Feeding Disorders Clinic
Kennedy Krieger Institute, 801 North Broadway, Baltimore, MD 21205
Director:
| Program Director: Charles Gulotta, Ph.D. Medical Director: Anil Darbari, M.D. | Kennedy Krieger Feeding Disorders Program Featured on CNN |
The Pediatric Feeding Disorders Program consists of an interdisciplinary team that treats children and adolescents with feeding disorders. Areas of concentration include management of the following: failure to consume enough nutrients to promote growth; abnormal suck and swallow patterns due to genetic or metabolic defects; abnormal eating problems; disruptive mealtime behavior; diagnosis of aspiration; and tube feeding management.
To identify and analyze children who are unable to consume sufficient calories via oral feeding to maintain and/or promote growth. A comprehensive team assesses all aspects of feeding disorders. The team consists of pediatric gastroenterology, pediatric nursing, behavioral psychology, occupational therapy, speech and language pathology, and pediatric nutrition. Based on the information obtained during this evaluation, the team meets and agrees upon general and specific recommendations, and if necessary, a treatment plan for the child. The child is then referred for inpatient, day program, or outpatient services from the appropriate disciplines as needed. Throughout the child's course of treatment, the team works closely together to provide comprehensive assessment, treatment, and follow-up.
The Program has enjoyed a national reputation and increasing numbers of patients are referred from throughout the United States for evaluation and therapy. Additionally, many patients are referred by Johns Hopkins International Services.
Laura was a 34-month-old female admitted to the Pediatric Feeding Disorder Unit for food refusal and bottle dependency. Her medical diagnoses were extensive, including Pierre Robin Sequence, gastroesphogeal reflux, delayed gastric emptying, Branchio-Oto-Renal Syndrome, failure to thrive, and required nasogastric tube feeding between 11 and 26 months of age. Although her parents reported no medical complications at birth, they noted that feeding problems were evident immediately. Her parents reported that they tried everything to get Laura to eat. They stated that they would entertain her and let her have access to her favorite toy as long as she was eating, but would remove the toy whenever she would begin to refuse food. They would bribe her to finish her meal by buying her new toys. They would plead and beg for her to eat. However, most meals would end due to Laura’s food refusal behaviors. When food was presented, Laura would turn her head away from the food, hit the spoon, throw the food to the floor, cry incessantly or cover her mouth; subsequently her parents would terminate the meal. Upon admission Laura was 100% bottle dependent. She received all of her caloric needs by mouth (i.e., Pediasure) and accepting only small amounts of yogurt, pudding or chicken nuggets, but nothing substantial to maintain and/or gain weight. During the course of her admission, it was determined that she engaged in these food refusal behaviors to terminate meals. Treatment consisted of structured meals, with her food refusal behaviors no longer resulting in the termination of the meal. Laura received enthusiastic praise and toys in meals for demonstrating appropriate mealtime behaviors such as accepting and swallowing all foods presented. Treatment resulted in Laura receiving 100% of her nutritional needs by mouth; consuming 50% of her caloric needs from solid foods, which was determined to be age appropriate by a nutritionist. Additionally, her food refusal behaviors reduced to 0% at the time of discharge. Laura continues to do well following discharge by maintaining low rates of food refusal behaviors and consuming an appropriate amount of calories from both solids and liquids as outlined by a nutritionist. Additionally, Laura is no longer dependent on a bottle but rather drinks the required amount of liquid needed by cup independently.
Tom was almost 10 years old when he entered the feeding program at Kennedy. His medical history was quite complicated and included diagnoses of an inborn error of metabolism, myopathy, growth hormone deficiency, reactive airway disease, developmental delay, gastroesophageal reflux, and delayed gastric emptying. His feeding difficulties were apparent at birth - any attempts to orally feed Tom resulted in vomiting, despite several formula changes and numerous medication trials. Due to poor weight gain and failure to thrive, a gastrostomy tube (G-tube) and a Nissen fundoplication were placed. Although this eliminated the vomiting, gagging and retching increased and Tom would cry, cover his mouth, and push food away whenever it was offered. Upon admission to our program, Tom was 100% dependent on his G-tube feedings to meet all of his nutritional and hydration needs. Initially, progress was slow and it was unclear whether Tom’s oral/motor skills would improve. However, after 8-weeks of intensive therapies, Tom was consuming 90% of his caloric needs (solids and liquids) by mouth. His refusal behaviors in meals decreased to nearly zero, and he stopped crying completely. Tom’s parents and grandparents were trained in his feeding procedures prior to discharge. Home protocols and a training video were also provided. Phone contact has been maintained and it is reported that Tom has maintained the success observed while at Kennedy. Parents are currently attempting to eliminate the last 10% of tube feedings. They recently mailed us a thank you note stating “we knew that when we came into this program that …this was Tom’s last chance to bring a little more ‘normalcy’ to his life. We feel like Tom has been reborn thanks to your wisdom, know-how, support, patience, and kindness, not just for Tom, but for our entire family. We now understand why this program is so successful. It is because of the 110% effort you all put forth every single day…We will never forget what you have done and how hard you all worked to make Tom’s treatment a complete success.….”
To identify and analyze children who are unable to consume sufficient calories via oral feeding to maintain and/or promote growth. A comprehensive team assesses all aspects of feeding disorders. The team consists of pediatric gastroenterology, pediatric nursing, behavioral psychology, occupational therapy, speech and language pathology, and pediatric nutrition. Based on the information obtained during this evaluation, the team meets and agrees upon general and specific recommendations, and if necessary, a treatment plan for the child. The child is then referred for inpatient, day program, or outpatient services from the appropriate disciplines as needed. Throughout the child's course of treatment, the team works closely together to provide comprehensive assessment, treatment, and follow-up.
The Program has enjoyed a national reputation and increasing numbers of patients are referred from throughout the United States for evaluation and therapy. Additionally, many patients are referred by Johns Hopkins International Services.
Laura was a 34-month-old female admitted to the Pediatric Feeding Disorder Unit for food refusal and bottle dependency. Her medical diagnoses were extensive, including Pierre Robin Sequence, gastroesphogeal reflux, delayed gastric emptying, Branchio-Oto-Renal Syndrome, failure to thrive, and required nasogastric tube feeding between 11 and 26 months of age. Although her parents reported no medical complications at birth, they noted that feeding problems were evident immediately. Her parents reported that they tried everything to get Laura to eat. They stated that they would entertain her and let her have access to her favorite toy as long as she was eating, but would remove the toy whenever she would begin to refuse food. They would bribe her to finish her meal by buying her new toys. They would plead and beg for her to eat. However, most meals would end due to Laura’s food refusal behaviors. When food was presented, Laura would turn her head away from the food, hit the spoon, throw the food to the floor, cry incessantly or cover her mouth; subsequently her parents would terminate the meal. Upon admission Laura was 100% bottle dependent. She received all of her caloric needs by mouth (i.e., Pediasure) and accepting only small amounts of yogurt, pudding or chicken nuggets, but nothing substantial to maintain and/or gain weight. During the course of her admission, it was determined that she engaged in these food refusal behaviors to terminate meals. Treatment consisted of structured meals, with her food refusal behaviors no longer resulting in the termination of the meal. Laura received enthusiastic praise and toys in meals for demonstrating appropriate mealtime behaviors such as accepting and swallowing all foods presented. Treatment resulted in Laura receiving 100% of her nutritional needs by mouth; consuming 50% of her caloric needs from solid foods, which was determined to be age appropriate by a nutritionist. Additionally, her food refusal behaviors reduced to 0% at the time of discharge. Laura continues to do well following discharge by maintaining low rates of food refusal behaviors and consuming an appropriate amount of calories from both solids and liquids as outlined by a nutritionist. Additionally, Laura is no longer dependent on a bottle but rather drinks the required amount of liquid needed by cup independently.
Tom was almost 10 years old when he entered the feeding program at Kennedy. His medical history was quite complicated and included diagnoses of an inborn error of metabolism, myopathy, growth hormone deficiency, reactive airway disease, developmental delay, gastroesophageal reflux, and delayed gastric emptying. His feeding difficulties were apparent at birth - any attempts to orally feed Tom resulted in vomiting, despite several formula changes and numerous medication trials. Due to poor weight gain and failure to thrive, a gastrostomy tube (G-tube) and a Nissen fundoplication were placed. Although this eliminated the vomiting, gagging and retching increased and Tom would cry, cover his mouth, and push food away whenever it was offered. Upon admission to our program, Tom was 100% dependent on his G-tube feedings to meet all of his nutritional and hydration needs. Initially, progress was slow and it was unclear whether Tom’s oral/motor skills would improve. However, after 8-weeks of intensive therapies, Tom was consuming 90% of his caloric needs (solids and liquids) by mouth. His refusal behaviors in meals decreased to nearly zero, and he stopped crying completely. Tom’s parents and grandparents were trained in his feeding procedures prior to discharge. Home protocols and a training video were also provided. Phone contact has been maintained and it is reported that Tom has maintained the success observed while at Kennedy. Parents are currently attempting to eliminate the last 10% of tube feedings. They recently mailed us a thank you note stating “we knew that when we came into this program that …this was Tom’s last chance to bring a little more ‘normalcy’ to his life. We feel like Tom has been reborn thanks to your wisdom, know-how, support, patience, and kindness, not just for Tom, but for our entire family. We now understand why this program is so successful. It is because of the 110% effort you all put forth every single day…We will never forget what you have done and how hard you all worked to make Tom’s treatment a complete success.….”
Hours of Operation:
Every Tuesday and Thursday, 1:00 p.m. - 5:00 p.m.
Contacts:
To make a referral or request an initial evaluation:
Contact our Care Management Office
Toll-Free Referral: (888) 554-2080
Local Referral: (443) 923-9400
For follow-up appointments
Lobby Care Center
Phone: (443) 923-2600
Contact our Care Management Office
Toll-Free Referral: (888) 554-2080
Local Referral: (443) 923-9400
For follow-up appointments
Lobby Care Center
Phone: (443) 923-2600
Failure to thrive
food refusal
G-tube dependence
·Behavioral Psychology Outpatient Programs
·Day Feeding Program
·Nutrition Outpatient Program
·Occupational Therapy Clinic
·Pediatric Feeding Disorders Continuum
·Pediatric Feeding Disorders Inpatient Program
·Social Work Outpatient Mental Health Program
·Speech and Language Outpatient Clinic
·Day Feeding Program
·Nutrition Outpatient Program
·Occupational Therapy Clinic
·Pediatric Feeding Disorders Continuum
·Pediatric Feeding Disorders Inpatient Program
·Social Work Outpatient Mental Health Program
·Speech and Language Outpatient Clinic
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