Treatment Time-Share A feeding day care program takes an interprofessional approach to treating children and training parents. In the Limelight
In the Limelight  |   March 01, 2016
Treatment Time-Share
Author Notes
  • Shelley D. Hutchins is content producer/editor for The ASHA Leader.
    Shelley D. Hutchins is content producer/editor for The ASHA Leader.×
Article Information
Hearing Disorders / Swallowing, Dysphagia & Feeding Disorders / Healthcare Settings / Professional Issues & Training / Speech, Voice & Prosody / In the Limelight
In the Limelight   |   March 01, 2016
Treatment Time-Share
The ASHA Leader, March 2016, Vol. 21, 20-21. doi:10.1044/leader.LML.21032016.20
The ASHA Leader, March 2016, Vol. 21, 20-21. doi:10.1044/leader.LML.21032016.20
Dale Swartos feeds a premature infant at Mt. Washington Pediatric Hospital. Swartos and occupational therapist Ellen Wingert helped establish the hospital’s feeding day program.
Name: Dale Swartos, MS, CCC-SLP
Hometown: Baltimore
Eating involves much more than chewing and swallowing. Children with feeding disorders often miss numerous cultural and social traditions by not enjoying meals, and face fear and anxiety about food well beyond physiological issues. So do parents.
Speech-language pathologist Dale Swartos and his colleague, occupational therapist (OT) Ellen Wingert, saw the need to address such complexities with more than outpatient sessions. They worked as part of a team of pediatric health professionals to create the Feeding Day Treatment Program at Mt. Washington Pediatric Hospital in Baltimore.
“Ellen and I were the two rehab clinicians involved from the start of the feeding day program,” says Swartos. “Plus, we worked with a psychologist—the three of us did all feeding treatments—but the team included nutritionists, dieticians, gastrointestinal doctors and nurses,” he added.
This broad interprofessional team makes up the most important and unusual component of the program, says Wingert. She adds that all professionals involved—a number that continues to grow—value everyone else’s opinions and expertise. The team evaluates and diagnoses each patient and eventually trains parents to successfully implement feeding protocols at home. What began with one child in 2001 is now a program with a waiting list so long it can take months for a new client to claim a spot.
As the program has grown, its mission now includes sharing the interprofessional approach with other clinicians. For example, the day care program hosted its first national conference in 2015, and the team is designing a training program for community clinicians who have limited access to other professionals.

“We wanted the mix of addressing medical, oral motor/sensory and behavior issues from the beginning, because feeding issues aren’t fixed by one type of treatment.”

Mixing it up
Interdisciplinary treatment protocols match the complexity of each child’s diagnosis. After the team’s initial evaluation, a designated primary clinician writes a protocol, which the rest of the team follows. That clinician also provides most of the feeding sessions for his or her patients. Only SLPs, OTs and psychiatrists are primary clinicians, with doctors, nurses and dieticians as consultants and reviewers. Patients are matched with a lead discipline depending on their primary feeding issue: medical, oral motor/sensory or behavioral. Swartos says the caseload is evenly distributed among the three clinical disciplines, but the primary clinician often changes during a standard six-week session.
If a child experiences a medical issue like severe reflux, for example, then Swartos—if designated primary clinician—writes treatment protocols and serves as lead. However, the child may feel anxious about eating because of bad experiences with food, so primary treatment might shift to a psychiatrist after a few weeks. In addition, the child might not chew correctly because of not eating many solid foods, so an OT also provides oral motor treatment.
“We wanted the mix of addressing medical, oral motor/sensory and behavior issues from the beginning because feeding issues aren’t fixed by one type of treatment,” says Swartos. “We identify clients’ one dominant issue, which receives the most focus, but all three get treated.”
The three disciplines participate in weekly “rounds” to review each client’s progress toward defined goals. All team members easily offer or accept one another’s ideas, according to Swartos. “This group always needs to be communicating,” he says. “We set up goals at the beginning of treatment. They’re very interdisciplinary, so one objective might need treatment ideas from all disciplines. We really rely on each other to accomplish larger goals.”
The program accepts children ages 18 months to 14 years, but most clients are 2 to 4 years old. A typical day involves treatment sessions for breakfast, lunch and a snack, plus naps, hospital services, sensory activities with non-food items, nonspeech oral movement practice, free play, crafts, and weigh-ins three times a week.

Only SLPs, OTs and psychiatrists serve as primary clinicians, while doctors, nurses and dieticians act as consultants and reviewers.

Taking it home
Parent training is a big priority for the program. “It sounds funny, because the parents fed them for their entire life,” Swartos says, “but we’re teaching a new way to feed and eat. We encourage parents to watch every session if they can. They’re required to observe or participate in a certain number and we make sure they can fully implement the protocol by the time the child is discharged.”
Parents begin by watching their kids through a video monitor, remaining behind the scenes. At first, nothing at home changes either, to avoid stressing the child. The last few weeks, parents participate in sessions and eventually administer meals using the protocols. The primary clinician sits by their side at first, but eventually leaves the room to offer corrections using an earpiece or feedback after each meal. Once a client completes the six-week day program, the primary clinician schedules follow-up outpatient sessions as needed until the client is discharged.
“This interdisciplinary approach helps us prepare the child to follow a protocol anyone can implement successfully,” says Swartos. “One thing we’ve really come to realize is that we need all these other disciplines to create a complete picture.”
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March 2016
Volume 21, Issue 3