Beating mealtime woes

Pediatric feeding program helps children overcome severe eating difficulties

Before Shannon and Bill Jones of Blue Grass, Iowa, were referred to the intensive feeding program at University of Iowa Children's Hospital in Iowa City, the only thing their son Henry, 3, would "eat" was a bottle of PediaSure. When the family first came to the program in March, Henry was taking in seven to eight 4-ounce bottles of the nutritional supplement a day.

"It's the worst feeling ever. All you want is for your baby to eat, for him to be happy and healthy and full," Shannon says. "I just feel so fortunate that there's someone we can go to, someone who understands and can help."

Henry, who is also diagnosed with Autism Spectrum Disorder, now eats food, little by little, and is working on drinking his PediaSure from a no-spill cup rather than a bottle. Working with Linda Cooper-Brown, clinical assistant professor of pediatrics with UI Children's Hospital's division of pediatric psychology, Shannon and Bill are learning techniques to improve Henry's eating and to get him off the bottle and on to eating solid foods.

Cooper-Brown leads the Pediatric Feeding Disorders Service at UI Children's Hospital, which is the only one of its kind in Iowa and one of just a handful in the Midwest.

Cooper-Brown works with young children—typically up to age 6 years, from as far away as Idaho, Maine, and Washington, as well as all of the surrounding states—who for one reason or another don't take in food "normally." Many of the children are still being fed through a gastric tube (G-tube), she says.

"There are medical issues that may keep them from eating; severe gastrointestinal problems that can't be overcome so easily, for instance," Cooper-Brown says. "Any kind of significant medical event could have prevented them from taking food in normally, but once the medical event is resolved, many children still don't eat normally."

The program starts with an initial one-hour visit and consultation so staff members can assess each child's feeding and oral-motor skills and obtain feeding histories as well as determine which treatment would work best. For children whose needs don't match the intensive program but who may still benefit from the program's expertise, there is a brief therapy session of two to three hours where the program's staff work with the child and provide information and advice to help families overcome feeding problems.

The intensive outpatient therapy, Henry's kind of therapy, is a more directed program, which entails daily sessions of two to three hours for about 15 days. The first few days involve measuring the child's feeding skills, food acceptances, and food refusals. Treatment focuses on specific skills and behaviors to introduce eating based on the child's age, skills and level of food refusal‚ the child may be tube-fed only or might drink from a bottle, like Henry.

"Our goal is to reduce the refusal," Cooper-Brown says. "We don't expect that we're going to get them to eat everything throughout this program. It's a jump-start; our long-range goal is to get them off that tube or bottle and eating normally. In the past four years, 92 percent of our patients have had reduction in refusals and 83 percent have had reductions in tube feedings following our program."