Feeding Protocol

The long term goal of the Encouragement Feeding Program is to promote normal oral eating by weaning or decreasing amounts taken via feeding tube. In order to meet this goal the following protocol is used:

Prior to Enrollment

I. The child must meet requirements for entrance into the program. These include:

  • No medical complications that interfere with the feeding situation (any conditions must be static).
  • Adequate respiratory status to support oral feeding.
  • Adequate nutritional status to allow for a possible small weight loss.
  • Successful tolerance of bolus feedings without emesis.
  • Family who is ready to address feeding problems.
  • Cognitive level that exceeds the 18 month level in order to understand use of contingencies.
  • Previously attempted feeding programs have been unsuccessful.

II. Oral Functional assessment has been completed via home speech pathologist's reports and reports from family.  

Upon Entry into Program

Day One

Objective: To determine the level of current eating readiness which will regulate how the program is carried out.

I. Evaluation of current level of feeding readiness:

  • Feeding therapist watches typical meal with parent and child.
  • Determination of diet level.
  • Determination of behavior modification techniques to use to increase compliance with eating for feeding therapist.

Objective: To promote normal feeding scheduling and begin to promote development of hunger/satiety cycle.

II. Feeding schedule and environment are determined:

  • Child will be fed four to five times per day, six days a week on a strict three meal, two to three snack schedule.  Meals last only 30 minutes, while snacks last 15 minutes.
  • Child will be fed in a quiet environment, seated in a chair or in a high-chair.  Parent will be included in each meal.   
  • Child's tube feedings will be cut back, as determined by the nutritionist based on the child's current level of nutrition. Tube feedings will be decreased on a daily basis if possible, with end result of less than one fourth of feedings by the beginning of the second week of hospitalization.  

Objective: To determine which behavior management methods increase compliance in eating.

III. Behavior modification methods are determined:

  • Use of positive reinforcement for active eating.
  • Use of consistent language during feeding sessions.

First Three Days of Program

The Compliance stage

Long Term Goal: The child will tolerate the presentation of pureed foods with increased compliance and decreased avoidance behaviors for the feeding therapist

Short Term Goals:

  1. The child will take 25 to 50% of pureed foods offered to them per meal within the allotted amount of time per meal. (Each meal usually consists of at least 4 to 6 ounces).  OR child actively eats small amounts of higher textured foods.
  2. The therapist will directly educate the parent as to which techniques have been successful in increasing compliance during meal times.

Fourth thru Seventh Day of Program

The Cooperation stage

Long Term Goal: The child will actively participate in the feeding process with increased amounts taken per meal and less than two avoidant behaviors per meal for the parent with the therapist as a coach. 

Short Term Goals:

  1. The child will take 50 to 75% of pureed foods offered per meal within the allotted time.
  2. The parent will utilize consistent language and actions during meals with 75% accuracy.
  3. The child will lick or bite a higher textured food three of five times or more during each feeding session.

Second to Third Weeks of Program

The Skill Mastery stage

Long Term Goal: The child will actively participate in the feeding process with the parent as the lead feeder with less than two avoidant behaviors per meal. The feeding therapist will provide coaching as necessary.

Short Term Goals:

  1. The child will take 75 to 100% of foods offered per meal within the allotted time.
  2. The child will transition to less structured meal environments with no change in feeding behaviors.
  3. The parent will utilize consistent language and actions during meals with 90% accuracy, as noted by the child's level of compliance..

Discharge

Discharge will occur when the child is taking at least 80% of caloric needs by mouth in an efficient and safe manner. A written feeding protocol is provided to families to help with the transition to home. Prior to discharge, community supports are set up as necessary to ease the transition from a structured program back into the home setting. Weekly weights are encouraged until adequate weight gain occurs for several months. Parents are told to follow up with their local doctors to determine when the tube can be removed if appropriate. Follow up phone calls will occur on a weekly basis at first and gradually decrease as parents feel necessary. If possible, the child will be seen in follow up in the KCRC Feeding and Swallowing Clinic.

This is not a research program.  The protocol outlined above is general in nature and is intended only as a guideline.  The protocol will be individualized for each child depending upon his or her status at the time of enrollment.  This protocol has been written primarily for those children who have never eaten by mouth and need to start from scratch.  Those children who enter the program eating small amounts of food by mouth generally require shorter stays.  All children enrolled in this program are admitted as day treatment patients and do not stay in the hospital.  They remain on the hospital inpatient unit from 8:00 a.m. until 5:00 p.m. and stay in on-site or off-site housing overnight. 

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