Thursday, September 24, 2026
5:15 pm – 6:15 pm
Committee Meetings
6:30 pm
Social
Friday, September 25, 2026
8:00 am – 9:00 am
S1 - Keynote Presentation - SPOON’s International Programs to Support Pediatric Feeding and Nutrition
Douglas Taren, PhD
Miselle Rudzinski, MA, CCC-SLP
SPOON is an international non-profit organization (NGO) that works to ensure children with disabilities and children without family care are reached by systems that prioritize, include and meet their nutrition and feeding needs. SPOON provides training and mentoring to service providers to deliver disability-inclusive nutrition and feeding care; utilizes the Count Me In app to assist providers with assessing and monitoring children’s nutrition, feeding, and disability status; and uses its expertise to advocate for national and international policies, services and investments to meet the nutrition and feeding needs of all children. SPOON has worked in 22 countries, provided training to 7,000 people, and has reached 140,000 children since its inception in 2007.
An example of SPOON partnership with academics, local service provider and the national governments is its work in Zambia. SPOON partnered with Access to Health Zambia and the University of Colorado to understand the risk of malnutrition among children with disabilities and children without family care in Zambia. Using SPOON’s Count Me In app 400 children at 22 residential care facilities and nearly 500 children with disabilities at 3 health centers and 10 community-based rehabilitation clinics were assessed for their nutritional status and how feeding was provided. 63% of the children with disabilities were underweight, and nearly all (98%) were at risk of feeding difficulties. Results were published and results were disseminated at a national conference. This work has led to increasing the focus of infant and young feeding guidelines to include children with disabilities.
At the end of this presentation, participants will be able to:
- Describe the need to include children with disabilities into national surveys and programs to meet the WHO Sustainability Goal to end hunger and all forms of malnutrition for all children by 2030.
- Identify and explain SPOON’s approach to providing technical assistance to service providers and governments on how to improve the feeding practices and nutritional status of children with disabilities living in low and-middle income countries.
- Identify and defend the justification for explicitly including children with disabilities in national and international infant and young children feeding guidelines.
Level of Learning: Intermediate
S2 - Supporting Infant Microbiomes and Feeding Behaviors From the Start: A Multidisciplinary Collaborative Effort to Improve Breastfeeding Rates and Reduce Associated Racial Disparities in Rural North Carolina
Kristen Cole, MSN, PNP-PC
Kerra Jackson, PAThough North Carolina performs well compared to the National Average of breastfeeding initiation rates (81.6% to 84.1% respectively), it has significant room for growth when it comes to the largest disparity between racial/ethnic groups compared to the National Average (36.9% to 16.7%) (North Carolina Breastfeeding Report 2023). In an effort to both address falling overall breastfeeding rates at a hospital in Guilford County, NC and its accompanying known racial/ethnic disparity, a group of multidisciplinary breastfeeding advocates (a pediatrician, pediatric nurse practitioner and physician assistant specializing in Newborn Medicine; a certified nurse midwife/IBCLC from the largest obstetrics group delivering at our hospital; and a Family Practice Physician/Breastfeeding and Lactation Medicine Physician from our Family Medicine Practice) created a group called “BOOB” or “Building Opportunities for Optimizing Breastfeeding”. This group is gathering data and hospital wide support to raise awareness for heightened attention and action to the indisputable benefits of breastfeeding in our infants and mothers. This presentation will highlight breastfeeding data specific to our hospital and county compared to the National Average and our quality improvement project’s goals and outcomes. We will also present historical context for breastfeeding racial/ethnic disparities and review important medical benefits to breastfeeding and barriers associated with its general under utilization in the United States. Finally, we will outline how critical breastmilk exposure is in early infancy in providing the most optimal foundation for the human microbiome and how this impact on the gastrointestinal tract has potential to positively impact pediatric feeding disorders.
At the end of this presentation, participants will be able to:
- Describe the historical barriers of breastfeeding in groups of racial/ethnic disparity.
- Describe three health benefits of using breastmilk for earliest infant feeding that provide life long benefits to both infants and mothers.
- Describe the importance of early education on the short and long-term benefits of human milk to parents of neonates, infants and children with pediatric feeding disorders.
Level of Learning: Intermediate
S3 - Interdisciplinary Collaboration in Inpatient Feeding Consultations for Pediatric Feeding Disorders: Structure, Strategies and Case Examples
Emily Jellinek-Russo, PhD
Robert Dempster, PhD
Shelley Coleman Casto, MS, OTR/L, BCP, FAOTA, CPST
Paige Martin, MA, CCC-SLP
Jody Wall, MS, MPAS, PA-CThe most researched treatment models for pediatric feeding disorders include outpatient and intensive outpatient/day treatment. However, feeding related challenges also contribute to inpatient admissions related to acute medical concerns such as admissions for viral illness, food refusal, weight loss, constipation, dehydration, nutritional deficiency (Tsang et al., 2020). This results in the need for collaborative care cross feeding specialists and the admitting medical team to determine the best course of action. Best practices for the treatment of pediatric feeding disorders include interprofessional team collaboration between psychologists, dietitians, social workers, feeding therapists, medical providers (AOTA, 2025; Goday et al., 2019). However, little is known about effective consultation and collaboration practices within the acute inpatient care context for feeding. This presentation will highlight interdisciplinary efforts at providing feeding treatment in a large midwestern inpatient hospital by a medical provider, speech language pathologist, occupational therapist, and psychologists. Providers will describe the different disciplines involved in feeding treatment in this setting compared to how these roles operate on an outpatient basis. Our team will describe the most common consultations, strategies for how these are treated, and ways to identify which challenges may be amenable to intervention while admitted. Opportunities for enhancing communication amongst consulting services and inpatient teams will be highlighted across disciplines. Finally, a variety of cases will be presented to illustrate this model, including success and challenges, outcomes, and follow up post admission.
At the end of this presentation, participants will be able to:
- Identify the roles and contributions of interdisciplinary team members such as psychologists, dietitians, feeding therapists, and medical providers—in the context of inpatient feeding consultation for pediatric feeding disorders.
- Describe the structure and components of an inpatient feeding consultation model implemented within an academic medical center
- Analyze case examples to understand the challenges, successes, and best practices in interprofessional collaboration for treating pediatric feeding disorders in acute care settings.
Level of Learning: Intermediate
S4 - Finding the Balance: Empowering Families Without Sacrificing Safety in Treatment of PFD
Mollie Studley, MS, RD, CSP, LDN
Carolyn Lubenow, MA, CCC-SLP, CLC
Kathleen Carr, DNP, MBA, APRN, CPNP-PC, FNP-CTreating pediatric feeding disorders can be both rewarding and challenging. Balancing the desires of the families while maintaining safety in the treatment of pediatric feeding disorders presents a unique clinical challenge. Shared decision-making fosters collaboration, empowers caregivers, and aligns treatment with family values, which is essential for long-term adherence and psychosocial well-being. However, pediatric feeding interventions often involve complex medical, behavioral, and nutritional considerations where safety cannot be compromised. Clinicians must navigate situations where parental preferences may conflict with evidence-based practices or pose risks to the child’s health.
A Case Study presentation will include a gastroenterology Nurse Practitioner, Registered Dietitian, and Speech-Language Pathologist specializing in feeding. Speakers will define shared decision-making and discuss the limits, when a child’s safety becomes at risk. Case studies will be presented to showcase different scenarios where patient safety and parent goals were not aligned, and how the team moved forward with treatment while maintaining a working relationship with the family. By integrating family-centered care with rigorous safety protocols, clinicians can optimize both relational and clinical outcomes in pediatric feeding disorder management.At the end of this presentation, participants will be able to:
- Define shared decision making
- Describe the limits of shared decision making when patient safety is impacted
- Define the role of interdisciplinary care in management of PFD.
Level of Learning: Intermediate
S5 - Premies Eat: An Innovative Program for Early Recognition and Intervention of Pediatric Feeding Disorders in Premature Infants in Southeastern North Carolina
Kristen Cole, MSN, PNP-PC
Brenda Melvin, FNPEach year, approximately 15 million infants are born prematurely worldwide with more than 400,000 of these births occurring in the United States (Osborn, 2022; Ermarth, 2022). We know that about 42% of premature infants experience pediatric feeding disorders following hospital discharge and that failure to achieve full oral feeding is often a primary factor delaying discharge of these infants from the neonatal intensive care unit (NICU) (Viswanathan & Jadcherla, 2019). Achieving full oral autonomy as quickly as possible has many health benefits, including promoting oral motor development, improving cognition and neurodevelopment, and decreasing parental stress (Lainwala et al., 2020; Lagetta et al., 2021). Medical professionals continue to wrestle with decisions regarding the safest way to discharge premature infants who are barely meeting oral feeding goals, especially when close follow-up is often unavailable (Ermarth et all, 2019). This can lead to the placement of many gastrostomy tubes that ultimately are used for only a very short time and carry with them many potential complications (Hatch, et al., 2018). In an effort to better support this vulnerable and growing population, we launched Premies Eat in January 2024—a program that provides both inpatient feeding consultations in our Level III NICU and outpatient follow-up within one week of hospital discharge. Two nurse practitioners with expertise in neonatal feeding lead this multidisciplinary initiative, providing educational opportunities for stakeholders such as speech and language therapists, registered dietitians, lactation consultants, neonatologists, neonatal nurse practitioners, nursing administrators, and care coordinators. This presentation will outline the program’s development and collaborative framework with case studies to highlight successes along with barriers encountered and proposed strategies for future improvement and research.
At the end of this presentation, participants will be able to:
- Describe the complexity of pediatric feeding disorders in the neonatal population.
- Describe three health benefits of earlier discharge from the NICU in premature infants who are otherwise medically stable
- Describe the importance of using specialized growth charts, monitoring weight/length trends and placing realistic expectations for growth on premature infants
Level of Learning: Intermediate
S6 - Best of Both Worlds: A Novel Co-treatment Approach to Outpatient Treatment of Avoidant-Restrictive Food Intake Disorder (ARFID)
Sean Tams, PhD
Seth Huffman, RD
Michelle Byrum, APNDespite evidence to support multidisciplinary treatment of avoidant-restrictive food intake disorder (ARFID), patients often receive treatment (e.g., cognitive behavioral therapy [CBT] for ARFID [CBT-AR] or nutrition intervention alone) from one discipline (i.e., mental health or nutrition) without integrative services to address both the nutritional and psychosocial impairment. Additionally, medical comorbidities are not addressed in this model of care. Patients would benefit from more integrative services to achieve optimal clinical outcomes and, in combining multiple disciplines into the same treatment visit, may experience more durable symptom remission with a smaller dose of treatment relative to a unidisciplinary approach. Hence, we present a novel application of CBT-AR delivered in a co-treatment modality by a pediatric psychologist and registered dietitian, supported by a nurse practitioner providing consultative services to address comorbid medical conditions. We discuss the components of our clinic protocol, which includes six to eight sessions of nutrition education, CBT psychoeducation, and exposure therapy adapted from CBT-AR and delivered in an outpatient, multidisciplinary feeding disorder clinic. Complementary referrals to initiate psychiatric medication for anxiety management and referrals to Gastroenterology for medical testing (e.g., esophagogastroduodenoscopy) are provided when pertinent based on clinical history. We present case examples and clinical outcomes from our first two years of operating the clinic and discuss strengths and limitations of a transdisciplinary approach. Implications for other outpatient treatment programs who serve patients diagnosed with ARFID and future directions for multidisciplinary, integrative approaches to treating ARFID are discussed.
At the end of this presentation, participants will be able to:
- Define current evidence-based treatments for ARFID, including typical disciplines involved, and identify limitations of existing treatment approaches.
- Describe the primary components of the ARFID Clinic co-treatment program model, including nutrition education, CBT psychoeducation, and exposure therapy.
- Identify and describe strengths, limitations, and clinical outcomes based on case examples from the ARFID Clinic co-treatment program.
Level of Learning: Intermediate
S7 - Integrated Inpatient Approach to a 13-year-old Patient With Severe Malnutrition, Linear Stunting and Psychological Maltreatment and Abuse
Tiera Nell, MD
Liliane Diab, MD
Ellen Guess, OTRIntroduction: 13-year-old male, with unknown medical history and no family available, presented to a tertiary Children’s Hospital from a community hospital ER with need for nutrition restoration, monitoring of refeeding syndrome, evaluation of neglect/abuse, and safe disposition planning.
Objective: To demonstrate how an integrated, multidisciplinary inpatient model supports the evaluation and management of a medically and psychosocially complex adolescent with severe malnutrition, linear stunting, and suspected neglect.
Method: Pediatric Hospital Medicine: reviews case including history/physical, labs, imaging, consult rationale. Pediatric Medical Nutrition Consult: refeeding syndrome, micronutrient evaluation, evaluation of linear growth stunting via growth chart. Pediatric Psychiatric evaluation and support staff including Child Life, Creative Arts, etc with specific emphasis on trauma evaluation and treatment goals while inpatient. Evaluation and treatment from Occupational Therapy, Speech Therapy, and Physical Therapy including review of Trauma Informed Feeding Strategies. Pediatric Hospital Medicine outlines contributions of Child Protection Team and Social Work: supporting the legal investigation and disposition planningConclusion : Description of our inpatient medical-mental health team displaying an integrated treatment approach with reference to the presented case. Currently, there are few institutions who have such a model. We highlight one approach for diagnosis and treatment to a complicated patient population.
At the end of this presentation, participants will be able to:
Identify three medical professionals who can be consulted to support patients with severe malnutrition and medical neglect.- Identify patients who may have concern for a diagnosis of refeeding syndrome.
- Identify lab evaluations needed for the diagnosis of refeeding syndrome.
- Identify need for and use of Trauma Informed Feeding Strategies.
Level of Learning: Advanced
S9 - They are Aspirating Every Consistency? Now What?!: Feeding Therapy for the Infant With no Safe Feeding Plan
Michelle Shalom, MS, OTR/L, CBS
Kerry Spencer, MS, OTR/L, CBS
Jenna Mathews, MOT, OTR/L, BCP, CLCWhat do you do when you get an infant on your caseload and they have “no safe feeding plan”? Infants with significant confirmed or suspected pharyngeal phase dysphagia present complex clinical challenges that require nuanced, developmentally appropriate intervention strategies. This presentation will guide clinicians through the creation of individualized treatment plans and feeding therapy goals tailored to three critical age ranges: 0–4 months, 5–8 months, and 9–12 months. Emphasis will be placed on understanding the evolving needs of infants across these stages and aligning therapy goals with developmental milestones and swallowing physiology.
Participants will explore the essential role of multidisciplinary collaboration—including medical, therapeutic, and caregiver support—in optimizing outcomes and monitoring overall health for this vulnerable population. The session will also address key considerations for planning initial and repeat instrumental swallow assessments, including timing, clinical indicators, and readiness factors as well as how to best prepare an infant for their swallow assessment. Through case-based examples and evidence-informed practices, this presentation aims to equip clinicians with practical tools to enhance safety, efficiency, and developmental progress in feeding therapy for infants with oropharyngeal phase dysphagia.
At the end of this presentation, participants will be able to:
- Create a treatment plan and feeding therapy goals for an infant (0-4 moths, 5-8 months, and 9-12 months) with significant confirmed or suspected pharyngeal phase dysphagia
- Describe the importance and type of multidisciplinary support and guidance needed when working with infants with significant confirmed or suspected pharyngeal phase dysphagia.
- Determine factors to consider when planning an initial or repeat instrumental swallow assessment for infants with significant confirmed or suspected pharyngeal phase dysphagia
- State treatment strategies and goals to utilize in feeding therapy sessions to prepare an infant with significant confirmed or suspected pharyngeal phase dysphagia for an initial or repeat instrumental swallow assessment
Level of Learning: Advanced
S10 - Risk or Reward?: Hunger Provocation Tube Weaning and the Role of the Speech-Language Pathologist
Sandra Galbally, MS, CCC-SLP
Hunger-provocation tube weaning is an increasingly common outpatient intervention in pediatric medicine, and the evidence base supporting its use continues to grow. Recent research suggests that this approach can help many types of patients achieve full oral feeding (Goldstein, 2025). However, for the speech-language pathologist (SLP), hunger-provocation models may appear to conflict with more traditional feeding approaches. For example, neuroprotective feeding frameworks often prioritize graded oral exposure (e.g., pacifier dips) when infants demonstrate stress responses such as gagging during bottle presentations, whereas hunger-provocation models reduce supplemental tube feeds and encourage more frequent oral feeding opportunities.
This presentation will review the principles of hunger-provocation tube weaning and its current evidence base. It will examine the role of the speech-language pathologist within multidisciplinary tube-weaning teams and highlight clinical considerations that arise during method implementation, including swallowing safety and neuroprotective feeding. Finally, this presentation will highlight the power of clinical collaboration through a review of case studies from a multi-disciplinary tube weaning team within a pediatric cardiology service. By integrating current evidence with clinical experience, this presentation will offer a therapeutic review of hunger-provocation tube weaning—its benefits, limitations, and the critical role SLPs play in ensuring safe, supportive, and effective patient care.
At the end of this presentation, participants will be able to:
- List one finding from the current evidence base on hunger provocation tube weaning outcomes
- Explain one to two clinical challenges an SLP may face when working with a patient undergoing a tube wean
- Identify three professionals commonly involved in hunger provocation tube weaning
Level of Learning: Intermediate
S11 - Enhancing Family Engagement and Program Preparedness: A Team-Based Model to Prepare for an Admission to an Intensive Feeding Program
Adina Seidenfeld, PhD
Sonja Calkins, CCC-SLP
Gabriela Echavarria-Moats, PhD
Miranda Gentile, RD, LD, CLC
Praveen Goday, MDWhile intensive feeding programs can be effective to address longstanding feeding concerns, they also can be burdensome on families and health care systems. Families’ work, financial situation, and family care can be impacted, in addition to the emotional and physical strain of attending day-long treatment. Intensive feeding programs involve coordination among multidisciplinary staff, specific space and nonbillable resources.
Ensuring that both families and providers are prepared for an admission could help minimize burden associated with treatment and optimize success.
We will present a transdisciplinary, family-focused model to prepare families and the treatment team for an admission to an intensive feeding program. The new approach includes: revised referral criteria, universal screening for eosinophilic esophagitis, team review for care coordination with a focus on risk/benefits for the patient, and a transdisciplinary preparation session with the family.
We expect that the team makes recommendations that address barriers prior to admission, that families understand and adhere to these recommendations, and that fewer families drop out of the program prematurely. Data from first 24-months of implementation are currently being collected and analyzed. Preliminary findings are promising. Of 63 families who completed the process, 81% received at least 1 recommendation prior to their admission, 11% deferred by team to work on barriers, and another 11% the family deferred or deferred per insurance.This presentation will describe each step to prepare the team and families for an intensive feeding program, highlight areas of increased clinical focus, and discuss implications for broader application in feeding care.
At the end of this presentation, participants will be able to:
- Name at least one challenge for admission to intensive feeding program from each of five disciplines.
- Name three steps in process of admission.
- Describe the family’s role to prepare for admission.
Level of Learning: Intermediate
S12 - Feeding Futures: Bridging Gaps in Infant Care Through Interdisciplinary Screening
Cindy Herdé, SLPD, MS, CCC-SLP, CLC
Early identification of infant feeding and swallowing difficulties remains inconsistent, particularly in less medically complex populations who may not receive specialized evaluation until problems escalate. To address this gap, we piloted the integration of a validated caregiver-report feeding screener into routine pediatric physical therapy (PT) assessments for infants (0–12 months).
Eight PTs at a large pediatric hospital were trained through a structured competency program to administer the screener, interpret findings, and collaborate with speech-language pathology (SLP) colleagues for referral. Using a Plan-Do-Study-Act (PDSA) quality improvement model, the project assessed feasibility, provider confidence, and workflow compatibility.
Preliminary pilot data from PDSA Cycle 1 demonstrated that PTs were able to reliably integrate the screener into sessions without extending visit length. PT confidence in identifying feeding concerns increased, supporting earlier access to care. Implementation challenges included standardizing documentation. These insights informed refinements for PDSA Cycle 2, currently in progress.
This pilot highlights the feasibility of embedding feeding screening into PT practice as a scalable strategy to reduce under-detection, strengthen interdisciplinary collaboration, and improve outcomes for at-risk infants. By sharing preliminary data, implementation processes, and lessons learned, this presentation aims to inspire replication and adaptation of interdisciplinary screening models across diverse pediatric care settings.
At the end of this presentation, participants will be able to:
- Examine the feasibility and early outcomes of embedding a caregiver-report feeding screener into pediatric PT assessments.
- Assess the impact of the pilot project on PT workflow integration, provider confidence and referral patterns.
- Identify challenges and opportunities for scaling interdisciplinary screening models in infant feeding care.
Level of Learning: Intermediate
S13 - A Novel Interdisciplinary Approach to Outpatient Tube Weaning: A Pilot Program
Kaitlyn Mosher, PhD
Elizabeth Evenson, MS, RD, LD, CLCUnlike intensive feeding programs that offer daily structured intervention, tube weaning in the outpatient setting presents several challenges due to infrequent medical follow-up and the lack of transdisciplinary care. In this presentation, we describe a novel outpatient tube weaning approach involving collaboration between a Feeding Psychologist and a Registered Dietitian (RD). We will highlight the program’s structure and preliminary outcomes. This co-treatment model was piloted within our Comprehensive Pediatric Feeding and Swallowing Program (CPFSP) on patients who were identified as ready for tube weaning. Readiness criteria were safe for oral intake, stable growth and medical conditions, and consumption of at least 1 oz each of food and a nutritional supplement. Patients were seen by both providers jointly every 1–3 weeks for up to 10 sessions.
During co-treatment visits, the team collaboratively assessed barriers to oral feeding, monitored growth, provided behavioral parent coaching, and developed individualized home interventions to support and advance oral intake between visits. To date, of four patients in the pilot phase, three have successfully transitioned from < 25% oral intake to 100%. One has since had their feeding tube removed. The remaining patient recently began the program and has improved oral intake by 15% thus far. By September 2026, we anticipate enrolling a total of 10 to 15 patients in order to gather additional data and assess scalability of this approach.
A structured outpatient co-treatment model shows promise as an effective, sustainable, and family-centered alternative to intensive feeding programs for tube weaning for some medically complex children.
At the end of this presentation, participants will be able to:
- Describe an interdisciplinary outpatient co-treatment model for tube weaning integrating behavioral and nutritional intervention.
- Apply an interdisciplinary framework to a case example to address feeding barriers and guide interventions.
- Discuss how this model addresses common barriers encountered across different tube weaning approaches and service delivery models.
- Evaluate pilot outcomes and consider implications for broader clinical application and program scalability
Level of Learning: Intermediate
S14 - From Stress to Support: A Pragmatic Screening Model for Caregivers of Children With Medical Complexity and Pediatric Feeding Disorder
Julia Mamana, BS
Rachel Kassel, PhD, MD
Cynthia Wozow, DO
William T Harris, MD
Carla Burroughs, LMSW
Lynzee Head, DO
Leslie Allen, RN
Ashley Chapman, RN
Alex Clifton, PA
Amanda Rogers, SLP
Kristen Kirkland, SLP
Kelly Trumbull, RD
Guillermo Beltran Ale, MD
Ryne Simpson, MDIt has been widely documented that caring for children with complex chronic illness, including pediatric feeding disorders, often results in significant emotional and financial stress for caregivers. We seek to better understand these stressors and the nuanced experiences of caregivers in order to provide more effective support to both caregivers and patients. To do this within a clinically busy environment with limited social work resources, we developed a caregiver well-being survey adapted from McConkey (2020), incorporating the Hunger Vital Sign and transportation insecurity screening. The survey was administered in multidisciplinary Physical Medicine and Rehabilitation-Gastroenterology Clinics, Aerodigestive Clinics, and Complex Gastroenterology Clinics clinics using printed resources and verbal dialogue addressing caregiver concerns. In parallel, we compiled and streamlined clinic-specific caregiver resources within the electronic medical record and advocated for resources where voids exist. Survey findings directly informed in-clinic resource provision. Compiled survey results will be presented, along with the next phase of the project, which evaluates the needs and wellbeing of pediatric caregivers identified through special-needs daycares and therapy centers. Thus far, these interventions have addressed high risk families and provided in-clinic resources, with survey responses proving able to predict caregiver outcomes based on relative medical complexity in logistical and robust regression analyses. This locally developed assessment tool and resource model may be adaptable to other pediatric centers seeking to support caregivers of children with medical complexity within high-volume clinical environments.
At the end of this presentation, participants will be able to:
- Examine the development, implementation, and key components of a pragmatic caregiver well-being survey, including social risk screening tools used in high-volume clinical settings.
- Describe the emotional, financial, and logistical stressors experienced by caregivers of children with complex chronic and feeding disorders.
- Identify and adapt a caregiver assessment tool for medical complex children to your institution.
- Develop caregiver resources for your institution.
Level of Learning: Intermediate
S15 - Pro-Active NG-Tube Placement for Oral Aversion in a Breastfeeding Baby
Jennifer Del Re, MS, CCC-SLP, CLC
Stephanie Brown, MSPH, RD, CSP, LDN
Gamze Ozsoy, MD, FAAP
Molly Golden, MS, OTR/LThe use of enteral support is often reserved for infants who present with poor growth or failure to thrive (FTT). We aim to suggest utilizing NG-tube placement as a treatment in cases where the infant presents with significant oral aversion and down trending growth, prior to meeting formal FTT diagnosis. Prior to intervention, baby would latch after mom bounced her for about 40 minutes until she is sleepy and only briefly latched (i.e., 5-10 minutes). This occurred 6-7x per day, resulting in mother feeding the baby continuously, impacting mother’s mental health. If baby was placed in a feeding position in an alert state, she immediately cried, arched, and refused to latch, resulting in a negative feeding experience at the breast. She did not accept alternative methods of feeding (i.e., bottle, cup, spoon) and presented with similar refusals when offered. An effective way to make notable gains in oral feeding skills and ensure adequate growth is to place an NG tube. This alleviates the pressure to feed while therapists work to build necessary skills and slowly increase PO demands. This case study will review a breastfeeding mother/infant dyad that developed maladaptive feeding practices and poor weight gain in the setting of undiagnosed gastroesophageal reflux disease and benefited from an interdisciplinary (including SLP, nutrition, OT, and medicine) approach to improve feeding outcomes for both the parent and the child.
At the end of this presentation, participants will be able to:
- Identify signs when enteral support is indicated
- Identify treatment approaches used by interdisciplinary team
- Identify differential diagnoses evaluated by medical providers.
Level of Learning: Advanced
S16 - IDDSI Implementation Through Interdisciplinary Collaboration
Shakeia Burgin, MS, CCC-SLP
Julia Welc, MA, CCC-SLP
Kimberly Duffy, MA, CCC-SLP
Andrea Burnside, MSN, CPN
Sherri Cohen, MD
The Children’s Hospital of Philadelphia (CHOP) transitioned from use of a modified National Dysphagia Diet terminology system to the International Dysphagia Diet Standardization Initiative (IDDSI) within an interdisciplinary project management team. Implementation of the IDDSI framework was applied across the enterprise consisting of 2 acute care hospitals and numerous outpatient specialty care sites including the Martha Escoll Lubeck Feeding and Swallowing Center. This effort was pursued to improve patient safety and enhance quality of care. Interdisciplinary team members from CHOP’s Feeding and Swallowing Center, Speech-Language Pathology, Food Services, Clinical Nutrition, Lactation, Nursing, Gastroenterology, and Digital and Technology services worked to implement process and policy changes, update the electronic medical record system, provide education to enterprise staff, and establish sustainable long term monitoring plans to ensure successful and safe implementation. This session will overview key components of the project including establishing and engaging the interdisciplinary team, adaptation and creation of new workflows, transformation of dysphagia diet menus, and creation of education materials and training plans. Attendees will gain insight into challenges encountered and collaborative efforts to pursue successful implementation.
At the end of this presentation, participants will be able to:
- Identify three key interdisciplinary team members for successful IDDSI implementation
- Describe two challenges encountered and their solutions within IDDSI implementation
- Describe at least one solution for long term monitoring to ensure successful IDDSI implementation
Level of Learning: Introductory
S17 - Validation of a new Feeding Screening Tool, the Pediatric Observational Feeding Screener: Transitional (POFS-T)
Jenna Mathews, OTR/L, BCP, CLC
Arwen Jackson, MA, CCC-SLP
Jennifer Maybee, PhD, CCC-SLP
Carolyn Ross, PhD
Rachel Arkenberg, PhD, CCC-SLP, CLCApproximately 50-80% of children with Down syndrome (DS) have pediatric feeding disorders (PFD), or “impaired oral intake that is not age-appropriate, associated with medical, nutritional, feeding skill, and/or psychosocial dysfunction” (Goday et al., 2019). A key developmental stage when children with DS struggle is the transitional feeding stage, when chewing develops. Unidentified PFDs at this stage can result in lifelong risks for choking, restrictive food variety, and nutritional deficiencies. To date, no screening tool exists to identify children with DS in the transitional stage at risk for PFD.
With recently awarded grant funding, we have begun data collection and validation of the Pediatric Observational Feeding Screener – Transitional (POFS-T), developed to identify children at risk for feeding difficulties during the transitional feeding stage. During POFS-T validation, we will also evaluate patterns of oral motor skill development in children with DS compared to children without DS using the Oral Feeding Skills Scale (OFSS). Our research entails scoring 26 prerecorded feeding observation videos of children 12-36 months (13 with DS, 13 without DS) using the POFS-T and OFSS and comparing findings across groups. Four non-clinician coders will also rate feeding observations using the POFS-T to gain insight about how non-experts can screen for PFD risk. Our study will examine the performance of the POFS-T in screening for PFD in children, its feasibility for scoring by non-experts, and its suitability for use in a future NIH R01 study on transitional feeding. We will share pilot data and the process behind our project’s implementation.
At the end of this presentation, participants will be able to:
- Decribe how the Pediatric Observational Feeding Screener – Transitional (POFS-T) was designed, what it measures, and how it can be applied in research to assess feeding skills and risk for PFD
- Describe clear patterns of oral motor skill development in children with DS compared to children without DS
- Interpret pilot data to evaluate the performance of the POFS-T in screening for PFD in children and its feasibility for scoring by non-experts
Level of Learning: Intermediate
S19 - Nutrition Best Practices: What Would the Registered Dietitian Recommend?
Aida Miles, EdD, MMSc, RDN, LD, CSP, FAND
Working with infants and children who have pediatric feeding and swallowing disorders requires an interprofessional approach. Although collaboration with registered dietitians is ideal, many feeding therapists do not have access to one. This workshop offers occupational therapists, speech-language pathologists, and mental health or behavioral therapy providers a comprehensive overview of pediatric nutrition, focusing on common nutritional concerns in this population. Topics include age-appropriate nutrition recommendations, key macro- and micronutrient considerations for selective eaters, and guidance on supplementation. The workshop features interactive case studies and provides participants with a reference guidebook. Resources for locating pediatric dietitians will also be included.
At the end of this presentation, participants will be able to:
- Identify at least one nutritional concern in a provided case study scenario of a toddler who is a selective eater.
- Develop a sample meal plan for a child with selective eating, providing an adequate balance of macronutrients.
- Identify a multvitamin/mineral preparation that is most appropriate for selective eater, based on their typical intake.
Level of Learning: Intermediate
S20 - Meeting Families Where They’re at: Prioritizing a Culturally Responsive and Affirming Treatment Approach
Zohal Heidari, PhD
Allyson Davis, PhD
Lillian Slavin, PhD, BCBAGiven the intricate tie of food and eating habits to culture and identity, it is imperative that feeding providers assess for and consistently adapt intervention strategies to meet the needs of each individual and family. This presentation will highlight methods of collaborating with families by assessing family food culture, neurodiversity factors, parenting styles, and the psychosocial impact of feeding disorders. Presenters will focus on treatment strategies that are affirming of individual and family identity and values by teaching families how to view food in a neutral manner, disrupt negative meal time patterns, support a positive relationship with food and our bodies, and improve the overall individual and familial meal experience. The utility of telehealth for increasing access to culturally responsive and neurodiversity affirming care will also be discussed. Special considerations for autistic and neurodiverse youth and their families will be included. Presenters will discuss considerations across the lifespan for working with individual patients and their families within a caregiver-mediated model.
Information will be drawn from the clinical experiences of the panel, current research, lived experience of people with ARFID, and case examples. This interactive presentation will include a feeding therapy goal-writing activity, reflection prompts, and group discussions.
At the end of this presentation, participants will be able to:
- Identify three ways of assessing cultural and familial values as it pertains to mealtime
- Identify and Describe food using neutral language to promote a healthy relationship with food
- Incorporate strategies for body positivity and body neutrality to educate families about the relationship with food and our bodies
- Write an affirming feeding therapy goal, taking into consideration intersectional identities and family values
Level of Learning: Intermediate
S21 - Meanwhile Out In the Community
Kaitlyn Cavanaugh, MS, OTR/L, CLC
Sally Asquith, MS, CCC-SLPWith high premature birth rates there is an increasing number of babies with feeding issues. Additionally, there has been notable acceleration of pediatric feeding disorders (PFD) among children and adolescents since the COVID-19 pandemic. PFD is predictably common among children with ASD/autism spectrum disorders, Down syndrome, and a host of other developmental disabilities. Community providers are key in helping meet the rising demands for feeding therapy services. Are you considering making the switch to running your own private practice? This session will highlight the challenges and advantages to working in the community outside the walls of a large institution. As two private practice owners, we will discuss what led us to starting a private practice, our practice structure and approach to care, patient recruitment, and how community providers can ensure high quality, evidence based care is provided.
At the end of this presentation, participants will be able to:
- Identify benefits to providing pediatric feeding therapy within the community setting.
- Identify limitations to working within a private practice setting.
- Summarize strategies utilized to ensure therapists are able to provide high quality, evidence based care when working outside of a large medical institution.
Level of Learning: Introductory
S22 - Beyond the Breast: Guiding Families Through Cessation of Breastfeeding in the Context of Pediatric Feeding Disorders and Parental Burnout
Ryan Davidson, PhD
Grace Landry, RD, LDN, IBCLC
Anna Rouse, LICSW
Juliet Ochura, MS, CCC-SLP, CLC, BCS-S
Mollie Studley, MS, RD, CSP, LDN
Carolyn Lubenow, MA, CCC-SLP, CLC
Arielle Starr, BSN, MSN, CPNP
Miriam El-Haoui, MS, CCC-SLP, CLCOver the past several decades, public health policies and messaging, along with associated research, has focused on how to increase the number of, and time that infants breastfeed or have access to human milk. However, there is little to no research on how to support the cessation of breastfeeding for families who wish to discontinue when the child is struggling with the transition. For toddlers with pediatric feeding disorders, transitioning the timing of breastfeeding can be helpful to support solid food intake and continue to transition division of responsibilities around mealtimes. Many caregivers face more difficulty with cessation of breastfeeding when their child with PFD refuses alternative beverages or strongly prefers human milk over other nutrition sources. Yet, there is no literature identifying important areas of assessment or behavioral interventions to support parents as they work towards either transitioning away from on-demand or overnight breastfeeding or total cessation of breastfeeding in children with PFDs.
This presentation will include Gastroenterology Nurse Practitioners, Registered Dietitians, Speech-Language Pathologists specializing in feeding, Pediatric Psychologists, and Social Workers addressing the available research and evidenced based practice strategies using case-based discussion. Speakers will discuss important areas of assessment when families identify goals around transition/cessation of breastfeeding, including discussion of cultural and religious factors which may influence parental values/decisions around breastfeeding. In addition, behavioral interventions to support cessation or transition of breastfeeding will be discussed, including how providers can utilize shared decision-making to develop a behavioral plan that focuses on sustainable change for families.
At the end of this presentation, participants will be able to:
- Identify and describe the role of multidisciplinary team members in assessment of pediatric feeding disorders, including family and cultural values related to cessation of breastfeeding in toddlers.
- Apply shared decision-making tools to identify and create intervention goals surrounding cessation of breastfeeding
- Develop introductory behavioral plan to support cessation of breastfeeding for toddlers and their caregivers.
Level of Learning: Intermediate
S23 - A Chart Review to Identify Variables That Predict Treatment Success for Tube-Dependent Children
Aaron Lesser, PhD, BCBA-D
Michelle Melicosta, MD, MPH, MScPatients admitted to the intensive Pediatric Feeding Disorders Program at Kennedy Krieger Institute generally have multiple goals focused on improving their eating and drinking. These goals may include increasing variety of accepted foods, increasing ability to self-feed, or improving mealtime behaviors. Children with feeding problems may require supplemental nutrition to ensure proper nutrition and hydration. Some will no longer require supplemental nutrition as they age and develop appropriate eating skills; while others will require behavioral therapy which has a substantive research base in treating pediatric feeding disorders. A common goal is to reduce dependence on enteral feeds delivered via tube. A chart review was completed to identify the patients that admitted to the inpatient intensive feeding program with tube feedings. We reviewed data to identify if there was any association with treatment success (e.g., date of tube placement, prior therapy, etc.). These outcomes can be used to inform clinicians about prospective progress and may be used to prepare patient families accordingly prior to admission.
At the end of this presentation, participants will be able to:
- Identify and describe why an individual may require tube feedings.
- Distinguish between the differences among types of tube feeds.
- Identify wo to three variables that impacted treatment success for this sample of patients.
Level of Learning: Intermediate
S24 - Aerodigestive and Feeding and Swallowing Programs
Micheline Silva, PhD
Melanie Stevens, MS,CCC-SLP, BCS-S
Meredith N. Merz Lind, MD, FAAP, FACS
Raul Sanchez, MDThis presentation highlights collaborative efforts between two transdisciplinary programs—the Pediatric Aerodigestive Disorders Clinic and the Comprehensive Pediatric Feeding and Swallowing Program—in delivering integrated and coordinated care to children with congenital and acquired conditions affecting breathing, feeding, and swallowing.
The Aerodigestive Clinic brings together specialists from Otolaryngology (ENT), Pulmonology, Gastroenterology, Speech-Language Pathology (SLP), and Nutrition (RD). The Feeding Program includes medical providers, RDs, SLPs or Occupational Therapists (OTs), and Psychologists. Together, these teams manage children with conditions such as esophageal atresia and tracheoesophageal fistula, tracheobronchomalacia, tracheostomy/ventilator dependence, and oropharyngeal dysphagia.
Given the anatomical proximity of the respiratory and gastrointestinal tracts, dysfunction in one system often impacts the other. Feeding difficulties can exacerbate airway and GI issues, just as airway or GI disorders can impair feeding and swallowing. While there is some duplication of providers across the transdisciplinary teams, each team has its own focus in treating patients with significant clinical complexity and comorbidity. To address this complexity, a dynamic “One Team” partnership between the two programs was established, enabling seamless coordination and shared decision-making across disciplines.This presentation will feature case studies that demonstrate how a collaborative care model enhances outcomes and quality of life for children with medically complex conditions. Through these examples, we will highlight the advantages of transdisciplinary teamwork, including improved diagnostic accuracy, streamlined treatment planning, and comprehensive support for families managing multifaceted care needs.
At the end of this presentation, participants will be able to:
- Recognize complex pediatric medical conditions where feeding, swallowing, airway, and gastrointestinal (GI) challenges frequently co-occur, and understand their interrelated nature.
- Explain the bidirectional impact between feeding/swallowing difficulties and airway or GI disorders, emphasizing how each can exacerbate the other.
- Illustrate collaborative care through a case example that highlights coordinated decision-making between aerodigestive and feeding and swallowing teams.
Level of Learning: Advanced
S25 - The Interdisciplinary Edge: PFD Programs as a Gateway to Successful Pediatric Obesity Management
Stephanie Brown, MSPH, RD, CSP, LDN
Lyndsay Fairchild, PhD, BCBA-D
Mallie Donald, PhD, BCBAPediatric obesity and overweight continue to be a significant public health problem. Obesity can cause health problems such as sleep apnea, type 2 diabetes, and dyslipidemia. Research has shown that obesity and overweight are more likely to be related to psychiatric disorders in children, such as attention deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). Treatment of obesity includes dietary intervention, physical activity, and behavioral support strategies. Children with pediatric feeding disorders (PFD) are more likely to struggle with implementation of these treatment components. These two case studies will review how an interdisciplinary Pediatric Feeding Disorders Program can help an obese and/or overweight child with diagnoses of autism in adopting dietary changes without pharmacological intervention.
At the end of this presentation, participants will be able to:
- Identify and decribe current treatments of pediatric obesity and overweight.
- Identify strategies for how an interdisciplinary Pediatric Feeding Disorder Program can set up implementation of obesity and overweight dietary interventions.
- Apply dietary interventions to promote improved health in children with obesity and overweight.
Level of Learning: Intermediate
S26 - Evaluating Food Avoidance and Feeding Related Concerns in a Multi-Disciplinary Clinic for Pediatric Patients With Atopic Dermatitis
Wendy Elverson, RD, CSP, LDN
Jennifer LeBovidge, PhD
Lynda Schneider, MD
Tina Ho, PhD, MD
Karol Timmons, PNP
Maya Dayanim, BSRationale: Children with Pediatric Feeding Disorders often have limited preferred foods. Unnecessary food avoidance can further limit diet diversity. In addition to a higher risk of IgE (Immunoglobulin E)-mediated food allergies in children with moderate to severe atopic dermatitis, caregivers of children with atopic dermatitis (AD) have frequent concerns about the relationship between diet and AD.
Methods: We retrospectively reviewed charts and surveys from the initial visits of 126 patients seen in a multidisciplinary AD clinic to identify the incidence of IgE-mediated food allergy, concerns regarding picky eating, and family-driven food avoidance, due to caregivers’ concerns that foods trigger or exacerbate AD.
Results: Of the 136 patients, 56% had IgE-mediated food allergies and 44% had multiple food allergies. 24% of caregivers reported their child was often or always a picky eater. 17.7% of caregivers reported their child often or always refused a food presented. 26% of caregivers reported avoiding at least one food in their child’s diet based solely on the caregiver’s suspicion that the food was triggering AD.
Conclusions: Caregivers of children in a multidisciplinary AD clinic reported concerns about picky eating (24%), children often or always refusing food presented (17.7%) and foods being a trigger of AD. It is important for health care providers to ask caregivers about dietary avoidance related to AD and refer to dietitians to support optimal growth, food variety and nutrition.
At the end of this presentation, participants will be able to:
- Identify and describe current evidence regarding the relationship between food allergens and atopic dermatitis
- Identify important questions to ask patients and caregivers regarding caregivers’ concerns of picky eating and foods triggering atopic dermatitis
- Recognize the nutritional risk of unnecessary food avoidances in the setting of atopic dermatitis.
Level of Learning: Intermediate
S27 - Are We Screening Enough Children With PFD for Eosinophilic Esophagitis (EoE)?
Adina Seidenfeld, PhD
Praveen Goday, MD
Isaac Kistler, MS
Rob Dempster, PhD
Brian Arand, MSEosinophilic Esophagitis (EoE) causes inflammation of the esophagus that has been associated with Pediatric Feeding Disorders (PFD) in young children likely due to discomfort while eating. Rates in pediatric populations are ~.03%, however, the prevalence of EoE in children with PFD is not known. Testing for EoE poses challenges due to the need for an invasive procedure (upper gastrointestinal endoscopy with biopsy) and the disorder’s non-specific symptoms, often leading to hesitation from both providers and families. Yet, untreated EoE can complicate feeding interventions, making prevalence data critical for guiding screening decisions.
This study examined the rate of EoE in a PFD population and evaluated an intervention to increase screening of EoE. Among 1843 patients seen in a feeding clinic from 2017-2024, 339 patients completed an EGD, with 18% of these testing positive for EoE. Referrals for EGDs increased across the intervention period from 20% to 33% (OR = 1.99, 95% CI [1.38, 2.83], p <.001) and were maintained a year after at 33% (OR = 2.03, 95% CI [1.57, 2.61], p <.001). Similar results were found for changes to completed EGDs, OR = 1.61, 95% CI [1.07, 2.37], p = .018. EoE rates among those screened remained relatively stable despite this increase in screening, with rates of 18% before the intervention and 19% after the intervention.
Findings suggest EoE is more prevalent in children with PFD than in the general population. Increasing screening efforts may help identify affected children, which leads to appropriate treatment to reduce discomfort associated with eating.
At the end of this presentation, participants will be able to:
- Name thee reasons providers and/or families may not refer/want an EGD.
- Name three benefits of receiving an EGD to screen for EOE.
- Identify rate of EOE (as identified in present study) in PFD population
Level of Learning: Intermediate
S28 - Understanding the Gag Reflex in Children With Pediatric Feeding Disorders
Krisi Brackett, PhD, CCC-SLP, C/NDT
Donna Scarborough, PhD, CCC-SLP
Christina Greeson, DNP, CPNPGagging (both typical and hypersensitive) is often observed by caregivers and feeding therapists in children with pediatric feeding disorders (PFD). The gag reflex is thought to be an evolutionary reflex that developed as a method to prevent oral contents from entering the oropharynx to prevent choking and swallowing of foreign objects (Sivakumar & Prabhu, 2022; Miller, 2002, Leder, 1996). The gag reflex receives stimulation from the glossopharyngeal (IX) nerve with the motor aspect of the reflex provided by the vagus nerve (X) (Wilson-Pauwels et al., 1988). Gagging is part of normal development when infants are mouthing items and transitioning to solid foods, however, many feeding therapists and caregivers observe gagging that interferes with feeding progression. Gagging is described in association with a wide variety of PFDs, including texture progression, oral aversion, gastrointestinal issues (GI), pharyngeal dysphagia, tube dependence, and oral care activities (Goday et al., 2019; Alexander et al., 2021; Barnhill et al., 2016; da Costa et al., 2017; Kumbhekar et al., 2022; Levine et al., 2011; Mazze et al., 2019; Saad et al., 2021;, Scarborough & Isaacson, 2006; Suarez et al., 2014, Sdravou et al, 2021). While gagging is often observed by feeding therapists working on feeding skill development, assessment measures and intervention tools are not well understood. This presentation will focus on our understanding of the gag reflex in association with PFD. Terminology, assessment, and intervention strategies (therapeutic, nutritional, and medical) will be explored through discussion and case studies.
At the end of this presentation, participants will be able to:
- Identify how ot examine gagging in children through the framework of the four domains of PFD.
- Describe factors associated with gagging in in children with PFD.
- Identify treatment options for gagging in children with PFD.
Level of Learning: Intermediate