Michelle L. W. Dawson, MS CCC-SLP, CLC
Pediatric Feeding Disorder: Embrace the Joy of Interprofessional Practice and How It Can Guide Your Intervention
In October 2021 the official ICD-10 Codes for Pediatric Feeding Disorder Acute and Chronic went live, thanks to the tireless volunteer work by Feeding Matters, LLC. These codes, R63.31 and R63.32, formally recognize a disorder that impacts every snack and meal that 1 in 37 children under the age of five struggle with on a daily basis.[1] Pediatric Feeding Disorder, (PFD), defined as impaired oral intake that is not age-appropriate and is associated with medical, nutritional, feeding skill, and/or psychosocial dysfunction, is not confined to the four walls of a home…but travels with the child to every environment that a snack or meal happens in…including hospitals, daycares, playdates, and LEAs.[2] These statistics are staggering, especially when we consider just how little we as professionals were truly prepared to adequately evaluate and treat a pediatric feeding disorder.
Honest question, did you have a PFD and/or pediatric dysphagia dedicated course in graduate school? Ouch, I heard a lot of “Nopes”. Alright, follow up question, did you have a night or two dedicated to PFD/pediatric dysphagia embedded in your traditional dysphagia course? Okay, so I saw a few “Yeses” to that one…with the caveat that they were primarily taught by an SLP who assessed and treated adult based dysphagia. If there is one thing that we can all agree to, it’s that pediatric versus adult based feeding and swallowing disorders typically have very different etiologies and treatments…and folks, that’s when we see all the enthusiastic nods of agreement! Another point that we can all agree to is that we can’t practice as a silo clinician, regardless of the age of our patients. We must embrace interprofessional practice (IPP) and collaborate with members of both the medical and allied health community in order to divine the true etiology/etiologies which directly drives the optimal treatment plan of care. (Cue the joyful clapping😊)
So, where does that leave you, the clinician who just picked up a new little one with a suspected PFD? You probably never had a formal course, but have “researched” the internet, checked a few social media posts, observed a few treatment sessions in grad school, and if you’re lucky you may have had a clinical practicum in PFD. But, without guidance and evidenced-based intuition of a seasoned, maybe slightly gray-haired, and sporadically botoxed CCC-SLP, looking over your shoulder and cheering you on… where does that leave you as you walk into their home for that initial eval? Most likely having a case of sweaty palms, elevated heartrate, and with serious misgivings if this is the chosen profession for you! This is where I raise my hands…y’all that was me…is me! Honestly, at least once a week I come across a new patient or get a consultative case and I still get plagued by those same intense emotions. The almost 39-year-old-me recognizes that anxiety has a fair bit to play in this response, but so does my heartfelt desire to give the best of myself to each patient that I am called to serve, whether that be directly or indirectly via a quick text, phone call, or zoom. So, this is where I rely on the village that I have forged around me. A village filled with interprofessional practice partners from the medical and allied health community. A village that is driven to see each child set on their own unique path towards healing. As you walk across the threshold of that new patient’s doorway, please allow me to invite you into my village, to support you in that patient’s care.
Most importantly, during that initial evaluation, you need to bond with the caregiver. Because, you are now, very much a part of their village. Remember they are the most important team member…and that the team is only as strong as they are. As you conduct your evaluation, you need to gather specific data points through multi-system observations to guide which IPP partner you will refer the child’s caregiver to as they begin their PFD journey. But what data points do you look for? What questions do you ask the caregiver? How do you ask the questions to build trust, but yield the information that you need? What do you do with that information? How do you know which practitioner to refer to? Biggest question… How do you embrace working in a village, when all you know is the silo? Breathe. I have you covered.
I spent roughly 2.5 years and 15lbs working on a project of the heart. A book that I hoped would go out and serve as a compass rose for clinicians just like you. Clinicians that were on their PFD journey and looking for guidance… a how-to-guide for, “If I see this symptom then I should consider referring to this IPP partner”… a how-to-guide complete with clinical case studies and moments meant to make you laugh, cry a little, but mainly to feel empowered to make a change and advocate for your patient! All that work culminated in “Chasing the Swallow: Truth, Science, and Hope for Pediatric Feeding and Swallowing Disorders”. (Cue the shameless plug that it is available on Amazon, can get to your doorstep in about 48 hours…oh and it’s eligible for 13.5 hours of ASHA CEUs on SpeechTherapyPD.com). I know the isolation of home health, the isolation of early intervention, I know how you feel in the muck and the mire of Monday through Friday. I built this, crafted this text to bring the village to you, so that as you stepped across the patient’s threshold on a busy Tuesday morning, (coffee in one hand, laptop in the other), you have me and this village of passionate evidenced-based driven specialists in your back pocket to help guide your next steps… all of them from Allergists, Gastroenterologists, Otolaryngologists, Psychologists, fellow SLPs, and more!
Lean in with me. Together, with the brilliant Erin Forward, MSP CCC-SLP, CLC, we’ve spent almost 4 years growing via “First Bite: Fed, Fun, Functional” a Speech Therapy Podcast. Take the next step along your PFD journey and embrace interprofessional practice wisdom that is found in “Chasing the Swallow”…chase down the etiology/etiologies with your IPP Team…let it guide your treatment plan of care…and as always…find joy on the journey!
#SLPSOFFAITH
~Michelle L. W. Dawson, MS CCC-SLP, CLC
P.S. Erin and I are working on a free PFD pdf too 😊 So stay tuned, we’ll have that to you soon!
[1] Kovacic K, Rein L, Kommareddy S, Szabo A Bhagavatula P, Goday PS. Pediatric feeding disorders: A nationwide prevalence study. J Peds. DOI: https://doi.org/10.1016/j.jpeds.2020.07.047
[2] Goday PS, Huh SY, Silverman A, Lukens CT, Dodrill P, Cohen SS, Delaney AL, Feuling MB, Noel RJ, Gisel E, Kenzer A, Kessler DB, de Camargo OK, Browne J, Phalen JA. Pediatric feeding disorder: consensus definition and conceptual framework. JPGN 2019;68(1):124-129.
