Pediatric Feeding Disorders Program

What is a feeding disorder?
A pediatric feeding disorder refers to a condition in which an infant or child fails to consume enough nutrients to promote growth. Twenty-five percent of all children experience some feeding difficulties. The child may have had limited experience with eating, have difficulty eating, or may simply refuse to eat. This can be a fairly common problem in infants and toddlers; however, it is most common in children with developmental disabilities.

What causes a feeding disorder?
Feeding and swallowing problems are most often associated with complex medical diagnoses (such as prematurity, Reflux, complications secondary to tube feeding for extended periods of time, and disorders of the digestive system), anatomical or structural abnormalities (such as congenital diaphragmatic hernia or tracheo-esophagael fistula), allergies, or oral-motor dysfunction. Early or delayed introduction of solid foods and active food refusal may cause child and parental anxiety during meals.

Out-Patient Feeding Services
EVALUATION: The mission of a Pediatric Feeding Evaluation at DUMC is to provide diagnostic and treatment planning for children whose congenital or acquired medical and developmental needs and oral-motor, feeding, and behavioral difficulties have affected their feeding and growth. The team, comprised of Speech Pathology and Occupational Therapy, works with each child and family to address the multiple factors involved with eating. Family education and training are provided. Consultative services are available with Nutrition, Nursing, Psychology, Social Work, and Medical within the Duke University Health System as necessary.

THERAPY: The feeding program offers outpatient feeding services with Speech Pathology and/or Occupational Therapy, which usually involves weekly visits. The goal of outpatient therapy is to meet children’s needs not only by addressing the oral-motor, sensory, and dietary needs, but also by helping caregivers develop and implement an effective home-based feeding program. The frequency of treatment and disciplines involved are based on the child’s specific needs.

CONSULTATION: Consultative services may also be provided to families and therapists in outlying areas following an initial evaluation. These visits would be treated as a follow-up for additional therapeutic suggestions for those accessing local services and/or when therapy services cannot be obtained.

Symptoms Indicating When To Refer
The following symptoms may indicate the presence of a feeding disorder:
Growth issues such as failure to consume enough nutrients to promote growth. (Reflux is often associated with this.)
Oral-motor concerns including abnormal suck-swallow-breathe synchrony, prolonged feeding time (over 30 minutes), and excessive fluid loss during feeding.
Swallowing concerns: frequent episodes of gagging, coughing, or choking while eating; difficulty managing saliva; noisy or gurgling respirations after eating; or a diagnosis of aspiration.
Difficulty transitioning from breast to bottle, baby foods, and solids as well as from tube feedings to oral feedings.
Active food refusal with any consistency and disruptive mealtime behaviors.

What is the referral process?
To schedule an evaluation, contact Duke University Medical Center’s Division of Speech Pathology and Audiology at (919) 684-3859 or the Department of Physical Therapy and Occupational Therapy at (919) 684-3730. After an appointment has been made, a questionnaire and food diary will be mailed to the family to be completed prior to the evaluation appointment. Caregivers and other professionals are welcome to attend the evaluation.

There are two copies of our Pediatric Feeding Disorders Program brochure available to download as PDF files. Low is a low resolution version for quick viewing; High is a high resolution version available for printing. Note that the file size of the high resolution version is 5.6 MB.