Selected Podcast
Feeding Team Therapy for Children
Kelly Sebold, speech and language pathologist, discusses Feeding Team Therapy for Children - what it is and how it can help.
Featuring:
Special Interests: Infant and Child Feeding and Swallowing Disorders, Pediatric Modified Barium Swallow Studies, General Speech and Language Delay, Autism, Early Intervention, Apraxia of Speech, Head and Neck Issues, Pet Partners/Prescription Pets program, care coordination and multidisciplinary collaboration.
Kelly Sebold, MA, CCC-SLP
Kelly Sebold, MA has worked primarily in the outpatient pediatric setting and helped establish the Pullman Feeding Team. Kelly also enjoys working with the Prescription Pets program and her dog, Lily, is one of the founding members.Special Interests: Infant and Child Feeding and Swallowing Disorders, Pediatric Modified Barium Swallow Studies, General Speech and Language Delay, Autism, Early Intervention, Apraxia of Speech, Head and Neck Issues, Pet Partners/Prescription Pets program, care coordination and multidisciplinary collaboration.
Transcription:
Bill Klaproth: (Host)So what is a feeding team and what types of issues do they treat? Let's find out with Kelly Sebold, speech and language pathologist at Pullman Regional Hospital. Kelly always great to talk with you. Thank you for your time. So what is the feeding team at Summit Therapy and what do they do?
Kelly Sebold: (Guest) Well, sure. Thank you for having me. The Pullman feeding team is actually a group of dedicated professionals who develop specialized care plans to address all areas of growth, nutrition, and feeding. We've actually treated children who have diagnosed growth or feeding difficulties, sometimes they actually have a feeding disorder. But these are more medical disorders, not, not what you would consider, like anorexia or some of the feeding disorders that you would think of more associated with adults. But our core team consists of the referring physician, a registered dietician, a speech-language pathologist, and the family, of course. We do have additional team members that we can bring in to work with us that might include occupational therapy, physical therapy, a behavioral counselor, and a genetic counselor.
Host: Wow. That is really interesting. So what kinds of training or licenses do feeding team therapists have to have?
Kelly: Well, it's actually interesting. I think that feeding has actually come a long way when I was in school back in the early nineties, feeding disorders was not really an organized topic for my schooling. So it was something I really learned on the job at a hospital up in Spokane and then I just was exposed to it and became interested in it. But really all of the therapists and providers have professional licenses that are required by each of their disciplines. We do participate in advanced training related to the field of feeding disorders. And currently, we are members of the Washington state feedings teams, a group of organized. Professionals that was, actually put together by the University of Washington and include feeding teams across the state. So we can collaborate with each other and learn. And do all the state of the art. Interventions that we possibly can learn from each other.
Host: Right. So then what types of issues does the feeding team treat?
Kelly: It's a very good question. It's kind of complicated sometimes and other times it's really straightforward. But generally speaking, the feeding team treats children and their families of all ages up to about 12 years old. But our most common patient is a premature newborn or newborn infant up to that age eight. And then narrowing it down even more. The majority of our patients are infants and toddlers. So I thought it might be helpful to maybe specifically answer that question even in more detail. It's not just an age or, you know, an infant, but some of the most common referrals that we might see are premature infants with feeding difficulties, either due to reflux, maybe they're not gaining weight appropriately or they're eating a lot and not growing anyway. We see children who require a feeding tube to help them get the nutrition that they need. We also see children with developmental delays or immature motor skills that make coordination for sucking and swallowing or transition to solid foods more difficult. Some other types of children that we might be working with are those that have sensory processing delays. This can interfere with their touch, taste, sense of smell, their ability to handle stimulation in general and maybe eating food is more difficult. It's got a lot of properties to it, like taste, temperatures, smell, texture. This can lead to children sometimes refusing to eat or self-limiting to a really narrow type of food. Sometimes they might develop behaviors during the meal that undermine the relationship that they have with their parents. Maybe the parent might feel compelled to bribe them or beg them sometimes to eat something and the kids maybe don't want to. This can limit their access to nutrients and minerals. Sometimes we'll see children that have a medical fragile diagnosis, or they just were really sick coming out of the womb, you know, being born into the world and maybe they had something was wrong with them physically. And those can be a complex neurologic function perhaps, or they're a respiratory illness. Cardiac, maybe they have a heart problem. Kidney problems. These can all interfere with feeding and growth, not always, but they can.
Host: Right. That is a long list of things.
Kelly: It's a lot, some of them have food allergies. We had one, not too long ago, he was allergic to maybe 20 different food items, and a couple of them were caused anaphylaxis reaction, so there's a lot out there.
Host: Yeah, there certainly is a lot, many wouldn't normally think of. So parents often have this push-pull relationship with kids and feeding time coaxing, pleading, bribing to get them to eat. So what is normal and what is not normal? Who is an ideal candidate for feeding team therapy?
Kelly: Well, I think an ideal candidate for our team, is any family with a child who needs help determining why they might be having these behaviors and how they can maybe approach things in a way that would bring more joy and enjoyment back into the feeding experience. If they wonder why they're struggling with mealtimes, why their child is small for their age or having trouble chewing, swallowing, maybe not growing. I mean, there's really so many different things that they might be able to talk to us about that we could point them in the right direction or encourage them. I think of some families that actually a lot of families who will come to us and say, you know, we have friends and family telling us all these suggestions and have you tried this? And have you tried that? And sometimes, you know, often those suggestions work for a typically developing child, or you might go through a phase. But they don't work with these children. And they can lead you down a path of real negative feelings about your child and you then feel guilty because you're having these feelings. And we just want to support families so that they don't feel that and go through that for more than they absolutely have to.
Host: Right. You definitely want to see an expert. So then what does a typical session look like?
Kelly: A typical session is in our clinic usually, but because of COVID-19, we have been experimenting and practicing teletherapy sessions, which is actually not hard at all. It allows us to see into the world of the family and see them in their homes. So it's a really nice option. But normally they would come into our clinic, we would see them for about 45 minutes to an hour. The first session they would meet just a small group of our team, which includes a registered dietitian and myself, speech-language pathologist. We would then observe the child at play, develop some rapport with them, we review their medical history. We talked to the family, and they've brought to us an example of what their day is like, as far as feeding over three days, they might track what they've been doing, what the child has been eating and maybe any behavioral concerns that they have. We also weigh them and measure them. We take a head measurement if they're under the age of two and evaluate their growth. So they would walk away knowing exactly where their child falls on the growth chart kind of how they compare to other children and where we would expect them to be. We kind of pack a lot into it, I would say the team that we have is an amazing team and we really want the family to get as much as they can in that first visit. So we will also ask them to let us watch them feed their child. And that allows us to observe their feeding skills, their oral motor coordination, and swallowing. And then we can brainstorm a few ideas. Maybe give them suggestions to try at home. And then, of course, answer questions and have them maybe come back in a month or so and check-in and see how things are going.
Host: Right. So I would imagine people are wondering, is feeding team therapy covered by health insurance?
Kelly: It often is, especially if there's a medical reason or a diagnosis attached to it, like failure to thrive is pretty common. A child maybe isn't growing and they're falling off the growth chart. Our off their own curve is more what that would be and so it often is covered by insurance, but we do help them navigate that, and make sure that they understand their insurance benefits cause they're all so different these days, but we're here to help with that too.
Host: This seems like a very beneficial and worthwhile program. So is there anything else you want people to know about feeding team therapy?
Kelly: Yeah, I would want people to know it is complicated and some people wonder, why am I going to see someone about feeding, but it is complex and we don't want families to feel alone. We want them to know that there is support here and that we can collaborate with their other providers. We're not just in a box doing our own thing. We really feel that it's important to help them in all their areas of life you know, some of these children have so many medical providers are going to Spokane or Seattle to see specialists. And we just want them to have local support. And I guess I would end on saying too, that we really want to encourage people not to wait too long, because feeding behaviors that are, you know, they might start out subtle or simple can become habits and are often emotionally draining and frustrating. You know, if you think about it, eating is really social. It should be fun. We like to eat most of the time. And if you have kids eating five and six times a day and they're not having fun in the family is not having fun, they need help, they need to come see us so that we can make that difference.
Host: Right. It sounds like there could be a problem. So sooner rather than later is the right advice. Alright, Kelly. Well, thank you so much, always informative and a pleasure to talk with you. Thank you so much again for your time. We appreciate it.
Kelly: Thank you. Thank you for having me.
Host: That's Kelly Sebold and to learn more about feeding team therapy for children or providers and services at Pullman Regional Hospital, please visit pullmanregional.org. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is the Health Podcast from Pullman Regional Hospital. I'm Bill Klaproth. Thanks for listening.
Bill Klaproth: (Host)So what is a feeding team and what types of issues do they treat? Let's find out with Kelly Sebold, speech and language pathologist at Pullman Regional Hospital. Kelly always great to talk with you. Thank you for your time. So what is the feeding team at Summit Therapy and what do they do?
Kelly Sebold: (Guest) Well, sure. Thank you for having me. The Pullman feeding team is actually a group of dedicated professionals who develop specialized care plans to address all areas of growth, nutrition, and feeding. We've actually treated children who have diagnosed growth or feeding difficulties, sometimes they actually have a feeding disorder. But these are more medical disorders, not, not what you would consider, like anorexia or some of the feeding disorders that you would think of more associated with adults. But our core team consists of the referring physician, a registered dietician, a speech-language pathologist, and the family, of course. We do have additional team members that we can bring in to work with us that might include occupational therapy, physical therapy, a behavioral counselor, and a genetic counselor.
Host: Wow. That is really interesting. So what kinds of training or licenses do feeding team therapists have to have?
Kelly: Well, it's actually interesting. I think that feeding has actually come a long way when I was in school back in the early nineties, feeding disorders was not really an organized topic for my schooling. So it was something I really learned on the job at a hospital up in Spokane and then I just was exposed to it and became interested in it. But really all of the therapists and providers have professional licenses that are required by each of their disciplines. We do participate in advanced training related to the field of feeding disorders. And currently, we are members of the Washington state feedings teams, a group of organized. Professionals that was, actually put together by the University of Washington and include feeding teams across the state. So we can collaborate with each other and learn. And do all the state of the art. Interventions that we possibly can learn from each other.
Host: Right. So then what types of issues does the feeding team treat?
Kelly: It's a very good question. It's kind of complicated sometimes and other times it's really straightforward. But generally speaking, the feeding team treats children and their families of all ages up to about 12 years old. But our most common patient is a premature newborn or newborn infant up to that age eight. And then narrowing it down even more. The majority of our patients are infants and toddlers. So I thought it might be helpful to maybe specifically answer that question even in more detail. It's not just an age or, you know, an infant, but some of the most common referrals that we might see are premature infants with feeding difficulties, either due to reflux, maybe they're not gaining weight appropriately or they're eating a lot and not growing anyway. We see children who require a feeding tube to help them get the nutrition that they need. We also see children with developmental delays or immature motor skills that make coordination for sucking and swallowing or transition to solid foods more difficult. Some other types of children that we might be working with are those that have sensory processing delays. This can interfere with their touch, taste, sense of smell, their ability to handle stimulation in general and maybe eating food is more difficult. It's got a lot of properties to it, like taste, temperatures, smell, texture. This can lead to children sometimes refusing to eat or self-limiting to a really narrow type of food. Sometimes they might develop behaviors during the meal that undermine the relationship that they have with their parents. Maybe the parent might feel compelled to bribe them or beg them sometimes to eat something and the kids maybe don't want to. This can limit their access to nutrients and minerals. Sometimes we'll see children that have a medical fragile diagnosis, or they just were really sick coming out of the womb, you know, being born into the world and maybe they had something was wrong with them physically. And those can be a complex neurologic function perhaps, or they're a respiratory illness. Cardiac, maybe they have a heart problem. Kidney problems. These can all interfere with feeding and growth, not always, but they can.
Host: Right. That is a long list of things.
Kelly: It's a lot, some of them have food allergies. We had one, not too long ago, he was allergic to maybe 20 different food items, and a couple of them were caused anaphylaxis reaction, so there's a lot out there.
Host: Yeah, there certainly is a lot, many wouldn't normally think of. So parents often have this push-pull relationship with kids and feeding time coaxing, pleading, bribing to get them to eat. So what is normal and what is not normal? Who is an ideal candidate for feeding team therapy?
Kelly: Well, I think an ideal candidate for our team, is any family with a child who needs help determining why they might be having these behaviors and how they can maybe approach things in a way that would bring more joy and enjoyment back into the feeding experience. If they wonder why they're struggling with mealtimes, why their child is small for their age or having trouble chewing, swallowing, maybe not growing. I mean, there's really so many different things that they might be able to talk to us about that we could point them in the right direction or encourage them. I think of some families that actually a lot of families who will come to us and say, you know, we have friends and family telling us all these suggestions and have you tried this? And have you tried that? And sometimes, you know, often those suggestions work for a typically developing child, or you might go through a phase. But they don't work with these children. And they can lead you down a path of real negative feelings about your child and you then feel guilty because you're having these feelings. And we just want to support families so that they don't feel that and go through that for more than they absolutely have to.
Host: Right. You definitely want to see an expert. So then what does a typical session look like?
Kelly: A typical session is in our clinic usually, but because of COVID-19, we have been experimenting and practicing teletherapy sessions, which is actually not hard at all. It allows us to see into the world of the family and see them in their homes. So it's a really nice option. But normally they would come into our clinic, we would see them for about 45 minutes to an hour. The first session they would meet just a small group of our team, which includes a registered dietitian and myself, speech-language pathologist. We would then observe the child at play, develop some rapport with them, we review their medical history. We talked to the family, and they've brought to us an example of what their day is like, as far as feeding over three days, they might track what they've been doing, what the child has been eating and maybe any behavioral concerns that they have. We also weigh them and measure them. We take a head measurement if they're under the age of two and evaluate their growth. So they would walk away knowing exactly where their child falls on the growth chart kind of how they compare to other children and where we would expect them to be. We kind of pack a lot into it, I would say the team that we have is an amazing team and we really want the family to get as much as they can in that first visit. So we will also ask them to let us watch them feed their child. And that allows us to observe their feeding skills, their oral motor coordination, and swallowing. And then we can brainstorm a few ideas. Maybe give them suggestions to try at home. And then, of course, answer questions and have them maybe come back in a month or so and check-in and see how things are going.
Host: Right. So I would imagine people are wondering, is feeding team therapy covered by health insurance?
Kelly: It often is, especially if there's a medical reason or a diagnosis attached to it, like failure to thrive is pretty common. A child maybe isn't growing and they're falling off the growth chart. Our off their own curve is more what that would be and so it often is covered by insurance, but we do help them navigate that, and make sure that they understand their insurance benefits cause they're all so different these days, but we're here to help with that too.
Host: This seems like a very beneficial and worthwhile program. So is there anything else you want people to know about feeding team therapy?
Kelly: Yeah, I would want people to know it is complicated and some people wonder, why am I going to see someone about feeding, but it is complex and we don't want families to feel alone. We want them to know that there is support here and that we can collaborate with their other providers. We're not just in a box doing our own thing. We really feel that it's important to help them in all their areas of life you know, some of these children have so many medical providers are going to Spokane or Seattle to see specialists. And we just want them to have local support. And I guess I would end on saying too, that we really want to encourage people not to wait too long, because feeding behaviors that are, you know, they might start out subtle or simple can become habits and are often emotionally draining and frustrating. You know, if you think about it, eating is really social. It should be fun. We like to eat most of the time. And if you have kids eating five and six times a day and they're not having fun in the family is not having fun, they need help, they need to come see us so that we can make that difference.
Host: Right. It sounds like there could be a problem. So sooner rather than later is the right advice. Alright, Kelly. Well, thank you so much, always informative and a pleasure to talk with you. Thank you so much again for your time. We appreciate it.
Kelly: Thank you. Thank you for having me.
Host: That's Kelly Sebold and to learn more about feeding team therapy for children or providers and services at Pullman Regional Hospital, please visit pullmanregional.org. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is the Health Podcast from Pullman Regional Hospital. I'm Bill Klaproth. Thanks for listening.