741 - Inpatient Feeding Program for a Vulnerable, Underserved, Pediatric Population: A Pilot Study

Publication Number: 741.5435

Shahzaib M. Khan, State University of New York Downstate Medical Center College of Medicine, newyork, NY, United States; David Inzerillo, SUNY Downstate Medical Center, BROOKLYN, NY, United States; Maria Farag, State University of New York Downstate Medical Center College of Medicine, Staten Island, NY, United States; Anne E. Levine, State University of New York Downstate Medical Center College of Medicine, Brooklyn, NY, United States; Simon s. Rabinowitz, State University of New York Downstate Medical Center College of Medicine, brooklyn, NY, United States; Thomas Wallach, SUNY Downstate Health Sciences University, Brooklyn, NY, United States

Background: There is a wide spectrum of pediatric feeding disorders that can interfere with a child’s ability to take an appropriate diet to yield adequate growth. These disorders are often clustered in complex care patients many of whom also have psychosocial challenges. Unfortunately, effective feeding programs have traditionally been limited for underserved populations.

Objective: Our study describes a multidisciplinary pilot program highlighted by a one week comprehensive inpatient stay in an inner-city medical center.

Design/Methods: Eleven children (8 months to 9 years) with failure to thrive or avoidant restrictive food intake disorder received 1-week of intensive in-patient feeding therapy. Each was screened by a pediatric gastroenterologist and had baseline laboratories as part of their initial intake. Feeding therapy sessions were conducted twice a day with a trained pediatric speech language pathologist who assessed barriers to oral feeding. Individualized sensory and behavioral techniques were employed such as desensitization, texture fading, portion fading, demand fading, allowing choices and providing preferred foods. Outcomes included: increased acceptance to a variety of foods, increased intake during mealtimes, and caregiver carry-over of feeding strategies. Changes in weight, caloric intake and subjective reporting by caregiver of improved oral intake were also recorded. Behavioral and development was formally assessed to identify needs and optimize follow up services. A questionnaire was created for parent/provider feedback and a summation meeting of the team discussed the hospitalization and future management.

Results: Of the eleven patients, five patients demonstrated weight gain during the admission; one patient had a documented weight loss. Ten out of eleven patients had acceptance to an increased variety of foods and successful carry-over of feeding strategies to caregiver. Within our cohort, a total of at least 56 new foods were successfully introduced and tolerated. Eight patients were accepted into an out-patient feeding therapy program. A total of four patients were referred for new services secondary to newly identified neurology and behavioral and developmental deficits.

Conclusion(s): A comprehensive, one-week in-patient feeding program coordinated by a multidisciplinary team shows promise to immediately improve feeding behaviors and to provide a basis for long term successful outcomes in vulnerable, underserved children with feeding disorders.

Figure 1
feeding therapy final - Copy.pdfWorkflow for 1-week pediatric in-patient feeding therapy program