Creating a structured mealtime routine is important to the progress of each child’s treatment in the CHOC Feeding Program. Because of this, a strict weekly and daily schedule is implemented upon admission to the hospital. School schedules, naptimes and the like are all taken into consideration when the schedule is made so that the child’s day resembles what it will be like once back home.
The feeding team uses both behavioral and sensory feeding strategies while working with children in the program. Each child’s therapy is based upon his or her specific needs and each child’s goals vary depending upon his or her individual feeding problems and conditions. Although each child is different, the following timeline serves as a guide to the child progresses through therapy during their inpatient stay:
Week 1: Improve the Child’s Feeding Experience
Goal: Increase child’s ability and willingness to eat foods by mouth
- Child is fed by feeding therapist during therapy sessions while parent watches from behind a one-way mirror and learns from team members about the strategies being used.
- Parent practices strategies in non-therapy mealtimes.
- Parent and child start to feel more positive about mealtimes and feel more successful.
Week 2: Maximizing The Child’s Potential
Goal: Increase the types and amounts of foods the child eats in a positive environment.
- Parent and therapist co-lead feeding sessions
- Parents receive consultation and direct feedback
- Child learns to increase oral intake, range of foods, and independent feeding skills
- Parents learn techniques to work through child’s negative behaviors or refusals
Week 3: Preparing for Transition Home
Goal: Teach the child and parent ways to continue improving and having positive meal times at home.
- Parent leads feeding sessions with therapist observing and offering feedback/consultation
- Generalize mealtime behaviors and expectations to other settings and incorporate family style meals
- Provide guidance and consultation with the transition back home, including orientation of a secondary feeder
Week 4: Home Implementation after discharge
Goal: Families and the patient put into action at home everything they learned while at CHOC.
This is a very important part of the program and requires patience, more hard work to ensure a smooth transition of skills learned in the hospital to the home setting.
Feeding therapy takes place three times each day, Monday through Friday.
- Breakfast: 8 a.m.
- Lunch: 12 p.m.
- Afternoon Snack: 3:15 p.m.
Breakfasts and lunches are delivered on disposable trays 15 minutes prior to the child’s mealtime (therapy session). The child and his or her caregiver must bring the tray to the appointment.
Independent mealtimes are those in which the child eats with the caregiver to work on the strategies learned during therapy sessions. These take place at a morning snack at 10 am and dinner around 5:30pm. The team may also schedule a bedtime snack if an additional meal opportunity is needed to increase calories or practice skills.
Weekends are an opportunity for the child and his or her caregiver to try out what the child has learned in various settings within the hospital grounds and to integrate others who are involved in feedings at home (i.e. other family members, babysitter etc.). Typically, the child may have one therapy session on the first Saturday to assist the child as he or she tries out his or her eating skills in new settings. In addition, a weekend pass is often granted during the second weekend so the child can practice his or her new eating skills in the community.
The child’s caregiver is responsible for ordering the child’s foods for snacks and meals each day. Learn more about role and responsibilities of the child’s caregiver while undergoing inpatient-feeding treatment.
Each child’s weight is closely monitored by medical staff on a daily basis. The child’s weight is typically taken early in the day. It is common for a child’s weight to vary day to day and typically drops while in the program. This weight loss is not a concern unless it dips below a weight that is considered unsafe by the child’s medical team.
Friday Team Conference
A team conference is held every Friday afternoons to review the child’s progress and set goals for the upcoming week. The child’s caregivers (parents) are a very important part of this meeting. The caregiver staying with the child must attend this meeting and any other caregivers or family members who cannot participate in person are welcome to join in via conference call.
Daily Team Member Support and Supervision
In addition to daily work with the child’s feeding therapist, the child will also work with a child life specialist, psychologist, dietitian, social worker and the bedside nursing staff throughout their stay.
- The dietitians will visit often to make sure the child’s food preferences are being offered, to check on the amount of food (calories) the child is taking in, monitor the child’s weight and hydration and make the child is tolerating the feeding changes.
- The psychologist and/or social worker visits patients in the feeding program each day to talk about the child’s progress, concerns, challenges, and strategies to reach the child’s feeding goals. They may also be present during a few feeding sessions to help with strategies. The psychologist or social worker helps with any struggles the parent or child may experience with one another or individually with the therapy or tasks they are asked to accomplish. They also work with the parents to help them feel empowered and strong while working with the child.
- The child life room is available three times each day from 10a.m. until noon, 2 p.m. until 4p.m. and 6 p.m. until 8 p.m. for the child to have directed play time that supports his or her feeding goals with a child life specialist or specially trained volunteer. Time in the playroom may be a good time for the caregiver to run errands or visit with his or her spouse or other family members away from the child.