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Pediatric Feeding Disorders Inpatient Program
Kennedy Krieger Institute • 707 North Broadway • Baltimore, MD 21205
Peter A. Girolami, Ph.D., BCBA
Eric Levey, M.D.
About Our Program:
The Pediatric Feeding Disorders Inpatient Continuum offers a unique, comprehensive and interdisciplinary program providing evaluation and treatment of individuals with impairment of oral intake or appetite who require 24-hour nursing, medical supervision or fluid intake.
Inpatient services are recommended for children with severe feeding difficulties (e.g., failure to thrive, vomiting, G-tube dependence, total food refusal), so that close medical assessments, nutritional monitoring, oral motor assessments and intense behavioral interventions can be conducted.
Each discipline conducts a variety of assessments to determine the child's course of treatment. For example, medical work-ups may be required to rule-out or begin medical treatments for possible physiological etiologies of the feeding problem. Behavioral psychology will assess the severity and type of the child's food refusal or selectivity, observe meals and begin to evaluate treatment options based on the information gathered. An occupational therapist and/or speech pathologist may need to assess the child's oral motor abilities to determine whether or not the feeding difficulty is related to neurological deficits or oral motor dysfunction. A nutritionist may need to evaluate the nutritional and caloric requirements for catch-up growth. Finally, social work may need to assist the family in dealing with psychosocial issues and/or identifying and obtaining other community resources.
During the first week of a child's inpatient admission, a steering meeting is held during which the team discusses each member's evaluation results and discusses potential goals for admission. Immediately following this meeting, a parent/caregiver conference is held where all participating disciplines present to review and finalize goals with the parent/caregivers. Throughout the child's admission, the team and parent/caregivers work together with each discipline coordinating therapies to meet the child's admission goals. Typical admission goals include, but are not limited to:
- Increase weight
- Increase PO intake
- Increase food texture/types of food consumed
- Decrease G-tube/bottle dependence
- Decrease mealtime inappropriate behaviors
- Increase self-feeding
- Assessment of and reduction of mealtime emesis (vomiting)
The interdisciplinary team and the caregivers develop measurable goals for each child's feeding behavior. Feeding behaviors are objectively measured and treatment decisions are data based. Outcomes are assessed regularly throughout the admission. A primary goal is to establish feeding patterns that can be maintained by the caregivers in the home and in other environments. Thus, caregiver training is an essential component to the success of the program.
Almost all children with feeding disorders display inappropriate mealtime behavior that interferes with food consumption, regardless of the disorder's etiology. Therefore, a major focus of the program for most children is on the behavioral assessment and treatment of feeding problems. The pediatric feeding disorders program has a long and successful history of applying the principles and procedures of applied behavior analysis to the assessment of feeding disorders. Throughout the child's admission, individualized behavioral assessments are conducted for a number of reasons: (a) to identify the appropriate behavioral treatment procedures; (b) to assess the efficacy of ongoing treatment and (c) to determine the components of treatment necessary to maintain treatment gains. Throughout the child's admission, the interdisciplinary team meets regularly to continually review and adjust the child's treatment as necessary to meet admission goals.
Prior to discharge, a parent/caregiver meeting is held to review with the parent/caregiver the outcomes of treatment and plans for follow-up care. Typically children receiving behavioral treatment during the admission will receive follow-up services from behavioral psychology for two years post-treatment, with continued adjustment and monitoring of home treatment protocols to ensure the child's continued improvement at home. Other disciplines will also provide follow-up services, usually through Feeding and Swallowing Clinic visits, or in conjunction with the behavioral psychology follow-up.
More information about the Pediatric Feeding Disorders Program >
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