Feeding problems are quite common, affecting approximately 25 % of children.
With all these children, the number one treatment goal is to identify the underlying causes of the problem to better enable adequate growth.
Children’s Mercy Kansas City utilizes a multidisciplinary feeding clinic to bring all the specialists needed together to address the often complex needs of these patients.
Team members include physicians, psychologists, occupational therapists, speech pathologists and nutritionists.
The clinic focuses on assessing the need for tube feedings, weaning children off tube feedings, assessing for underlying causes, and providing education for parents all with an end goal focused on promoting oral intake while maintaining growth.
Listen today as Sarah Edwards, DO discusses Children’s Mercy's Multidisciplinary Feeding Clinic.
Multidisciplinary Feeding Clinic: Transforming the Approach to Complex Feeding Disorders
Featured Speaker:
Learn more about Dr. Edwards
Sarah Edwards, DO
Dr. Edwards is a pediatric gastroenterologist with special interest in feeding disorders and nutrition. Dr. Edwards received her medical degree from the Kansas City University of Medicine and Biosciences. She completed her pediatric residency at Children’s Mercy and followed by a fellowship in Pediatric Gastroenterology, also at Children’s Mercy.Learn more about Dr. Edwards
Transcription:
Multidisciplinary Feeding Clinic: Transforming the Approach to Complex Feeding Disorders
Dr. Michael Smith (Host): Welcome to Transformational Pediatrics. I'm Dr. Michael Smith and our topic is “A Multidisciplinary Approach to Feeding Issues.” My guest is Dr. Sarah Edwards. Dr. Edwards is a pediatric gastroenterologist with special interest in feeding disorders and nutrition. Dr. Edwards, welcome to the show.
Dr. Sarah Edwards (Guest): Thank you.
Dr. Smith: So, how big of a problem are feeding issues in the infant and pediatric population?
Dr. Edwards: It is quite a common problem. We see about 25% of children in general have feeding problems with about 3-10% of those having more severe feeding problems. Then, more specifically, about 80% of that population seems to be in the developmentally delayed or intellectual disability type patient population.
Dr. Smith: So, how do you go about identifying a feeding problem and what are the most common causes that you see?
Dr. Edwards: Well, typically when we're seeing a patient, we're seeing a wide variety of diagnoses that are contributing to their feeding problem. We see really everything from children with severe picky eating that can be contributing to their feeding problem to such diagnoses as eosinophilic esophagitis, reflux, structural problems that can contribute to not being able to eat or drink at their developmentally appropriate level.
Dr. Smith: So, you're seeing quite a spectrum of patients from just simple issues to you know, downright pathologies, correct?
Dr. Edwards: Correct. Yes.
Dr. Smith: So, tell us about – you describe your feeding clinic as multidisciplinary. What do you mean by that and why do you think this type of approach is really important?
Dr. Edwards: So, when we say “multidisciplinary”, we really are indicating that the patient is seeing 5 different disciplines in one office visit. This includes myself, a psychologist, a speech language pathologist, occupational therapist and a dietician. This gives us a tremendous advantage, not only for us as providers but also the patient. In regards to the providers, we can then discuss our assessment and plan and make sure that we're all taking into account each other's recommendations and assessment, which can affect our treatment plan as a whole and then the patient is not having to go to 5 different appointments. They have one unified treatment plan that is developed by the full team.
Dr. Smith: How do you involve the parents in this process as well? I'm sure they're, obviously, with the child but what do you to address the needs of the parent in this clinic?
Dr. Edwards: You know, that's a great question because we do talk a lot during the visit about the importance of the parents’ role and that really they are the advocate for the child and we do this as a team approach and they're one of those players on the team. So, when they're leaving the visit, we want to make sure that they have a full understanding of what the treatment approach is and the maps for how we see their child getting better or treating the feeding problem. We watch the parents feed their child during the visit so that we can also have some insight into that interaction and how that could be affecting their feeding problem. That's also where our psychologist can be quite helpful in monitoring both the stress that’s involved in patients with feeding problems and also helping the parent with any of those behavioral questions or those kinds of strategies.
Dr. Smith: Is there any follow up for the parent and what you have taught the parent in terms of feeding techniques? Is there any follow up at their home through maybe a social worker? Or, do they always come into the clinic for follow up?
Dr. Edwards: So, they always come into the clinic but we try to work very closely with the providers that are in the community. So, a lot of our patients are being followed by the 0-3 services in their community. We see quite a few patients that drive significant distance and so we try to work with those community providers in the interim between visits to really make sure that we're making progress and consider them an extension of the team because they're the one really seeing the patient every week. We do also have some patients who live closer that will see one or two members of the team weekly in between visits with the full team.
Dr. Smith: Walk us through a typical visit, then, with one of the patients and speak to some of the strategies that you use to addressing feeding problems.
Dr. Edwards: Okay. Well, the initial visit we ask parents to bring both preferred and non-preferred foods for the child. We see such a wide range of patients--some of our patients aren't taking anything by mouth when they see us initially. So, we definitely are willing to see any patient that is having a feeding problem, no matter what the level of feeding is when they initially meet us. So, with the initial visit the parent and child is in the room with the full team and we are asking them about family history. We have them fill out a packet ahead of time and we use that to guide. It's a family history, physical exam, and really allowing that to guide initial questioning. Then, when the patient has warmed up a little bit, we will often times go ahead and ask the parent to feed the patient and our feeding therapist will often times work alongside the parent or interact with them to also get a better idea of the oral motor skills that the child has. Then, once we've completed that history and physical and the feeding assessment, then we typically discuss as a team what the best strategy – first of all our assessment and then the best strategy for a plan to reach the goal because, I failed to say that one of the first things we ask parents is, “What is your goal? What would you like to accomplish in being here?” So, we really want to target that goal and that could look different for every child. For some children, it can mean social eating, having a few bites with their family at a meal. For some children, it can mean weaning them completely off of their feeding tube or just expanding the level of foods that they're actually taking.
Dr. Smith: So, in this approach where in one visit you're seeing 5 different disciplines; you work as a team so, you're saving, obviously, a lot of time because before your clinic, the parent and the patients would have to go to 5 different office visits which can be very difficult. So, this is a wonderful approach and I know you're doing some awesome things there. How do patients get to you and the clinic? How do they find out about it? How do they get referred to you? Where do most of your patients come from?
Dr. Edwards: So, they can be referred from their primary care physician. They can get a referral from, if they're being seen in Children's Mercy. Oftentimes, if they see a provider that thinks they need to be seen in the feeding clinic, they can get a referral there. They can also call our contact center at 816-234-3700 and that's where the providers can make a referral as well as on the ChildrensMercy.org/providers and then, you can select “Make a Referral” and providers can also refer through that portal.
Dr. Smith: Well, Dr. Edwards, I want to thank you for the work that you're doing and thank you for coming on the show. You're listening to Transformational Pediatrics with Children's Mercy Kansas City. For more information you can go to ChildrensMercy.org. That's ChildrensMercy.org. I'm Dr. Michael Smith. Have a great day.
Multidisciplinary Feeding Clinic: Transforming the Approach to Complex Feeding Disorders
Dr. Michael Smith (Host): Welcome to Transformational Pediatrics. I'm Dr. Michael Smith and our topic is “A Multidisciplinary Approach to Feeding Issues.” My guest is Dr. Sarah Edwards. Dr. Edwards is a pediatric gastroenterologist with special interest in feeding disorders and nutrition. Dr. Edwards, welcome to the show.
Dr. Sarah Edwards (Guest): Thank you.
Dr. Smith: So, how big of a problem are feeding issues in the infant and pediatric population?
Dr. Edwards: It is quite a common problem. We see about 25% of children in general have feeding problems with about 3-10% of those having more severe feeding problems. Then, more specifically, about 80% of that population seems to be in the developmentally delayed or intellectual disability type patient population.
Dr. Smith: So, how do you go about identifying a feeding problem and what are the most common causes that you see?
Dr. Edwards: Well, typically when we're seeing a patient, we're seeing a wide variety of diagnoses that are contributing to their feeding problem. We see really everything from children with severe picky eating that can be contributing to their feeding problem to such diagnoses as eosinophilic esophagitis, reflux, structural problems that can contribute to not being able to eat or drink at their developmentally appropriate level.
Dr. Smith: So, you're seeing quite a spectrum of patients from just simple issues to you know, downright pathologies, correct?
Dr. Edwards: Correct. Yes.
Dr. Smith: So, tell us about – you describe your feeding clinic as multidisciplinary. What do you mean by that and why do you think this type of approach is really important?
Dr. Edwards: So, when we say “multidisciplinary”, we really are indicating that the patient is seeing 5 different disciplines in one office visit. This includes myself, a psychologist, a speech language pathologist, occupational therapist and a dietician. This gives us a tremendous advantage, not only for us as providers but also the patient. In regards to the providers, we can then discuss our assessment and plan and make sure that we're all taking into account each other's recommendations and assessment, which can affect our treatment plan as a whole and then the patient is not having to go to 5 different appointments. They have one unified treatment plan that is developed by the full team.
Dr. Smith: How do you involve the parents in this process as well? I'm sure they're, obviously, with the child but what do you to address the needs of the parent in this clinic?
Dr. Edwards: You know, that's a great question because we do talk a lot during the visit about the importance of the parents’ role and that really they are the advocate for the child and we do this as a team approach and they're one of those players on the team. So, when they're leaving the visit, we want to make sure that they have a full understanding of what the treatment approach is and the maps for how we see their child getting better or treating the feeding problem. We watch the parents feed their child during the visit so that we can also have some insight into that interaction and how that could be affecting their feeding problem. That's also where our psychologist can be quite helpful in monitoring both the stress that’s involved in patients with feeding problems and also helping the parent with any of those behavioral questions or those kinds of strategies.
Dr. Smith: Is there any follow up for the parent and what you have taught the parent in terms of feeding techniques? Is there any follow up at their home through maybe a social worker? Or, do they always come into the clinic for follow up?
Dr. Edwards: So, they always come into the clinic but we try to work very closely with the providers that are in the community. So, a lot of our patients are being followed by the 0-3 services in their community. We see quite a few patients that drive significant distance and so we try to work with those community providers in the interim between visits to really make sure that we're making progress and consider them an extension of the team because they're the one really seeing the patient every week. We do also have some patients who live closer that will see one or two members of the team weekly in between visits with the full team.
Dr. Smith: Walk us through a typical visit, then, with one of the patients and speak to some of the strategies that you use to addressing feeding problems.
Dr. Edwards: Okay. Well, the initial visit we ask parents to bring both preferred and non-preferred foods for the child. We see such a wide range of patients--some of our patients aren't taking anything by mouth when they see us initially. So, we definitely are willing to see any patient that is having a feeding problem, no matter what the level of feeding is when they initially meet us. So, with the initial visit the parent and child is in the room with the full team and we are asking them about family history. We have them fill out a packet ahead of time and we use that to guide. It's a family history, physical exam, and really allowing that to guide initial questioning. Then, when the patient has warmed up a little bit, we will often times go ahead and ask the parent to feed the patient and our feeding therapist will often times work alongside the parent or interact with them to also get a better idea of the oral motor skills that the child has. Then, once we've completed that history and physical and the feeding assessment, then we typically discuss as a team what the best strategy – first of all our assessment and then the best strategy for a plan to reach the goal because, I failed to say that one of the first things we ask parents is, “What is your goal? What would you like to accomplish in being here?” So, we really want to target that goal and that could look different for every child. For some children, it can mean social eating, having a few bites with their family at a meal. For some children, it can mean weaning them completely off of their feeding tube or just expanding the level of foods that they're actually taking.
Dr. Smith: So, in this approach where in one visit you're seeing 5 different disciplines; you work as a team so, you're saving, obviously, a lot of time because before your clinic, the parent and the patients would have to go to 5 different office visits which can be very difficult. So, this is a wonderful approach and I know you're doing some awesome things there. How do patients get to you and the clinic? How do they find out about it? How do they get referred to you? Where do most of your patients come from?
Dr. Edwards: So, they can be referred from their primary care physician. They can get a referral from, if they're being seen in Children's Mercy. Oftentimes, if they see a provider that thinks they need to be seen in the feeding clinic, they can get a referral there. They can also call our contact center at 816-234-3700 and that's where the providers can make a referral as well as on the ChildrensMercy.org/providers and then, you can select “Make a Referral” and providers can also refer through that portal.
Dr. Smith: Well, Dr. Edwards, I want to thank you for the work that you're doing and thank you for coming on the show. You're listening to Transformational Pediatrics with Children's Mercy Kansas City. For more information you can go to ChildrensMercy.org. That's ChildrensMercy.org. I'm Dr. Michael Smith. Have a great day.