Children's Hospital Colorado
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The Feeding and Swallowing Program at Children's Hospital Colorado

The Feeding and Swallowing Program at Children's Colorado offers care for patients with feeding or swallowing challenges through the focused attention of a team of experts. This clinic brings together pediatric experts from developmental pediatrics, speech-language pathology, occupational therapy, nutrition, dentistry, pulmonology, psychiatry, gastroenterology and more. We offer specialized evaluation and treatment to children with a variety of feeding and swallowing conditions across Colorado and throughout the nation. The program also offers unique therapy options, as well as telemedicine support for our most remote patients.

Who we help in the Feeding and Swallowing Program

Our program is designed to support children and families living with feeding or swallowing difficulties. With our team of experts, we work to address:

  • Growth concerns
  • Difficulty gaining weight
  • Poor eating habits
  • Picky eating or food refusal
  • Choking, gagging, coughing and throwing up while eating
  • Inability to chew and/or swallow
  • Recurrent lung illnesses, such as coughs, cold, or pneumonias, that may be related to food and/or liquid entering the lungs when swallowing

Experts at our Feeding and Swallowing Program also find solutions to empower children to feed themselves if they are tube-fed or have had a previous tube placement.

Feeding and swallowing services we provide

The Feeding and Swallowing Clinic provides a wide range of evaluation and treatment services for children with feeding and swallowing difficulties.

Feeding and swallowing evaluations

Video fluoroscopic swallow studies (VFSS) are a nutritional and radiographic assessment of feeding and swallowing. VFSS is used to address concerns about swallowing dysfunction and aspiration (when food, saliva and other materials are breathed into the airway).

What can we expect from a video fluoroscopic swallow study?

A visit for a video fluoroscopic swallow study is approximately 1.5 hours long. A typical visit includes:

  • Caregiver interview: A speech therapist, occupational therapist and registered dietitian will meet with you and ask about your concerns for your child’s swallow function.
  • Observation and radiology: You will then accompany your child into the radiology suite. While your child drinks and eats, a radiologist will take moving X-ray images. Your child may be asked to eat and drink different liquids and foods during the study.
  • Results: After the team has completed the exam, they will share evaluation results with you and your child after the visit. A brief report will be handed to you before you leave, including recommendations for the safest diet for your child.
  • Report: A more detailed report is sent in the mail within one to two weeks of the visit.
  • Outpatient referrals: Your child will be referred for outpatient services if further evaluation or intervention is needed.

The Fiberoptic Endoscopic Evaluation of Swallowing (FEES) Clinic is a collaborative effort between the Pediatric Otolaryngology Department and the Feeding and Swallowing Program. In the FEES Clinic, a multidisciplinary team of otolaryngologists (ear, nose and throat doctors), speech pathologists, occupational therapists and nursing personnel evaluate a child's feeding and swallowing skills. In this clinic, our team uses a fiberoptic endoscopic evaluation of swallowing (FEES), a small tube used to evaluate your child's swallowing or feeding.

What can we expect from a fiberoptic endoscopic evaluation of swallowing?

A visit to the outpatient FEES Clinic is approximately one hour long. A typical visit includes:

  • Caregiver interview: Team members will ask about your child's medical history and your concerns regarding your child's feeding and swallowing.
  • Observation: Team members will observe your child while eating and drinking.
    • A brief endoscopy procedure: During the FEES evaluation, the doctor places a flexible, narrow endoscope inside your child's nose. The doctor may ask your child to talk, cough, eat or drink with the scope in their nose. If your child eats or drinks, the food and liquid is dyed blue to help the evaluators see it easily on the screen. You and your child (if able) can observe the procedure as it is happening on a screen. The procedure lasts anywhere from less than a minute to approximately five minutes.
    • Results: The evaluating therapist will share evaluation results with you and your child after the visit. A brief report will be handed to you before you leave, including recommendations for the safest diet for your child.
    • Report: A more detailed report is sent in the mail within one to two weeks of the visit.
  • Outpatient referral: Your child will be referred to outpatient nutrition services if further evaluation or intervention is needed.

The Feeding and Swallowing Program also offers a medical, nutritional, feeding and developmental assessment, called a multidisciplinary feeding evaluation. This evaluation helps in cases of limited oral intake, food refusal, picky eating, poor weight gain and difficulty transitioning from a feeding tube or supplemental feedings. A developmental pediatrician, dietitian, occupational therapist and speech-language pathologist perform the evaluation.

What can we expect from a multidisciplinary feeding evaluation?

A visit for an outpatient multidisciplinary feeding evaluation is approximately two hours long. A typical visit includes the following:

  • Caregiver interview: Team members will ask about your child's medical history and your concerns regarding your child's feeding and/or swallowing.
  • Observation: Team members will observe your child while eating and drinking to get a full sense of his or her challenges.
  • Assessment: Team members will assess your child's current level of development and nutritional and medical status to determine what factors are contributing to their feeding concerns.
  • Results: The evaluating therapist will share evaluation results with you and your child after the visit. A brief report will be handed to you before you leave, including recommendations for the safest diet for your child.
  • Report: A more detailed report is sent in the mail within one to two weeks of the visit.
  • Outpatient referral: Your child will be referred for any outpatient services if further evaluation or intervention needs to be addressed.

Individual feeding assessments are available for children with specific oral motor, oral sensory and developmental concerns that impact feeding. An occupational therapist or speech-language pathologist conduct the assessment.

What can we expect from an individual feeding assessment visit?

A visit for an individual feeding evaluation is approximately two hours long. A typical visit includes the following:

  • Caregiver interview: The evaluating feeding specialist (an occupational therapist or speech-language pathologist) will ask about your child’s medical history, feeding history and caregiver concerns regarding your child's feeding and/or swallowing.
  • Observation: The evaluating therapist will observe your child while eating and drinking to get a full sense of their challenges.
  • Assessment: The evaluating therapist will assess your child's oral motor skills, oral/sensory skills, mealtime participation, behavior and development to determine which factors are contributing to their feeding concerns.
  • Results: The evaluating therapist will share evaluation results with you and your child after the visit. A brief report will be handed to you before you leave, including recommendations for the safest diet for your child.
  • Report: A more detailed report is sent in the mail within one to two weeks of the visit.
  • Outpatient referral: Your child will be referred for any outpatient services if further evaluation or intervention needs to be addressed.

Treatment for feeding and swallowing conditions

Once a child has received an initial evaluation or assessment, we make recommendations regarding the most appropriate feeding therapy and treatment. Within the Feeding and Swallowing Program, we offer a number of therapies to help patients.

Individual feeding therapy is a once-weekly feeding session, where you and your child will meet individually with an occupational therapist or speech-language pathologist. This one-on-one therapy focuses on individualized feeding intervention for your child, as well as recommendations to help make progress with goals at home.

Intensive feeding therapy is a series of sessions held over two weeks with an occupational therapist and speech-language pathologist. They work together, one-on-one with your child, to help progress toward specific feeding goals. These sessions are for a child with swallowing or feeding challenges, as well as for family members or caregivers who feed the child most often.

Families will also meet with a clinical social worker and may meet with a dietitian depending on the child's needs.

Intensive feeding therapy is designed to lower stress and fear about eating, and it will help your child learn to take their next steps toward successful eating. Families will learn ways to work with a child's eating and to set goals that improve mealtimes.

Group feeding therapy is designed to support children with feeding difficulties and their families using consistent routines and strategies to reduce stress and anxiety regarding eating. Group feeding therapy promotes comfortable interactions with food and includes peer interaction, caregiver education and home program support.

Groups meet once per week for two-hour sessions. Groups are offered on a seasonal basis (usually summer, fall and spring). Children may return for more than one session if recommended by the therapy team.

Telemedicine feeding therapy is designed for patients with limited services within their communities or for families who would normally have to travel long distances. Our specialized occupational therapists and speech-language pathologists provide support to these children and families via video.

Why choose the Feeding and Swallowing Program for your child?

Our program focuses on providing a comprehensive, family-centered approach to the assessment and treatment of children with feeding and swallowing difficulties. It is not uncommon for many different aspects of a child's health, development, growth, nutrition and overall wellbeing to be affected by these challenges. That's why we offer a patient-focused treatment program that considers medical and nutritional status, motor skills, sensory systems, behavioral and emotional factors and communication into our recommendations and treatment plans.

Contact us

You can reach the Feeding and Swallowing Program at 720-777-6168.

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