The pain and discomfort of Gastroesophageal Reflux Disease (GERD) often leads to feeding issues in infants and children. Poor weight gain may be an early sign of feeding difficulty. There may be resistance to drinking from a bottle with fussing and arching or a delay in learning new feeding skills such as eating from a spoon. A child may experience sensory issues causing problems with taste, temperature, variety or texture of foods. Fortunately, reflux responds readily to treatment and most of these feeding challenges are temporary and go away over time as the reflux improves.
A few infants and children with GERD continue to have feeding challenges despite treatment. The digestive discomfort may be combined with sensory and oral motor issues such as difficulty swallowing (dysphagia), a strong gag reflex, a weak gag reflex, aspiration (food and liquid going into the lungs) and problems associated with high or low muscle tone in the face and mouth. Food allergies, constipation, delayed gastric emptying and developmental delay may add to the challenges. Over time, painful reflux may have a negative effect on how a child approaches mealtime. Additionally, eating that used to be painful may linger in the form of picky eating or a great deal of distrust about new foods.
I wish there was a “one size fits all” treatment for reflux but the reality is every infant and child needs a treatment plan to address their individual needs. While most infants and children with GERD will respond to the typical treatments: diet, positioning and medication, a few children will need the special assistance provided by a feeding therapist or feeding team. A feeding clinic or program can provide the additional support and assistance to help an infant or child learn new feeding skills and overcome sensory and behavioral challenges that may have developed from reflux and other causes.
A feeding therapist may be a pediatric speech language pathologist or an occupational therapist with special training in feeding. Feeding therapy may take place in an office or clinic setting where the feeding therapist works with the child and then trains the family to carry out feeding activities at home. A feeding therapist may be in private practice in an office or work at a hospital. It may be possible to receive feeding therapy from an Early Intervention/Child Find Program offered by the local public school special education department.
A feeding clinic is often in a hospital or outpatient clinic affiliated with a hospital. A feeding team may consist of a pediatric gastroenterologist, a speech language pathologist, an occupational therapist, behavioral psychologist and a dietician. The team works with the child and the family to evaluate and manage infants and children with significant feeding challenges.
An inpatient feeding program may be considered when a child had a significant feeding problem and requires medical supervision. The child has several feeding sessions a day and stays at the hospital for a few days or even a few weeks. Parents are trained to carry out the program at home and come back to the feeding program for follow up outpatient sessions.
The pediatrician and the pediatric gastroenterologist will work with you to develop a plan for overcoming feeding challenges. If a feeding clinic is recommended, parents can consult the Guide to Feeding Clinics to find out the options in their area. Feeding clinics and feeding therapists have different philosophies and training. You may have to do a bit of research to locate a good match for your child’s needs. Keep in mind that feeding therapy is quite costly and it is generally covered by medical insurance. You will need to work with the doctor and the insurance company to find a program covered by your plan. In addition, it may be necessary to get special authorization from the insurance company to attend a feeding clinic.
The link to The Reflux Mom’s Guide to Feeding Clinics: http://refluxmom.com/?p=128
Published On: July 18, 2009