1. Referral and management of children with feeding difficulties

2. Community Eating and Drinking clinic
Our Aim:
To support children from birth to 19 years with eating, drinking and swallowing difficulties and/or enteral feeding and their families. We provide assessment and intervention to enable children to eat, drink or have tastes as safely and efficiently as possible in order to maximise their participation in daily life. We also assess and monitor growth and provide support around nutrition and hydration for children requiring enteral feeding and work together as a team with families to wean children off tube feeding when appropriate.

4. Community Eating and Drinking clinic
Who are we?
Speech and Language Therapists = Sonja Jacobs and Jane Oswell
SLT co-workers = Rujina Begum and Nazma Begum
Dietitians = Karen Blake (Mon-Wed) and Kayee Chan (Thu-Fri)
Joint SLT and Dietetics clinics for children on enteral feeds
SLT only clinics for all other children with difficulties eating and drinking (children often seen in outpatients dietetics clinic at RLH)
DT only clinics for children on enteral feeds who either do not have any swallowing difficulties or are likely to have limited or no oral intake for foreseeable future

5. Community Eating and Drinking clinic
Our current caseload
Caseload size: 215 children and young people
30% under age of 2 years
40% between 2-5 years
30% over 5 years
Tube fed: 30% of caseload

7. Community Eating and Drinking clinic
Our Role:
Feeding assessment and intervention – babies, children and young people with neurodevelopmental difficulties, cerebral palsy, regressive conditions, laryngomalacia or TOF, CLP, Down syndrome, ex-prem babies, babies with VFP post cardiac surgery…
Tube weaning jointly with Dietitian
Implementing strategies to make feeding safer, easier and reducing respiratory infections and choking risk - Using different utensils, work with OT and PT to get optimal positioning for feeding, changing consistencies and texture to optimise safe feeding, pacing …
Feeding skills development
(Sensory and/or behavioural difficulties –children with ongoing or undiagnosed GOR, oesophageal motility issues, prolonged NG feeding or previous or ongoing force feeding)

8. Community Eating and Drinking clinic
A few daily challenges…

14. Anatomy
Neurology
Motor skills
Cardio-respiratory support
Gastro-intestinal
Appetite regulation
Sensory functioning
Cognitive & communication development
Growth
Cultural & Social functioning
“Feeding is clearly a multi-system skill. It requires anatomical integrity, neuromuscular control and co-ordination, sensory perception, adequate gastro-intestinal function, cardio-respiratory support, and integration from the autonomic nervous system. It is also heavily intertwined with behavioural responses.”
Wolf & Glass (1992) in Sullivan & Rosenbloom (1996)

15. Community Eating and Drinking clinic
Take home messages:
Enlarged tonsils and a persistent blocked nose are likely to impact on eating, drinking and swallowing
Regular vomiting during or after feeding can impact on a baby/child’s willingness to eating / drink, and can have impact into adult life
A healthy growth chart does not mean that the baby/child does not have a feeding difficulty

16. FEEDING/EATING AND DRINKING ASSESSMENT PAEDIATRIC DIETETIC SERVICE
Eating and Drinking Referral Pathway
Does your child:
Have repeated respiratory infections?
Cough/choke during meals?
Have difficulties initiating and maintaining sucking?
Have a constant open mouth posture?
Dribble or drool (more than expected for their age)?
Have nasal regurgitation of food/fluid?
Eyes water/tear during meals?
Does your child:
Frequently gag during/after meals?
Have food remaining in his /her mouth after meals?
Frequently refuse to eat or drink?
YES
GASTROENTEROLOGY (before considering SLT)
BEHAVIOUR SUPPORT
Under 5 – Educational Psychology
Over 5 - CAMHS NO
Does your child have a history of reflux/vomiting?
YES
Does your child still have episodes of reflux/vomiting?
YES NO
YES
Does your child have a history of throat infections/tonsillitis?
Does your child still have episodes of throat infections/tonsillitis?
YES
YES
FEEDING/EATING AND DRINKING ASSESSMENT
ENT
(before considering SLT)
Does your child have a history of poor weight gain/growth?
YES
YES
Is weight gain still a concern?
Is your child taking any supplements to support weight gain? NO
PAEDIATRIC DIETETIC SERVICE NO
Has your child seen a dietitian?

17. Contact details Sonja Jacobs
Lead Speech and Language Therapist for Complex Needs
First Floor, Hastings Ward
Mile End Hospital
Bancroft Road
London E1 4DG
Tel: