1 The Community-Based Feeding Team… Improving the lives of children and families

2 Comprehensive interdisciplinary evaluation of the feeding skills, including but not limited to oral motor development; nutritional status; growth and eating behaviors. Development of a family centered plan for community referrals and/or intervention The purpose of a community-based feeding team is to provide these needed services to infants and children and their families close to home:

3 Participating agencies may include: Children’s Therapy Centers Elks Therapist Hospital or Medical Clinic Infant-Toddler program Local Health Department Neurodevelopmental Center School-based Special Services WIC Program

4 Training and Formation of Feeding Teams in Washington State...

5 The first two community feeding teams were formed in a pilot training program sponsored by the Center on Human Development and Disability (CHDD) at the University of Washington and the Washington State Department of Health (WSDOH) in 1993.

6 Since 1993, 16 community- based teams have been brought together for training. Annual updates are provided for these teams by CHDD and WSDOH.

7 Feeding Teams in Washington State are located in the following counties: Benton-Franklin, Chelan-Douglas, Cowlitz, Grays Harbor, King,Kitsap, Pierce, Skagit, Snohomish, Spokane, Thurston, Whatcom, Yakima

8 Why… A feeding team? a little background…

9 Successful feeding goes hand in hand with developmental progress. Here are some aspects of that mutual relationship…

10 Feeding supports physical development and good health… Well nourished infants and children grow well Well nourished infants and children experience less illness

11 Feeding supports social development… It provides an important opportunity for babies and their parents or caregivers to bond to each other Meal time may be the only time of day when the family is together

12 Feeding supports speech development… Eating involves movement patterns similar to those used in speech Good feeding programs develop the muscles needed for speech acquisition

13 Successful feeding helps infants and children develop a sense of autonomy... Being able to feed or refuse food helps the child develop a sense of control over her environment

14 These developmental tasks require a large repertoire of feeding skills…

15 A newborn needs a strong reflexive suck to nurse successfully.

16 Later, the baby must suppress the sucking reflex in order to develop the ability to use the tongue to take food from a spoon and move it in the mouth… from side to side for chewing from front to back for safe swallowing

17 The baby must be able to sit in a stable fashion and open her mouth to signal readiness for a spoonful of food.

18 The baby must develop the ability to pick up food and put it in his mouth in order to self feed.

19 Later still, the infant will need to learn… to use a spoon, to hold and drink from a glass to chew textured foods

20 The infant and mother/caregiver must develop a mutually satisfying relationship that is contingent on the ability of both to give, read and interpret the others’ cues. The baby must be able to show hunger, satiety, pleasure and displeasure; The mother must be able to interpret the baby’s cues and act accordingly

21 Since the ability to feed her infant is often seen as an element of nurturing in a mother, disruption of this feeding relationship may affect both… a mother’s perception of her ability to parent; and her relationship with her baby.

22 Many children progress quite naturally and easily through the various stages of feeding development…

23 However… nearly 25% of all infants and children are affected by feeding disorders.

24 Among infants and children with developmental disabilities, as many as 80% may face feeding challenges. Here are some of those challenges…

25 Primitive reflexes (such as suck, gag or startle) fade in the typically developing infant but may remain in the child with neuromotor concerns and interfere with the ability to feed.

26 Oral defensiveness is often seen in an infant or child who has been on a respirator or has experienced tube feeding and may result in unwillingness to accept new foods or textures by mouth.

27 Neurological impairment may interfere with the ability to give clear hunger or satiety cues.

28 Poor coordination of oral structures may interfere with the ability to move food in the mouth, to chew or swallow in a safe and effective manner.

29 Delayed motor skills may interfere with efforts to self feed.

30 Children with feeding problems such as these are unlikely to “outgrow” their abnormal behavior patterns without intervention.

31 Watch for these common “red flags”… Stagnated growth Frequent bouts with pneumonia due to aspiration Feedings which exceed 45 minutes in duration

32 Which children are likely to be at risk for feeding challenges?

33 Infants or children who are not growing appropriately, or whose parents are concerned about the adequacy of their diet…

34 Infants and children with delayed feeding skills or abnormal oral motor patterns… inadequate use of utensils difficulty in chewing textured foods swallowing difficulties

35 Infants or children with feeding tubes… those transitioning from tube feeding to oral feeding those who will continue to need tube feeds in order to meet nutrient needs, but –would benefit from the social aspects of being able to consume some food orally –would experience oral feeding as an enhancement to speech therapy

36 Infants or children with problematic feeding behaviors, including… significant distractibility during mealtimes unclear hunger and appetite signals disruptive feeding behaviors such as throwing food, gorging or rumination

37 Medical diagnoses in which feeding difficulties are commonly seen include… Autism Cerebral palsy Cystic Fibrosis Failure to Thrive Gastro-esophageal reflux Genetic disorders Metabolic disorders Prematurity Short bowel syndrome

38 “Coming together is the beginning, Staying together is progress, Working together is success.” Henry Ford

39 An interdisciplinary feeding team works with the family to identify, prioritize and address feeding concerns.

40 The Multidisciplinary Feeding Team may include… Family Behavioral Psychologist Dental Hygienist Nurse Nutritionist Occupational Therapist Parent Advocate Physical Therapist Social Worker Speech Therapist

41 Family and Child School Health Department Behavioral Psych Birth to Three Hospital Therapist Physician Nutritionist The Family is at the center of the team.

42 How does the Feeding Team work?

43 Assessment The interdisciplinary team provides comprehensive assessment of oral-motor development, nutrition and eating behaviors through Direct or videotaped observation of feeding Individual assessments by team members

44 Planning, Referral and Follow-up The team works with the family to make a written plan for intervention The team communicates closely with community professionals already involved Appropriate referrals are made at the family’s request Periodic follow-up is provided to address changing needs

45 The Family Centered Approach is key to a successful feeding team… The team works with the family to prioritize goals for the child The team works together to make consistent recommendations The team helps consolidate appointments for the family Team evaluations and planning are sensitive to the cultural background of the family

46 Working together, the family and team produce positive outcomes… Nutritional status and overall health of the child are improved Parent-child interactions are strengthened Developmental progress is enhanced

47 Feeding Teams provide cost effective interventions

48 A recent study of community feeding teams in Washington State showed the following positive outcomes for Children with Special Health Care Needs and their families: Appropriate growth Improved dietary intake Decreased illness and hospitalization Improved feeding skills Improved health status

49 Medical cost savings for children studied ranged from $1700 (over a four month period) to $8100 (over one year)

50 Medicaid Third party insurance payments School district contracts Part-C funds-US Department of Education of Individuals with Disabilities Education Act (IDEA) Health department Maternal and Child Health Programs CSHCN Diagnostic and Treatment Funds Local community grants Depending on the location, reimbursement for feeding team services may be provided by…

51 Credits/References 1.Dietetics in Developmental and Psychiatric Disorders Practice Group, The American Dietetic Association; Survey of the University Affiliated Program Feeding Evaluation Teams. The American Dietetic Association, Chicago, IL, Goodwin, Annie. Personal Communication, Benton-Franklin Pediatric Feeding Team, Benton-Franklin Health Department. Kennewick, WA, Office of Children with Special Health Care Needs, Division of Community and Family Health, Washington State Department of Health: Cost Considerations: The benefits of Nutrition Services for a Case Series of CSHCN in Washington State. Washington Department of Health, Olympia, WA, Pipes, P and Lucas B. Guidelines for the Development and Training of Community-Based Feeding Teams in Washington State, Office of Children with Special Health Care Needs, Division of Family and Community Health, Washington Department of Health, Olympia, WA Position of the American Dietetic Association; Nutrition services for Children with Special Health Needs. J Am Diet Assoc. 95: , 1995.

52 August 1, 2001 Community and Family Health