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A Caregiver’s Guide to Outpatient Feeding Supports

Important information:

Feeding is a complex, developmental skill that involves many of the systems in our bodies. When you have a concern about your child’s feeding, it can be difficult to figure out what type of support they need and where to find that support. The goal of this document is to provide caregivers with basic information related to outpatient oral feeding services. Please note that this document is not comprehensive, and services vary across the country. If you have questions related to your child’s feeding, you are encouraged to speak with your healthcare team.

Professionals that can help with feeding

Occupational therapists (OT) and speech-language pathologists (SLP) are trained in helping infants and children obtain the skills needed for feeding. An OT can help with proper positioning for feeding, self-feeding, and tolerance of the sensory properties of food. They help children feel comfortable with touching and tasting different foods. An SLP can help with latching and sucking, drinking from a cup or straw, chewing food, and swallowing safely. These therapies are usually not successful when a child’s primary feeding difficulty is refusal to eat or drink.

Registered dietitians are trained to help infants and children meet their nutrition and hydration needs to grow and be healthy. They provide recommendations related to both oral feeding and supplemental or tube feedings.

Pediatric psychologists can help children who have developed negative associations or behaviors around feeding and eating. They work with families to help children who refuse food or fluid, appear scared or anxious about eating, or are restricted in the way that they will eat.

Some professionals may not have the specialty training and experience needed to properly address feeding. When contacting a provider, ask if they have training and experience in pediatric feeding.  

Where you can find these professionals:

Early Intervention is a program run by your state and local government. It provides children ages 0-3 years with therapy support to help them reach developmental milestones. Therapies are family and child centered. They are typically provided in the home or daycare setting. Cost of services vary by state. Some Early Intervention agencies allow for therapists to target feeding, and staff OTs and SLPs who have experience in feeding. Other agencies will not provide feeding therapy or have difficulty staffing therapists who have adequate training in feeding. You will need to contact your specific program to obtain more information. Resources for Pennsylvania, New Jersey, and Delaware Early Intervention are listed below. For all other states, conduct an internet search for “Early Intervention [your county and state]”.

Early Intervention

Once a child reaches 3 years of age, they are transitioned to services within their local public-school district or county Intermediate Unit. Like with Early Intervention, availability of feeding services will vary.

Out-patient therapy sessions with an Occupational Therapist (OT) or Speech Language Pathologist (SLP)

OTs and SLPs with training in feeding will usually work within a hospital or private therapy setting. These therapists will complete an initial evaluation of your child. If therapy is recommended, they will see your child for a set number of therapy sessions at their hospital or clinic. They may provide “homework” or recommendations for you to complete in-between sessions. The cost of these services and need for a referral are determined by your insurance company.

Comprehensive Feeding Teams

If you have multiple concerns related to your child’s feeding, an evaluation with a comprehensive team may be beneficial. These teams usually consist of a medical provider, a dietitian, a speech language pathologist, and an occupational therapist. Some of these teams may also include a pediatric psychologist. Most feeding teams will see a child for intermittent assessments every few months and typically do not provide weekly treatment services. They will refer families out to these services if they are needed. Some feeding teams may offer an intensive, daily treatment program. These programs are successful at treating a very specific type of feeding difficulty, so may not be appropriate for all children. Feeding teams are often associated with large pediatric hospitals. There are a limited number of these teams across the country.

It is important to note that this is not a comprehensive list of feeding therapies. If you have a concern related to your child’s feeding, speak with your healthcare provider. Use this resource to help guide your conversation. Feeding therapy is often in high-demand and the wait time for appointments can be lengthy. Most families will wait several weeks to several months for an initial visit and should take that into consideration when seeking support services.

Tips for successful feeding

Take care of yourself first: Having a child with feeding difficulties is very stressful. Before a feeding session, spend a few minutes taking some deep breaths. Set a small realistic goal for the session, even if that is just exposure to a food. Afterward compliment yourself on giving your child an opportunity to progress.

Know that feeding is a journey: Feeding is a complex skill, and progress is often slow. Anticipate that your child may need several different treatment approaches with different therapists. Ask questions and don’t be afraid to seek out treatment options. Celebrate every small gain and remember that if your child has a setback this is a normal part of the process!

Make eating positive: In each feeding opportunity, try to create a fun atmosphere. Follow your child’s lead and pull back if they are overwhelmed.

Avoid “forcing” your child to eat and drink. Children may eat less when they feel pressure and may do better when they feel a sense of control over their eating. Give choices and include your child in the social experience of mealtime together.

Remember that feeding is a developmental skill: Just like learning how to walk or talk, feeding is a developmental process, where one skill helps support the acquisition of the next. In addition, a child’s other developmental skills will support their feeding skills. It is important to consider a child’s developmental level, more than their age, when determining what a realistic next step for feeding should be.

Children with congenital diaphragmatic hernia (CDH)

Infants with CDH are at an increased risk for feeding difficulties due to associated medical conditions. These include:

  • Increased calorie needs related to pulmonary hypoplasia and weaning respiratory support

  • Pulmonary hypertension

  • Increased incidence of gastroesophageal reflux disease (GERD) and dysmotility

  • Increased risk for developmental delays

These issues can make feeding difficult and even unpleasant for children. Oral aversion, or difficulty tolerating anything in the mouth, can be common due to medical interventions during the NICU stay (like intubation). The presence of GERD and dysmotility can contribute to oral aversions. Many infants and children with CDH require the use of a feeding tube to achieve normal growth and development.

Therapy resources

Click on the hyperlink to access each facility’s main page. Search “feeding” to find provider location and contact information. Note that in most facilities, pediatric feeding services reside within the department of speech language pathology, or the department of pediatric rehab.

Pennsylvania

New Jersey

Delaware

Maryland

Washington D.C Metro Area

New York

Additional resources

Created by CHOP Speech Therapy department for the Congenital Diaphragmatic Hernia team, updated August 2023. Provider’s location, availability, and contact information may change over time.

 

Reviewed August 2023, Sandra Galbally, MS, CCC/SLP

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