Guest Commentary

Guest commentary: A new age for pediatric feeding disorder

James Phalen
James A. Phalen

In this guest commentary from Feeding Matters, James A. Phalen, MD, Medical Director of Feeding Matters discusses a newly-published article that he co-authored on pediatric feeding disorder. Phalen serves as developmental pediatrician, University Health System, University Medicine Associates, San Antonio, Texas; Adjunct Professor of Pediatrics, University of Texas Health San Antonio, Texas; and Clinical Professor of Pediatrics, Uniformed Services University of the Health Sciences F. Edward Hébert School of Medicine, Bethesda, Maryland.

A smooth, perfectly plump firm apple sits in front of you. The skin is unblemished and the interior is firm and sweet. The seemingly simple task of opening your mouth to take a bite, in actuality, is quite complex. The feeding process depends on intricate and well-coordinated interactions within the body systems, the acquisition of age-appropriate feeding skills, ongoing nutritional availability and variance, and psychosocial well-being in the caregiver-child dyad. Any disruption of health, development, experience, or environment creates risk for feeding dysfunction. That gorgeous apple will remain uneaten.

Although 25% to 50% of neurotypical children and up to 80% of those with developmental disabilities have feeding problems, this heterogenous population often goes undiagnosed and underserved. When feeding is failing, we, as medical professionals meet with an equally complex task: the diagnosis and management of an undefined condition with poorly identified parameters viewed through the lens of a single discipline. Fortunately, for children who suffer from a feeding disorder, the paradigm is shifting.

The Journal of Pediatric Gastroenterology and Nutrition published our field-leading consensus paper proposing a unifying term and diagnostic criteria for the broad spectrum of pediatric feeding struggles known as pediatric feeding disorder (PFD). Our team of 15 experts from seven fields defined PFD as impaired oral intake that is not age-appropriate, and is associated with medical, nutritional, feeding skill, and/or psychosocial dysfunction.

Your role in advancing care

We are in a unique position to advance best practices in PFD by serving as a conduit for change. This article calls us to action. Praveen S. Goday, MD, lead author of the consensus paper and director of the Feeding, Swallowing and Nutrition Center at Children’s Hospital of Wisconsin, stated, “By incorporating associated functional limitations, the proposed diagnostic criteria for PFD should enable the health care community to better characterize the needs of this diverse population of patients; facilitate collaborative care among the relevant disciplines; and promote the use of common, precise, terminology necessary to advance clinical practice, research, and health-care policy.”

What are our collective next steps?

  • Establish common terminology by using the term PFD and the proposed diagnostic criteria in clinical documentation and professional communication.
  • Advocate for comprehensive multidisciplinary care:
    • Recognize the parent/caregiver as a team member.
    • Refer patients, as needed, to specialists in all 4 domains:
      • Medical dysfunction: pediatric gastroenterologists, developmental pediatricians.
      • Nutritional dysfunction: registered dietitians.
      • Feeding skill dysfunction: occupational therapists, speech-language pathologists.
  • Psychosocial dysfunction: Involve psychologists and counselors.
    • Seek coordination of care amongst disciplines.
  • Promote early identification of children and families at risk for PFD through screening.
  • Advocate for medically necessary care:
    • Use the definition of PFD to seek reimbursement or authorization for service.
    • Use the terms “impairment” and “dysfunction” to identify areas of need.
  • Maintain advance clinical practice.
    • Identify research opportunities.
    • Maintain body of knowledge relevant to PFD.

Every touch point is an opportunity to promote system wide change. Where will you start?

For more information:

Phalen can be reached at PediDev@uhs-sa.com. Established in 2006, Feeding Matters is the first organization in the world uniting the field’s leading advocates, experts, and allied health care professionals with the concerns of families to ignite unprecedented change to the system of care through advocacy, education, support, and research – including a standalone diagnosis, the International Pediatric Feeding Disorder Conference, and the Infant and Child Feeding Questionnaire. To learn more about Feeding Matters or PFD, visit feedingmatters.org.

Disclosures: Phalen reports no relevant financial relationships.

James Phalen
James A. Phalen

In this guest commentary from Feeding Matters, James A. Phalen, MD, Medical Director of Feeding Matters discusses a newly-published article that he co-authored on pediatric feeding disorder. Phalen serves as developmental pediatrician, University Health System, University Medicine Associates, San Antonio, Texas; Adjunct Professor of Pediatrics, University of Texas Health San Antonio, Texas; and Clinical Professor of Pediatrics, Uniformed Services University of the Health Sciences F. Edward Hébert School of Medicine, Bethesda, Maryland.

A smooth, perfectly plump firm apple sits in front of you. The skin is unblemished and the interior is firm and sweet. The seemingly simple task of opening your mouth to take a bite, in actuality, is quite complex. The feeding process depends on intricate and well-coordinated interactions within the body systems, the acquisition of age-appropriate feeding skills, ongoing nutritional availability and variance, and psychosocial well-being in the caregiver-child dyad. Any disruption of health, development, experience, or environment creates risk for feeding dysfunction. That gorgeous apple will remain uneaten.

Although 25% to 50% of neurotypical children and up to 80% of those with developmental disabilities have feeding problems, this heterogenous population often goes undiagnosed and underserved. When feeding is failing, we, as medical professionals meet with an equally complex task: the diagnosis and management of an undefined condition with poorly identified parameters viewed through the lens of a single discipline. Fortunately, for children who suffer from a feeding disorder, the paradigm is shifting.

The Journal of Pediatric Gastroenterology and Nutrition published our field-leading consensus paper proposing a unifying term and diagnostic criteria for the broad spectrum of pediatric feeding struggles known as pediatric feeding disorder (PFD). Our team of 15 experts from seven fields defined PFD as impaired oral intake that is not age-appropriate, and is associated with medical, nutritional, feeding skill, and/or psychosocial dysfunction.

Your role in advancing care

We are in a unique position to advance best practices in PFD by serving as a conduit for change. This article calls us to action. Praveen S. Goday, MD, lead author of the consensus paper and director of the Feeding, Swallowing and Nutrition Center at Children’s Hospital of Wisconsin, stated, “By incorporating associated functional limitations, the proposed diagnostic criteria for PFD should enable the health care community to better characterize the needs of this diverse population of patients; facilitate collaborative care among the relevant disciplines; and promote the use of common, precise, terminology necessary to advance clinical practice, research, and health-care policy.”

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What are our collective next steps?

  • Establish common terminology by using the term PFD and the proposed diagnostic criteria in clinical documentation and professional communication.
  • Advocate for comprehensive multidisciplinary care:
    • Recognize the parent/caregiver as a team member.
    • Refer patients, as needed, to specialists in all 4 domains:
      • Medical dysfunction: pediatric gastroenterologists, developmental pediatricians.
      • Nutritional dysfunction: registered dietitians.
      • Feeding skill dysfunction: occupational therapists, speech-language pathologists.
  • Psychosocial dysfunction: Involve psychologists and counselors.
    • Seek coordination of care amongst disciplines.
  • Promote early identification of children and families at risk for PFD through screening.
  • Advocate for medically necessary care:
    • Use the definition of PFD to seek reimbursement or authorization for service.
    • Use the terms “impairment” and “dysfunction” to identify areas of need.
  • Maintain advance clinical practice.
    • Identify research opportunities.
    • Maintain body of knowledge relevant to PFD.

Every touch point is an opportunity to promote system wide change. Where will you start?

For more information:

Phalen can be reached at PediDev@uhs-sa.com. Established in 2006, Feeding Matters is the first organization in the world uniting the field’s leading advocates, experts, and allied health care professionals with the concerns of families to ignite unprecedented change to the system of care through advocacy, education, support, and research – including a standalone diagnosis, the International Pediatric Feeding Disorder Conference, and the Infant and Child Feeding Questionnaire. To learn more about Feeding Matters or PFD, visit feedingmatters.org.

Disclosures: Phalen reports no relevant financial relationships.

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