. T., Dodrill, P., Cohen, S. S., Delaney, A. L., Feuling, M. B., Noel, R. J., Gisel, E., Kenzer, A., Kessler, D. B., Kraus de Camargo, O., Browne, J., & Phalen, J. A. (2019). Pediatric feeding disorder: Consensus definition and conceptual framework. Journal of Pediatric Gastroenterology and Nutrition, 68(1), 124–129. https://doi.org/10.1097/MPG.0000000000002188
Gosa, M. M., Dodrill, P., Lefton-Greif, M. A., & Silverman, A. (2020). A multidisciplinary approach to pediatric feeding disorders: Roles of the speech-language pathologist and behavioral psychologist. American Journal of Speech-Language Pathology, 29(2), 956–966. https://doi.org/10.1044/2020_Ajslp-19-00069
Houtrow, A., Murphy, N., & Council On Children With, D. (2019). Prescribing physical, occupational, and speech therapy services for children with disabilities. Pediatrics, 143(4). https://doi.org/10.1542/peds.2019-0285
Kerzner, B., Milano, K., MacLean, W. C., Jr., Berall, G., Stuart, S., & Chatoor, I. (2015). A practical approach to classifying and managing feeding difficulties. Pediatrics, 135(2), 344–353. https://doi.org/10.1542/peds.2014-1630
Kim, A. R., Kwon, J. Y., Yi, S. H., & Kim, E. H. (2021). Sensory based feeding intervention for toddlers with food refusal: A randomized controlled trial. Annals of Rehabilitation Medicine, 45(5), 393–400. https://doi.org/10.5535/arm.21076
Kovacic, K., Rein, L. E., Szabo, A., Kommareddy, S., Bhagavatula, P., & Goday, P. S. (2021). Pediatric feeding disorder: A nationwide prevalence study. Journal of Pediatrics, 228(126–131), e123. https://doi.org/10.1016/j.jpeds.2020.07.047
Lukens, C. T., & Silverman, A. H. (2014). Systematic review of psychological interventions for pediatric feeding problems. Journal of Pediatric Psychology, 39(8), 903–917. https://doi.org/10.1093/jpepsy/jsu040
Manikam, R., & Perman, J. A. (2000). Pediatric feeding disorders. Journal of Clinical Gastroenterology, 30(1), 34–46. Retrieved March 13, 2023, from https://journals.lww.com/jcge/Fulltext/2000/01000/Pediatric_Feeding_Disorders.7.aspx
Milano, K., Chatoor, I., & Kerzner, B. (2019). A functional approach to feeding difficulties in children. Current Gastroenterology Reports, 21(10), 51. https://doi.org/10.1007/s11894-019-0719-0
Miranda, A., Mira, A., Berenguer, C., Rosello, B., & Baixauli, I. (2019). Parenting stress in mothers of children with autism without intellectual disability. Mediation of behavioral problems and coping strategies. Frontiers in Psychology, 10, 464–464. https://doi.org/10.3389/fpsyg.2019.00464
Nelson, S. P., Chen, E. H., Syniar, G. M., & Christoffel, K. K. (1998). One-year follow-up of symptoms of gastroesophageal reflux during infancy. Pediatrics, 102(6), E67. https://doi.org/10.1542/peds.102.6.e67
Orenstein, S. R., Shalaby, T. M., & Cohn, J. F. (1996). Reflux symptoms in 100 normal infants: Diagnostic validity of the infant gastroesophageal reflux questionnaire. Clinical Pediatrics (Phila), 35(12), 607–614. https://doi.org/10.1177/000992289603501201
Palmer, S., Thompson, R. J., Jr., & Linscheid, T. R. (1975). Applied behavior analysis in the treatment of childhood feeding problems. Developmental Medicine and Child Neurology, 17(3), 333–339. https://doi.org/10.1111/j.1469-8749.1975.tb04671.x
Peterson, K. M., Piazza, C. C., Ibanez, V. F., & Fisher, W. W. (2019). Randomized controlled trial of an applied behavior analytic intervention for food selectivity in children with autism spectrum disorder. Journal of Applied Behavior Analysis, 52(4), 895–917. https://doi.org/10.1002/jaba.650
Peterson, K. M., Piazza, C. C., & Volkert, V. M. (2016). A comparison of a modified sequential oral sensory approach to an applied behavior-analytic approach in the treatment of food selectivity in children with autism spectrum disorder. Journal of Applied Behavior Analysis, 49(3), 485–511. https://doi.org/10.1002/jaba.332
Phalen, J. A. (2013). Managing feeding problems and feeding disorders. Pediatrics in Review, 34(12), 549–557. https://doi.org/10.1542/pir.34-12-549
Ramsay, M., Martel, C., Porporino, M., & Zygmuntowicz, C. (2011). The Montreal Children’s Hospital Feeding Scale: A brief bilingual screening tool for identifying feeding problems. Paediatrics & Child Health, 16(3), 147-e117. https://doi.org/10.1093/pch/16.3.147
Rogers, S., Ramsay, M., & Blissett, J. (2018). The Montreal Children’s Hospital Feeding Scale: Relationships with parental report of child eating behaviours and observed feeding interactions. Appetite, 125, 201–209. https://doi.org/10.1016/j.appet.2018.02.007
Saini, V., Kadey, H. J., Paszek, K. J., & Roane, H. S. (2019). A systematic review of functional analysis in pediatric feeding disorders. Journal of Applied Behavior Analysis, 52(4), 1161–1175. https://doi.org/10.1002/jaba.637
Sarcia, B. (2021). The impact of applied behavior analysis to address mealtime behaviors of concern among individuals with autism spectrum disorder. Psychiatric Clinics of North America, 44(1), 83–93. https://doi.org/10.1016/j.psc.2020.11.007
Sharp, W. G., Volkert, V. M., Scahill, L., McCracken, C. E., & McElhanon, B. (2017). A systematic review and meta-analysis of intensive multidisciplinary intervention for pediatric feeding disorders: How standard is the standard of care? Journal of Pediatrics, 181, 116–124.e114. https://doi.org/10.1016/j.jpeds.2016.10.002
Sigurdardottir, A. O., Garwick, A. W., & Svavarsdottir, E. K. (2017). The importance of family support in pediatrics and its impact on healthcare satisfaction. Scandinavian Journal of Caring Sciences, 31(2), 241–252. https://doi.org/10.1111/scs.12336
Silverman, A. H., Erato, G., & Goday, P. (2020). The relationship between chronic paediatric feeding disorders and caregiver stress. Journal of Child Health Care, 1367493520905381. https://doi.org/10.1177/1367493520905381
Stanley, M. A., Shepherd, N., Duvall, N., Jenkinson, S. B., Jalou, H. E., Givan, D. C., Steele, G. H., Davis, C., Bull, M. J., Watkins, D. U., & Roper, R. J. (2019). Clinical identification of feeding and swallowing disorders in 0–6 month old infants with Down syndrome. American Journal of Medical Genetics. Part A, 179(2), 177–182. https://doi.org/10.1002/ajmg.a.11
Toomey, K., & Ross, E. (2011). SOS approach to feeding. Perspectives on Swallowing and Swallowing Disorders (Dysphagia), 20, 82. https://doi.org/10.1044/sasd20.3.82
Tutor, J. D. (2020). Dysphagia and chronic pulmonary aspiration in children. Pediatrics in Review, 41(5), 236–244.
van Dijk, M., Bruinsma, E., & Hauser, M. P. (2016). The relation between child feeding problems as measured by parental report and mealtime behavior observation: A pilot study. Appetite, 99, 262–267. https://doi.org/10.1016/j.appet.2016.01.026
van Dijk, M., & Lipke-Steenbeek, W. (2018). Measuring feeding difficulties in toddlers with Down syndrome. Appetite, 126, 61–65. https://doi.org/10.1016/j.appet.2018.03.018
van Dijk, M. W. G., Buruma, M. E., & Blijd-Hoogewys, E. M. A. (2021). Detecting feeding problems in young children with autism spectrum disorder. Journal of Autism and Developmental Disorders. https://doi.org/10.1007/s10803-021-04869-1
Vincent, L. B., Stone-Heaberlin, M., Kandarpa, K., McIntire, H., Turner, K., & Krebs, K. (2023). Clinical outcomes from an interdisciplinary outpatient feeding treatment pilot program. Journal of Clinical Psychology in Medical Settings, 1–16. https://doi.org/10.1007/s10880-023-09963-3
Waltz, C. F., Strickland, O., & Lenz, E. R. (2018). Measurement in nursing and health research. Retrieved June 18, 2021, from http://www.credoreference.com/book/spmnah
Williams, C., VanDahm, K., Stevens, L. M., Khan, S., Urich, J., Iurilli, J., Linos, E., & Williams, D. I. (2017). Improved outcomes with an outpatient multidisciplinary intensive feeding therapy program compared with weekly feeding therapy to reduce enteral tube feeding dependence in medically complex young children. Current Gastroenterology Reports, 19(7), 33. https://doi.org/10.1007/s11894-017-0569-6
Woodman, A. C., Mawdsley, H. P., & Hauser-Cram, P. (2015). Parenting stress and child behavior problems within families of children with developmental disabilities: Transactional relations across 15 years. Research in Developmental Disabilities, 36C, 264–276. https://doi.org/10.1016/j.ridd.2014.10.011
Zeleny, J. R., Volkert, V. M., Ibanez, V. F., Crowley, J. G., Kirkwood, C. A., & Piazza, C. C. (2020). Food preferences before and during treatment for a pediatric feeding disorder. Journal of Applied Behavior Analysis, 53(2), 875–888. https://doi.org/10.1002/jaba.625
Funding
The study was performed without funding support.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The authors do not have any financial interests that are directly or indirectly related to the work submitted for publication.
Ethical Approval and Informed Consent
The research was performed on human subjects with informed consent obtained with the approval of the Human Subjects Review Committee at Ann and Robert H Lurie Children’s Hospital of Chicago and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Benton, K., Delzell, D., Nalepa, N. et al. Characterization and Impact of a Multidisciplinary Outpatient Pediatric Feeding and Swallowing Program. J Dev Phys Disabil (2024). https://doi.org/10.1007/s10882-024-09946-8
Accepted:
Published:
DOI: https://doi.org/10.1007/s10882-024-09946-8