The Feeding Clinic provides multidisciplinary assessment, consultation and treatment for children (birth to age 18) with feeding problems related to an underlying medical, neurological or developmental condition. Its team currently consists of a Speech-Language Pathologist (SLP), Occupational Therapist (OT), and Registered Dietician (RD).
The Speech-Language Pathologist: Completes a clinical assessment of oral-motor and pharyngeal dysfunction. He/she determines whether swallowing is safe and effective with varying textures. The SLP may recommend ways to improve swallowing function or mitigate risk for aspiration. He/she also screens for communication-related delays or difficulties.
The Occupational Therapist: Evaluates fine and gross motor function as well as sensation and sensory differences. She/he assesses a client’s body positioning and prerequisite skills for feeding. The OT may recommend oral motor techniques, seating and/or adaptive equipment.
The Registered Dietician: Assesses growth (based on length and weight), nutritional status and energy requirements. She/he may recommend a change or supplement to the client’s diet, a meal structure, and/or an appropriate feeding regimen (oral or enteral).
Note the clinic is unable to see children whose feeding difficulties relate primarily to an underlying psychiatric illness, autism spectrum disorder, or parent/child interaction difficulties. A paediatrician must refer children requiring a Feeding Clinic assessment.
Visits to the Feeding Clinic
At the initial assessment, information is gathered through an interview with caregivers and observation of a snack or meal. Together with the family, the team develops strategies to optimize feeding skills and the child’s nutritional intake. If appropriate, the child is followed by one or more team members for treatment.
Please note a visit to the feeding clinic may involve the following:
An intake package sent to the family. They are asked to complete this beforehand and bring it with them to the assessment. The package asks for the following: demographic information; feeding concerns, medical, developmental and feeding histories; some psychosocial/behavioural information; and a 3-day feeding journal/diet history.
Families are asked to bring food items. These should include the child’s preferences and non-preferred items, textures that are tolerated and those that may be difficult, solids and liquids.
Parents are encouraged to feed the child in the same manner as in the family’s home.
The team discusses results of the evaluation and makes recommendations. These can include changes to nutrition, diet textures/flavours, equipment or oral motor exercises, therapeutic strategies, etc.
Referrals for additional assessment, e.g., a videofluoroscopic swallowing study, or additional specialists in the community, e.g. ENT or behaviour therapists.
The team may want to carry out a follow-up assessment in the home, at the daycare, or school. A follow-up appointment is scheduled as appropriate.
Clinicians in the community should be aware of some ‘red flags’ that may signify feeding difficulties or swallowing risk with paediatric clients. These are:
Falling off growth percentiles (e.g., failure to thrive)
Ongoing gagging, coughing, and/or choking during meals or snacks.
Recurrent nasal reflux.
History of eating and breathing coordination problems, with ongoing respiratory issues.
Inability to transition to baby food purees by 10 months of age.
An infant who cries and/or arches at most meals.
Difficulty chewing and swallowing functionally.
Food refusal if it’s related to significant event(s) in the client’s medical history (e.g., refusal after being extubated or concurrent with GERD)