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Research and advocacy

Our Feeding, Swallowing and Nutrition Program is dedicated to testing new treatments and determining ideal ways to enhance care for children with feeding and nutrition concerns.

Research is an integral part of what we do. And at Children's Hospital of Wisconsin's Feeding Program, we know that it is very important to collaborate with feeding programs across the nation to collect data and share ideas. That way, we work and learn together to provide the best care to patients and their families right here in Wisconsin.

We also continue to explore new solutions in technology to help make care more effective and more accessible for families. We try to be innovative with strategies like virtual reality options of care to help reach families wherever they may be.

Video: Feeding, swallowing and nutrition research and advocacy

Recent research efforts

The Feeding Program is driven by an evidence-based practice approach. This means that the Feeding team looks to validate their clinical approach and treatments with evidence that tracks our patients’ progress and confirms these treatments are effective. Below are a few recent published articles that showcase our team’s positive outcomes from our treatment approaches:

Retrospective study to evaluate the effectiveness of an inpatient feeding program to help children wean off a gastrostomy tube (g-tube). This study reviewed the data of 77 patients who were admitted into our inpatient feeding program. The results of this study showed significant improvement in oral calorie intake, mealtime enviornment and feeding behaviors for the patients. After two weeks of treatment, 51% of the patients were fully weaned from their tube. These patients also maintained nutritional stability and tube independence at their one year post treatment follow-up appointment. This study’s results confirmed that our inpatient interventions are a safe and effective approach in helping long-term tube feeding children transition to oral feeding. Article

Retrospective study to identify the adverse effects that occur when appetite manipulation is used for g-tube weaning. Appetite manipulation can be an effective approach for children weaning off of their g-tubebut can result in dehydration, low blood sugar and loss of appetite. At Children’s Hospital of Wisconsin, we admit medically complex patients to the hospital to perform g-tube weaning in a safe environment. Our team performed a retrospective study of 143 patients who underwent appetite manipulation. Results showed that 78.2% of these patients experienced at least one adverse event, such as signs of dehydration or low blood sugar, which emphasizes the need for monitoring in an inpatient setting by a team with expertise in feeding disorders. Overall, the study found that appetite manipulation is the safest for the patient when done in the inpatient setting and that our inpatient program demonstrated positive outcomes for the patient as it relates to time to discharge and adverse events. Article

Study to evaluate the effectiveness of intensive outpatient feeding programs. While intensive outpatient feeding programs are often used to treat severe feeding disorders, there was little to no information available that described treatment protocols for an intensive outpatient program and little information on clinical effectiveness. The Feeding Program addressed this with a paper that described our treatment protocol and evaluated the clinical outcomes of the protocol. The findings of the study included improvement in caregiver/child interactions at mealtime and improved caregiver use of effective mealtime strategies. The data also showed decreases in caregiver distress, as well as caregiver perceptions of their child as “difficult”. The study confirmed the effectiveness of our intensive outpatient treatment program and its aim of supporting caregivers in learning effective strategies to help their child in feeding. Article 

Recent advocacy efforts

Beyond the clinical and research work, our team understands the importance of advocating for children who struggle with a feeding or swallowing disorder. Below are a few examples of how our providers are working in the field to improve outcomes for our children:

Leadership in feeding advocacy groups: We are proud to have four of our specialists sit on the medical council for Feeding Matters, the first organization in the world dedicated to advancing the research, identification and collaborative care of pediatric feeding disorders.

Feeding Research Consortium: In 2017, the Feeding team was integral to the creation of the International Pediatric Feeding Research Consortium (IPFRC). The IFPRC is an alliance of some of the top academic interdisciplinary feeding teams in the country, with a mission to promote more consistent data collection and information sharing amongst the consortium partners.

Defining a code for medical reimbursement: One of the major issues with a feeding or swallowing diagnosis is that there isn’t a code to help families get medical reimbursement from their insurance provider. The Feeding team sought to correct that by writing a paper that defines pediatric feeding disorder. This paper will ultimately result in a medical code to help families get the financial support they need to help their child with their feeding disorder.

Reent publications and presentations

The Feeding team is exceptionally active in research on pediatric feeding disorders. In just the past two years alone, the team has been published nearly 30 times, and their findings have helped improve the standard of care for children nationwide. Through their research, the team has been recognized worldwide for their leadership in pediatric feeding disorders and has been invited to share their expertise across the globe. Our team has engaged in over 60 site visits in 20 states and 12 countries in the past two years for lectures, presentations and workshops.

See below for a full listing of the Feeding team’s most recent work:

Recent Publications (2015-2017)

  1. Arvedson JC, Lefton-Greif MA. Instrumental assessment of pediatric dysphagia. Seminars in Speech and Language 2017;38(2):135-146.
  2. Benfer KA, Weir KA, Ware RS, Davies PSW, Arvedson J, Boyd RN, Bell KL. Parent-reported indicators for detecting feeding and swallowing difficulties and undernutrition in preschool-aged children with cerebral palsy. Developmental Medicine & Child Neurology 2017;59(11), 1181-1187.
  3. Dharmapuri S, *Hettich K, Goday PS. Contemporary Dietary Practices: FODMAPs and Beyond. Adolesc Med State Art Rev. 2016 Spring;27:109-24.
  4. Dharmaraj R, Goday PS. Gastrointestinal Manifestations of Endocrine Disorders. Fellows Concise Review of Pediatric Gastroenterology, Hepatology and Nutrition. 2nd edition. 2016.
  5. El-Chammas K, Rumman N, Goh V, Quintero D, Goday PS. Rectal Prolapse and Cystic Fibrosis. J Ped Gastr Nutr. 2015;60:110-2. PMID: 25162364. DOI : 10.1097/MPG.0000000000000546
  6. Goday PS, Wakeham M, Kuhn E, Collins MM, Werlin SL. Acute Pancreatitis in the Pediatric Intensive Care Unit. J Ped Gastr Nutr. February 2015.PMID: 25749464
  7. Larson-Nath C, Goday PS. Failure to thrive: a prospective study in a pediatric gastroenterology clinic. J Ped Gastr Nutr. December 2015. PMID: 26720767
  8. Larson-Nath C, Goday PS. Growth failure and Malnutrition – presentation, differential diagnosis, evaluation and management. Fellows Concise Review of Pediatric Gastroenterology, Hepatology and Nutrition. 2nd edition. 2016.
  9. Larson-Nath C, St. Clair N, Goday PS. Hospitalization for Failure to Thrive: A prospective descriptive report. Accepted by Clin Pediatr (Phila). February 2017.
  10. Lefton-Greif MA, Arvedson JC. Pediatric feeding/swallowing: Yesterday, today, and tomorrow. Seminars in Speech and Language. 2016;37(4), 298-309.
  11. Machogu E, Cao Y, Miller T, Simpson P, Levy H, Quintero D, Goday PS. Comparison of the WHO and the CDC growth charts in predicting pulmonary outcomes in cystic fibrosis. J Ped Gastr Nutr 2015 Mar. 60(3):378- 83.PMID: 25714581.
  12. Martin KL, Arvedson JC, Bayer ML, Drolet BA, Chun R, Siegel DH. Risk of dysphagia and speech and language delay in PHACE syndrome. Pediatric Dermatology. 2015;32(1), 64-69.
  13. Massoumi RL, Abdelhafeez,AL, Christensen MA, Vo NN, Goday PS, Leack KM, Duesing LA, Wagner AJ. Gastro-Jejunostomy Tube Complications in Low Weight Infants. JPEN J Parenter Enteral Nutr. January 2015. pii: 0148607115575741. PMID: 25754440
  14. Mehta NM, Skillman HE, Irving SY, Coss-Bu JA, Vermilyea S, Farrington EA, McKeever L, Hall AM, Goday PS, Braunschweig C. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Pediatric Critically Ill Patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition. Jointly published in JPEN J Parenter Enteral Nutr 2017 May 1:148607117711387. doi: 10.1177/0148607117711387and Pediatr Crit Care Med. 2017 Jul;18(7):675-715. doi: 10.1097/PCC.0000000000001134.
  15. Mendell DA, Arvedson JC. Dysphagia in pediatric traumatic brain injury. Current Physical Medicine & Rehabilitation Reports, Published online 16 August 2016. DOI 10.1007/s40141-016-0132-7.
  16. Merritt RJ, Cohran V, Raphael, BP, Sentongo T, Volpert D, Warner BW, Goday PS. Clinical Report: Intestinal Rehabilitation Programs in the Management of Pediatric Intestinal Failure and Short Bowel Syndrome. Accepted by J Ped Gastr Nutr. July 2017.
  17. Mikhailov TA, Gertz SJ, Kuhn EM, Scanlon MC, Rice TB, Goday PS. Early Enteral Nutrition is associated with significantly lower hospital charges in critically ill children. Accepted by JPEN J Parenter Enteral Nutr. 2017 October
  18. Pollow A, Karls C, Witzlib M, Noel R, Goday PS, Silverman A. Safety of Appetite Manipulation in Children with Feeding Disorders Admitted to an Inpatient Feeding Program. Accepted by J Ped Gastr Nutr. November 2017.
  19. Silverman, A. H. Behavioral Management of Feeding Disorders of Childhood. Ann Nutr Metab 2015;66(suppl 5):33–42. DOI: 10.1159/000381375
  20. Silverman, A. H. (2017). Feeding Disorders: Cultural Factors. In A. Wenzel (Ed.), Encyclopedia of Abnormal and Clinical Psychology (pp. 1441-1142). Thousand Oaks, CA: SAGE Publications.
  21. Silverman, A. H. (2017). Feeding Disorders: Medical Complications. In A. Wenzel (Ed.), Encyclopedia of Abnormal and Clinical Psychology (1447-1448). Thousand Oaks, CA: SAGE Publications.
  22. Silverman, A. H. (2017). Feeding Disorders: Social Factors. In A. Wenzel (Ed.), Encyclopedia of Abnormal and Clinical Psychology (1451-1453). Thousand Oaks, CA: SAGE Publications.
  23. Silverman, A. H. (2017). Feeding Refusal and Psychogenic Dysphagia. In: B UK Li and C Waasdorp-Hurtado (eds.) Second Edition of the Fellows Concise Review of Pediatric Gastroenterology, Hepatology and Nutrition, Section 11. Psychologic Considerations, Ambler, PA: National Association of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN), pp. 751-754.
  24. Silverman, A. H. & Tarbell, S. (2017). Pediatric Feeding Problems, Undernutrition, and Vomiting Disorders. In M.C. Roberts & R.G. Steele (Eds.), Handbook of Pediatric Psychology, (5th ed., pp. 401-415). New York: Guilford Press.
  25. Smith A, Duesing L, Feuling MB, Larson-Nath C, Leon CG, Opichka PJ, Pipkorn R, van Hoorn M, Walia CLS, Martinez A, Goday PS. Laboratory Monitoring of Children on Home PN: A Prospective Study. JPEN J Parenter Enteral Nutr. 2016 Oct 11. pii: 0148607116673184. PMID: 27729404
  26. Walia C, Feuling, MB, Gimenez, L and Goday PS; Food Allergies: Chapter 20; The ASPEN Pediatric Nutrition Support Core Curriculum, 2nd Edition; 2015
  27. Walia CLS, Goday PS. Parenteral Nutrition. In Pediatric Nutrition, 8th edition. Anticipated 2018.
  28. Walia C, Van Hoorn M, Edlbeck A and Feuling, MB. The Registered Dietitian Nutritionist’s Guide to Homemade Tube Feeding. J Acad Nutr Diet. 2016 Mar 16. pii: S2212-2672(16)00117-9. doi: 10.1016/j.jand.2016.02.007
  29. Wall, M & Silverman, A. H. (in press). Psychological Aspects and Behavioral Issues in Pediatric Feeding. In Arvedson & Lefton-Greif (Eds.), Pediatric Swallowing and Feeding: Assessment and Management (3rd ed.). Plural Publishing.

Invited Lectures/Workshops/Presentations/Site Visits (2015-2017)

International

  1. Arvedson J. Decision Making with Complex Swallowing and Feeding Problems in Pediatrics. Skalica, Slovakia. May 2015.
  2. Arvedson, J. Paediatric Feeding Seminar. KK Women’s and Children’s Hospital, Singapore. May 2015
  3. Arvedson, J. Pediatric Swallowing and Feeding: Assessment and Intervention. Uppsala University, Uppsala Sweden. October 2015.
  4. Arvedson, J. Pediatric Swallowing and Feeding: Simple to Complex, Let’s Figure It Out. Trinity College, Dublin, Ireland. October 2015.
  5. Arvedson, J. Airway Issues: Critical Basis for Oral Feeding. 4th Annual Turkish Dysphagia Congress. Istanbul, Turkey. November 2015.
  6. Arvedson, J. Assessment & Diagnosis of Feeding Disorders in CP Children. Feeding & Nutritional Considerations in Children with Cerebral Palsy (CP): Tools and evidence. International Advisory Board Meeting. Vienna, Austria. November 2015.
  7. Arvedson, J. Treatment Decision Making Based on Clinical and Instrumental Evaluations in Pediatric Swallow Problems. 4th Annual Turkish Dysphagia Congress. Istanbul, Turkey. November 2015.
  8. Arvedson, J. Weaning from Gastrostomy Tube Feedings. 4th Annual Turkish Dysphagia Congress. Istanbul, Turkey. November 2015.
  9. Arvedson, J. Pediatric Feeding and Swallowing: Decision Making with Complex Problems. Pediatric Dysphagia Intensive Course. Security Forces Hospital. Riyadh, Saudi Arabia. January 2016.
  10. Arvedson, J. Pediatric Feeding and Swallowing: Decision Making with Complex Problems. Dar Al-Hekma University. Jeddah, Saudi Arabia. February 2016.
  11. Arvedson, J. Pediatric Dysphagia: Training Course for Speech-Language Pathologists in Czech Republic and Slovakia. Skalica, Slovakia. May 2016.
  12. Arvedson, J. Red Flags and Clinical Assessment of Feeding Disorders in CP Children. Feeding & Nutritional Considerations in Children with Cerebral Palsy (CP): Tools and evidence. International Advisory Board Meeting. Vienna, Austria. May 2016.
  13. Arvedson, J. Precongress Course. Management of tracheostomy in children with oropharyngeal dysphagia. 6th European Society for Swallowing Disorders (ESSD Congress), Deglutology: From Science to Clinical Practice. Milan, Italy. October 2016.
  14. Arvedson, J. Evidence in screening application in the paediatric population. 6th European Society for Swallowing Disorders (ESSD Congress), Deglutology: From Science to Clinical Practice. Milan, Italy. October 2016.
  15. Arvedson, J. Feeding children with cerebral palsy. 6th European Society for Swallowing Disorders (ESSD Congress), Deglutology: From Science to Clinical Practice. Milan, Italy. October 2016.
  16. Arvedson, J. What parents need to know: Principles of clinical assessment and management decisions. Nicosia, Cyprus. October 2016.
  17. Arvedson, J. Solving Complex Pediatric Feeding and Swallowing Problems. Nicosia, Cyprus. October 2016.
  18. Feuling, MB. Meet the Professor session. Nutritional (and other) management of acute pancreatitis. World Congress of Pediatric Gastroenterology. Montreal, Canada. October 2016
  19. Goday PS. Meet the Professor session. Nutritional Management of the Hospitalized Child. World Congress of Pediatric Gastroenterology. Montreal, Canada. October 2016
  20. Goday PS. Stump the Experts. Council for Nutrition Professionals Nutrition Symposium. World Congress of Pediatric Gastroenterology, Hepatology and Nutrition. Montreal, Canada. October 2016
  21. Arvedson, J. Management of swallowing disorders in children and adults: Pediatric Feeding and Swallowing Problems: Let’s Figure it out. Universidad de Chile, Facultad de Medicina, Santiago, Chile. November 2016.
  22. Arvedson, J. Challenges in Pediatric Dysphagia: Let’s Figure It Out. McGill University. Montreal, Quebec, Canada. April 2017.
  23. Arvedson, J. Pediatric Swallowing & Feeding Disorders: Simple to Complex, Let’s figure it out. Mansouora University, Mansoura, Egypt. September 2017.
  24. Arvedson, J. Infant Feeding in NICU and Beyond: Through First Year of Life. Universidad de Chile, Facultad de Medicina, Santiago, Chile. October 2017.

National

  1. Silverman, A. H. Interdisciplinary Inpatient Approaches to Weaning Tube Dependent Children from Enteral Feeding. 2015 NASPGHAN Annual Meeting. Washington, D.C. October 2015.
  2. Arvedson J. Thickened Liquids: Pros and Cons for Infant Feeding. 43nd Annual Meeting of Society for Ear, Nose & Throat Advances in Children, Hyatt Regency San Antonio, TX. December 2015.
  3. Goday PS. Poster Professor for Malnutrition. Clinical Nutrition Week. Austin, TX. January 2016. Las Vegas, NV.
  4. Goday PS. I’ve tried it all! Approaches to the poor grower. Clinical Nutrition Week. Austin, TX. January 2016.
  5. Lefton-Greif, M, Arvedson, J. Cardiac and Gastrointestinal Congenital Defects: From Survival to Feeding. American Speech-Language-Hearing Convention. Philadelphia, PA. November 2016.
  6. Arvedson J, Miller C, Saavedra J. Problem-Solving the Complexities of Pediatric Dysphagia. American Speech-Language-Hearing Convention. Philadelphia, PA. November 2016.
  7. Goday PS. Clinical and Practical Approaches to the Poorly Growing Pediatric Patient. Clinical Nutrition Week. Orlando, FL. January 2017.
  8. Goday PS. 2017 ASPEN + SCCM Pediatric Critical Care Nutrition Guidelines: Parenteral nutrition –role and optimal timing. Clinical Nutrition Week. Orlando, FL. January 2017.
  9. Goday PS. Failure to Thrive. American Academy of Pediatrics National Conference and Exhibition. Chicago, IL. September 2017.
  10. Goday PS and Skillman H. 2017 ASPEN + SCCM Pediatric Critical Care Nutrition Council for Pediatric Nutrition Professionals. Las Vegas, NV. October 2017. 

Regional

  1. Arvedson J. Pediatric Dysphagia: Aspiration with Swallowing and/or Gastroesophageal Reflux. The Michigan Otolaryngological Society. Detroit, MI. January 2015.
  2. Arvedson J. Pediatric Dysphagia: Airway & Gastrointestinal Tract Interferences for Oral Feeding. 55th Annual Convention Illinois Speech-Language-Hearing Association. Rosemont, Illinois. February, 2015.
  3. Arvedson J. Solving Problems: Clinical and Instrumental Evaluations for Infants and Children. 55th Annual Convention Illinois Speech-Language-Hearing Association. Rosemont, Illinois. February, 2015.
  4. Barkmeier-Kraemer, J. & Silverman, A. H. The Infant and Child Feeding Questionnaire: It’s Role as an Engagement Tool and as a Potential Tool for Screening. Feeding Matters 4th Pediatric Feeding Conference. Phoenix, AZ. February 2015.
  5. Arvedson, J. Pediatric Swallowing & Feeding: Simple to Complex, Let’s Figure It Out. Frazier Rehabilitation Institute, Louisville, KY. March 2015.
  6. Arvedson, J. Pediatric Feeding and Swallowing Problems: Let’s Figure It Out. Children’s Hospital, University of California San Francisco. San Francisco, CA. April 2015.
  7. Arvedson J. Pediatric Swallowing & Feeding: Simple to Complex, Let’s Figure It Out. North Carolina Speech-Hearing-Language Association Spring Convention. April 2015.
  8. Arvedson, J. Solving Complex Pediatric Feeding and Swallowing Problems. Johnston, Iowa. June 2015.
  9. Silverman, A. H. The Infant and Child Questionnaire: A Method for Early Detection and Treatment of Feeding Problems. 2015 Annual Pediatrics in the Red Rocks meeting of the Arizona Academy of Pediatrics. Sedona, AZ. June 2015.
  10. Arvedson, J. Solving Complex Pediatric Feeding and Swallowing Problems. Orlando, FL. July 2015.
  11. Arvedson, J. Solving Complex Pediatric Feeding and Swallowing Problems. Stafford, TX. October 2015.
  12. Feuling, MB. Food Allergies and Nutrition Support. Virginia Society for Parenteral and Enteral Nutrition Fall Conference. Virginia Beach, VA. November, 2015
  13. Arvedson J., Dodrill, P. Instrumental Swallow Studies and Thickened Fluids. What, When, and Why? Feeding Matters 4th Annual Pediatric Feeding Conference – Pediatric Feeding: It Takes a Village. Phoenix, AZ. February 2016.
  14. Arvedson, J. Solving Complex Pediatric Feeding and Swallowing Problems. Minneapolis, MN. March 2016.
  15. Goday PS. Pediatric Malnutrition and Failure to Thrive. The 1st Annie Terry Pediatric Gastroenterology and Nutrition Grand Rounds. Oregon Health Sciences University, Portland, OR. May 2016.
  16. Arvedson, J. Solving Complex Pediatric Feeding and Swallowing Problems. Omaha, NE. August 2016.
  17. Begotka, A., & Edwards, M. A practical approach to feeding issues in pediatrics and IEM. 2nd Annual Midwest Metabolic Educational Event. Chicago, IL. October 2016.
  18. Arvedson, J, Phalaen, J., Dunn Klein, M., & Neiderer, R. It takes a village: Successful team collaborations. Feeding Matters 5th Annual Pediatric Feeding Conference. Phoenix, AZ. January 2017.
  19. Feuling, MB. Expanding the Focus - What Happens After Graduating From Feeding. Feeding Matters 5th Annual Pediatric Feeding Conference. Phoenix, AZ. January 2017.
  20. Feuling, MB. Pediatric Feeding Disorder (PFD): A Consensus Definition and Practical Considerations. Feeding Matters 5th Annual Pediatric Feeding Conference. Phoenix, AZ. January 2017.
  21. Arvedson, J. Solving Complex Pediatric Feeding and Swallowing Problems. Memphis, TN. March 2017.
  22. Arvedson, J. Pediatric Swallowing & Feeding: Simple to Complex, Let’s Figure it Out. University of Mississippi. Oxford, MS. April 2017.
  23. Goday PS. Reconceptualizing Failure to Thrive. Nutrition Support Colloquium Lecture 1. Children’s Healthcare of Atlanta. Atlanta, GA. June 2017.
  24. Goday PS. Nutrition Support of Hospitalized Children. Nutrition Support Colloquium Lecture 2. Children’s Healthcare of Atlanta. Atlanta, GA. June 2017.
  25. Silverman A and Goday PS. Case Studies in Rapid Tube Weaning: Clinical Effectiveness and Safest Practices. 2017 Pediatric Feeding Conference: Feeding and Swallowing across the Lifespan. Columbus, OH. July 2017.
  26. Arvedson, J. Solving Complex Pediatric Feeding and Swallowing Problems. Houston, TX. October 2017.

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