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Caring for children with feeding disorders

Learn how our Gastroenterology, Liver and Nutrition Program cares for children with feeding disorders.

Related tests and treatments:

Our approach to feeding disorders

The Feeding Program at Children's Hospital of Wisconsin is an internationally recognized leader in treating feeding disorders in medically complex children, and treats more than 200 new cases a year. Our specialists are very active in research on pediatric feeding disorders, and their findings have helped improve the standard of care for children nationwide.

Pediatric feeding disorders can be complex. Often times there’s not just one problem: A child might have a medical issue that makes eating difficult, but then there can be a behavioral component if the child has learned to associate eating with pain and fear.

Our team of feeding experts understands the complexity that is associated with feeding disorders. Our program is made up of pediatric gastroenterologists, speech pathologists, psychologists and dietitians who will see your child in the same clinic on the same day. We’re one of just a few pediatric feeding programs in the nation that offer this truly interdisciplinary approach, and we believe it’s key to offering our families the most comprehensive and efficient care.

Our team is committed to truly listening to patients and their families: Although we may be experts on feeding problems, parents are the experts on their children, and their input is essential. Our goal is to partner with families to provide the best treatment and support possible.

Feeding disorders services we offer

  • Diagnosis and evaluation
  • Advanced endoscopic procedures
  • Customized treatment plan
  • Nutritional counseling
  • Psychological services

Most patients can be managed through our outpatient program, but we also offer an intensive, two-week inpatient feeding program and an intensive outpatient program for more complex cases.

Our inpatient program is designed to help children who are medically complex rapidly accomplish a nutritional objective, such as weaning off of gastrostomy tube support.

The intensive outpatient program works best for children who are resistant to treatment or who have traveled from a distance. This five-day program includes a focus on parent training as the child eats breakfast, lunch and dinner under supervision of the medical staff. Initially parents watch from behind a one-way mirror as the medical team feeds the child, and then eventually parents take over the feeding as the medical team offers coaching through the parent’s ear piece.

Diagnosing and treating feeding disorders

At Children’s Hospital of Wisconsin, your child will be assigned a pediatric gastroenterologist, dietician, speech language pathologist, psychologist and GI nurse. Patients usually see the full team every three to four months and then may have weekly follow-up appointments with individual team members.

After taking a thorough medical history, our feeding experts will observe your child while he or she eats via a one-way mirror to see what the child’s refusal strategies are and how the caregiver responds. The speech pathologist will look for signs of choking, coughing or gagging during eating and will make sure your child can eat safely. The team will collaborate on a report of detailed recommendations that you will receive that same day.

To assess swallowing function, your child’s providers may recommend one or more of the following imaging tests:

If there’s a physiological cause behind your child’s difficulty eating, the medical team will work to treat the underlying condition. If your child’s problem is more behavioral in nature — or if a physical problem has led your child to associate eating with pain and fear — then the doctor might recommend psychological treatment.

Older children may benefit from cognitive behavior therapy, which involves teaching the patient how to change his or her thought process as it relates to eating. That could mean focusing on the positive aspects of food and why it’s important and learning strategies to help cope with feeding anxiety.

With younger children, we focus on creating an environment that’s most conducive to eating (i.e., eliminating distractions and avoiding grazing between meals) and parental strategies. We teach parents to ignore negative behavior (such as crying or spitting) and to reward positive behaviors so that the child learns what behaviors catch the caregiver’s attention.

The first month or two of treatment tends to be the most intense, and then appointments become more spaced out once the family develops the necessary skills to manage the child’s feeding problem. The average duration of treatment is about a year, though some children may require long-term treatment.

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