Nutrition/Feeding Clinic at Easterseals DuPage & Fox Valley –The Comprehensive Approach

By – Cindy Baranoski, MS, RDN, LDN and Laura Van Zandt OTR/L

-Updated February 2023-

In January 2019, a groundbreaking article was published in the Journal of Pediatric Gastroenterology and Nutrition describing children challenged with feeding problems and their care. Pediatric Feeding Disorders (PFD) are defined as “impaired oral intake that is not age-appropriate, and is associated with medical, nutrition, feeding skill, and/or psycho-social dysfunction.”

It emphasizes the importance of early identification and interdisciplinary evaluations and interventions for children. Interdisciplinary evaluations and treatment have been the foundation of Easterseals DuPage & Fox Valley’s Feeding Clinic since 2000.

What Brings You Here

From the moment we are born, feeding and eating is something that is supposed to come naturally to everyone. When a baby is born, we feel an overwhelming sense of love and a strong desire to watch over, protect, and nourish to grow. When it’s time for feeding, our bodies are already preparing the necessary tools to breakdown and process what is provided. Feeding involves more than just our mouths. Eating involves sensory experiences like sight, texture, smell, sound, and how the body functions during mealtimes. Foundational skills like posture, reaching, and coordinating suck, swallow, and breathing support positive mealtime experiences. Our past and current experiences all shape our belief around feeding and nutrition. Your body must work all together to receive and process nourishment.

For some children, however, this process isn’t easy and doesn’t always come naturally. Difficulties with eating, drinking, food processing, or breathing coordination can impact growth, health, and positive mealtime experiences. Yet, they still need what other children need – nourishment, socialization, variety, scheduled mealtimes, and interaction with foods. For children who are tube fed, these experiences still support development, health, and growth.

Watching your child grow and thrive is important, and seeing them struggle can be incredibly difficult for families. When a child does not eat, parents feel blame and guilt. We ask ourselves why? Did I do this? What could I have done differently? We try a host of different strategies. We Google and seek advice from family, friends, and medical providers. We fall back to what we know, which may or may not work.

Who We Are

Our Feeding Clinic team is passionate about supporting children with feeding, mealtimes, health, tolerance, and growth. Our team assesses the many different reasons why a child might be struggling. We look beyond behavior to understand its root cause and what your child may be communicating. Eating is so much more than bringing food to the mouth, chewing, and swallowing.

Our Clinic consists of a registered dietitian nutritionist, speech and language pathologist, occupational therapist, and a social worker. Our team brings more than 230 years of combined expertise and advanced training in a variety of therapeutic approaches.

As a team, we review your child’s birth and developmental history before the appointment, with a thorough analysis of the diet record you submit. We ask you to let us know your evaluation expectations when filling out the paperwork, both online and written forms. Our goal is to meet these expectations. During the actual meeting we are looking and listening for red flags that clue us into issues driving the challenges your child is having. A list of possible reasons why your child might be seen by our feeding clinic is found in Table 1.

Table 1

What Happens, What We Do, and What’s Next

At Easterseals DuPage & Fox Valley, we are able to evaluate a child at our Villa Park center or through tele-therapy. Keeping our clients, families, and staff safe remains a top priority as we continue providing impactful Feeding Clinic services. Our clinic has provided virtual evaluations since 2020 using the HIPAA-compliant Microsoft Teams platform to support full participation. When your child is referred for an evaluation, our Clinical Admissions Coordinator will guide you through the secure intake process. We have revamped the process to make it easier for you and provide written suggestions to help you prepare for the evaluation day. For virtual consultations, we provide tips to help create a comfortable and successful evaluation experience for your child and family.

During the interdisciplinary evaluation, the full team meets with your family. The speech-language pathologist and occupational therapist help your child feel comfortable while providing guidance and completing assessments. We have created a safe and streamlined process to continue providing high-demand Feeding Clinic evaluations and support. Parent’s positive comments and impactful outcomes of our evaluations speak for themselves.

Medical & Nutrition

First the team reviews and establishes your child’s medical health and overall nutrition status. Many medical complications from birth can impact a child. Undiagnosed medical and gastrointestinal (GI) problems often come to light in the clinic.

Think of your child’s health as the foundation of your house. If your foundation is weak, then the floors above it will compensate for weakness. Children experiencing constipation, reflux, gagging, or other GI challenges may begin associating food and drink with discomfort. Understanding your child’s nutrition helps the team identify contributing factors and make recommendations to support healthy growth and development. Nutritional analysis includes meal balance, timing, hydration, growth, and your child’s overall nutritional needs. Understanding both medical health and nutrition status allows for changes from the foundation first and foremost.

Speech and Language Pathology & Occupational Therapy

Observing your child’s engagement during evaluation helps therapists assess the physical aspects of eating and drinking. No matter where your child is in their journey with food and feeding, our goal is to have a positive relationship during the process. While observing your child, therapists evaluate motor skills and determine whether postural supports may be helpful. Mary Massery, a well-known physical therapist, has said “breathing always wins”, and she is not wrong. Breathing dominates. Where your body is in space and stability is its second priority. Swallowing and feeding behavior must continually adapt to changing respiratory and postural systems.

The speech-language pathologist evaluates oral motor skills while the occupational therapist assesses sensory processing and a child’s relationship with food. Anxiety around meals and feeding can increase adrenaline which suppresses our desire to eat. Assisting with overall regulation is essential for comfort at mealtimes.

Family Support

The emotion with feeding and nutrition difficulties can be overwhelming for both the parents and child. Often, a child’s survival from birth and medical health is the primary focus, as it should be. As a child becomes more stable, families can begin focusing more on positive feeding experiences beyond medical concerns. With this new focus, the emotions, fear, concerns, and hope are still there. Whether your child is struggling to be an oral eater or being fed by tube, the emotions can be immobilizing. Our social worker is a vital team member in our clinic, helping every parent know they are not alone. She provides support, empathy, and connections to any number of resources.

Wrapping Up

By the end of the evaluation, the team confers together, with immediate and long-term recommendations being made. Recommendations often focus first on gut health, breathing, positioning, and nutrition before addressing oral motor or sensory processing needs. Recommendations may address several areas at once or focus on one key concern affecting your child’s overall stability. Returning to our 90-minute clinic for a follow-up visit may be one of the recommendations made.

Final Thoughts

Wherever you are at in your child’s journey, there are many aspects to feeding disorders in the pediatric population. Therefore, identifying and addressing all of them is a priority that should not be overlooked. Easterseals DuPage & Fox Valley’s Feeding Clinic uses an interdisciplinary Pediatric Feeding Disorders approach led by a skilled team of professionals. Nutrition issues is an area that brings an enormous amount of stress and anxiety to a child and his caregivers. Our team is uniquely qualified and experienced to assist children at all levels of feeding, instilling hope and helping them be their very best.

Every child is unique, and each intervention is tailored to fit your child and family. While you research options you have, consider the following –

• Aim to help your child feel their best. They need to feel well – this is key for success in any area.
• Assess their positioning with mealtimes and feeding to be sure they are fully supported. Positioning is key. Optimal positioning includes sitting on a firm surface with feet supported and the head, shoulders, and hips aligned. Allow her arms to rest on her tray or table with shoulders down.
• Ensure a regular schedule. A mealtime plan supports hunger and fullness cues, nutrition, tolerance, and positive mealtime experiences for orally or tube-fed children.
• Patience – feeding therapy is a journey with bumps and curves along the road. Share your compassion and empathy. Learning to eat and mealtimes, after a rough beginning, might involve reshaping many memories. You might have to start over to build trust. Remember even the tortoise finished the race with the hare.
• Expose, expose, expose and don’t limit opportunities for exposure. Have fun and play with food. Model appropriate food reactions – don’t “yuck someone else’s yum.” Continue to find ways to present food to your child even if he is not ready to taste them. You can support food exploration by reading books, visiting markets, taking cooking classes, and involving your child in mealtime preparation. And we encourage this, if a child is tube fed too.

To learn more on our Feeding Clinic and Nutrition Department at Easterseals DuPage & Fox Valley:

Contact Clinical Admissions at 630.261.6287 for questions or to schedule an appointment.