Multi-Disciplinary Providers Come Together to Combat Mealtime Miseries
August 13, 2018
August 13, 2018
We are lucky to live in an era with so many advancements in diagnostics and medicine. Premature infants are living longer. Diagnostic practices are progressing to better identify autism spectrum disorder (ASD) and neurodevelopmental concerns are more commonly addressed in pediatric patients. But with each of these gains, new challenges are discovered. These same micro-preemies are often discharged with problems eating, and many of the children on the spectrum also become classic feeding disorder patients.
Data shows up to 80 percent of individuals with a developmental disability also have some type of feeding disorder. While the level in which it impacts their lives varies, the numbers are still quite staggering in the world of developmental pediatrics.
To add to the issue, the topic of feeding is unfortunately easily overlooked in education programs. Professionals may not necessarily receive quality training on the subject in graduate school, then end up struggling in the feeding area when they receive a difficult case on the job.
In an effort to overcome these challenges, Elizabeth Clawson, MS, Ph.D., LCP, HSPP and Carol Elliott, BS, OTR/L of the Pediatric Feeding Institute joined forces to create the Mealtime Miseries course. Together, they share their knowledge and teach their innovative techniques to occupational therapists, speech therapists, registered nurses, psychologists and others in the industry – and we were lucky enough to host them at the Hopebridge corporate offices this month!
The focus of the two-day course was on Transdisciplinary Effective Assessment and Treatment (TR-eat) model, which integrates oral motor and sensory therapy techniques with behavioral and medical management for complex feeding problems. It covered strategies and case examples to address oral aversion, food refusal, poor transition onto solid foods, texture grading, learning to chew, self-feeding and feeding difficulties related to autism and picky eaters.
When Elizabeth and Carol first started working together, there were few resources for help with feeding.
“I’ve worked in a number of locations where different therapists will own the issue of a child’s feeding disorder. The problem is, without a consistent approach, they are often treating it in silos and overlooking important pieces,” said Elizabeth.
For example, if only coming at it from the behavioral perspective, some of the skill-building components needed for success may be missing. If only approaching it from a sensory angle, some of the underlying ideology for food avoidance or escape avoidance isn’t being addressed because it’s often so child-led.
“Trying to find that balance between a child-centered approach versus a therapist-centered approach, and then combining them into a child-guidance approach takes everyone coming onto the same page,” said Elizabeth. “Each discipline may have a different take on where they fall into the continuum, so they need to work together.”
Much like Hopebridge360, the TR-eat model not only encourages providers across different fields to collaborate – it’s dependent upon it. Practices from occupational therapy, speech therapy and Applied Behavior Analysis (ABA therapy) are married together so children learn quicker.
“The purpose of this course is not to provide a one-size-fits-all, step-by-step guide. No one way fits every patient,” said Carol. “Instead, we hope to inspire other therapists’ reasoning and thinking by providing information on how these trends work together. Our goal is to arm them with another methodology so they have enough variety in their background to choose the best match for each learner.”
Above all, Elizabeth and Carol hope course participants walk away with:
The ability to look at feeding as a melded model.
Combining medical nutrition, oral motor, behavioral and sensory knowledge and practices is first and foremost. Many people see them as distinctly different and separate, but they often go hand-in-hand when it comes to intervention for kids with feeding disorders. Therapists should be able to utilize the tips and package them together to build an effective treatment plan for their learners.
Don’t skip the medical component
Many times, some of the true underlying ideology has never been asked or fully assessed, simply because no one has ever seen inside the kid’s mouth. For example, a child may have a tongue-tie or enlarged tonsils, but since the child is so orally averse, no one could look in there. Medical conditions need to be properly assessed and treated in order for the child to fully benefit from therapy. The longer the child goes with dysfunctional eating patterns, the more heightened sensory and oral motor pieces can be layered into the problem.
Approach feeding as a process.
When we teach our children how to ride a bike, we first talk with them about it. Next, we put them on it with training wheels and go along with them for the ride. Later, we take off the training wheels, hold the seat and help them along before they can do it on their own. But with eating, children who are struggling are often left to figure it out. We must remember to support these kiddos through the process together as we do with many other new skills they are learning.
Challenging the child is encouraged, but you have to find the right balance.
For some reason, many people are hesitant to ‘push’ kids when it comes to eating and instead put them completely in control. This is not often realistic because as humans, we don’t always push ourselves that’s why we pay for life coaches and trainers at the gym! We need someone to tell us to do it again and remind us that we can do it. By using your analysis to match your kids with the right challenge, you can edge them along appropriately, which leads to a higher success rate in learning and developing the skill. There’s also a difference between finding that balance and pushing them into something that is too hard, in which they might feel threatened by the failure.
“As we do this, I want to reach kids I would never have otherwise been able to help,” said Carol. “By sharing information and providing therapists with more tools to house in their toolbox, I know I’ll have an effect on more children without ever even meeting them.”
We are grateful to Elizabeth and Carol for sharing their experience and knowledge at Hopebridge. By training other professionals on their findings and encouraging them to collaborate, they hope they can make a greater impact across the communities that need them.
In hearing from therapists who took the course, it sounds like they are doing just that, no matter where they are in their journey.
“I took the course to learn new strategies to overcome the aversions outside of the mouth in order to get the food inside. These kiddos come to us with a lot of behaviors, and it can be difficult to cross barriers and gain their trust enough to present them with new foods in order to make the therapy successful. I also want to make feeding fun! Rather than forcing them to eat, I’d rather make the environment fun and less stressful so they’re apt to try new things,” said Becca Montgomery, an SLP out of the Hopebridge Jeffersonville center.
“Where have you been in my life? After 2 days of this course, I feel significantly more confident and excited vs anxious to treat all my ‘feeding kiddos.’ I will implement what I’ve learned immediately upon returning to work,” said Kaitlin Nishida, an occupational therapist from St. Louis, MO, who has three years of experience.
“I have been involved with feeding programs since the 1970s. There have been changes in the approaches and it is important to keep updated. Very well organized and informative,” said OT Toby Black of Bowling Green, KY, with more than 40 years of experience.
The Mealtime Miseries course provides American Speech-Language-Hearing Association (ASHA) CEUs and contact hours for occupational therapists. If you’re interested in learning more and attending an upcoming event, visit the Pediatric Feeding Institute website.
*Informed consent was obtained from the participants in this article. This information should not be captured and reused without express permission from Hopebridge, LLC.