of children with feeding difficulties Community Eating and Drinking clinic To support children from birth to 19 years with eating drinking and swallowing difficulties andor enteral feeding and their families We provide assessment and intervention to enable children to eat drink or have ID: 1043186
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1. Referral and management of children with feeding difficulties
2. Community Eating and Drinking clinicTo support children from birth to 19 years with eating, drinking and swallowing difficulties and/or enteral feeding and their families. We provide assessment and intervention to enable children to eat, drink or have tastes as safely and efficiently as possible in order to maximise their participation in daily life. We also assess and monitor growth and provide support around nutrition and hydration for children requiring enteral feeding and work together as a team with families to wean children off tube feeding when appropriate.Our Aim:
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4. Who are we?Community Eating and Drinking clinicSpeech and Language Therapists = Sonja Jacobs and Jane OswellSLT co-workers = Rujina Begum and Nazma BegumDietitians = Karen Blake (Mon-Wed) and Kayee Chan (Thu-Fri)Joint SLT and Dietetics clinics for children on enteral feeds SLT only clinics for all other children with difficulties eating and drinking (children often seen in outpatients dietetics clinic at RLH)DT only clinics for children on enteral feeds who either do not have any swallowing difficulties or are likely to have limited or no oral intake for foreseeable future
5. Our current caseloadCommunity Eating and Drinking clinicCaseload size: 215 children and young people30% under age of 2 years40% between 2-5 years30% over 5 yearsTube fed: 30% of caseload
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7. Our Role:Community Eating and Drinking clinicFeeding assessment and intervention – babies, children and young people with neurodevelopmental difficulties, cerebral palsy, regressive conditions, laryngomalacia or TOF, CLP, Down syndrome, ex-prem babies, babies with VFP post cardiac surgery…Tube weaning jointly with DietitianImplementing strategies to make feeding safer, easier and reducing respiratory infections and choking risk - Using different utensils, work with OT and PT to get optimal positioning for feeding, changing consistencies and texture to optimise safe feeding, pacing …Feeding skills development (Sensory and/or behavioural difficulties –children with ongoing or undiagnosed GOR, oesophageal motility issues, prolonged NG feeding or previous or ongoing force feeding)
8. A few daily challenges…Community Eating and Drinking clinic
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14. “Feeding is clearly a multi-system skill. It requires anatomical integrity, neuromuscular control and co-ordination, sensory perception, adequate gastro-intestinal function, cardio-respiratory support, and integration from the autonomic nervous system. It is also heavily intertwined with behavioural responses.”Wolf & Glass (1992) in Sullivan & Rosenbloom (1996)
15. Take home messages:Community Eating and Drinking clinicEnlarged tonsils and a persistent blocked nose are likely to impact on eating, drinking and swallowing Regular vomiting during or after feeding can impact on a baby/child’s willingness to eating / drink, and can have impact into adult lifeA healthy growth chart does not mean that the baby/child does not have a feeding difficulty
16. Does your child:Have repeated respiratory infections?Cough/choke during meals?Have difficulties initiating and maintaining sucking?Have a constant open mouth posture?Dribble or drool (more than expected for their age)?Have nasal regurgitation of food/fluid?Eyes water/tear during meals?FEEDING/EATING AND DRINKING ASSESSMENTYESDoes your child:Frequently gag during/after meals?Have food remaining in his /her mouth after meals?Frequently refuse to eat or drink?Does your child have a history of reflux/vomiting?Does your child still have episodes of reflux/vomiting?Does your child have a history of throat infections/tonsillitis?Does your child still have episodes of throat infections/tonsillitis?Does your child have a history of poor weight gain/growth?Is weight gain still a concern?Is your child taking any supplements to support weight gain?Has your child seen a dietitian?PAEDIATRIC DIETETIC SERVICEENT (before considering SLT)BEHAVIOUR SUPPORT Under 5 – Educational PsychologyOver 5 - CAMHSYESYESYESYESNONONONOYESYESYESGASTROENTEROLOGY (before considering SLT)Eating and Drinking Referral Pathway
17. Contact detailsSonja JacobsLead Speech and Language Therapist for Complex NeedsFirst Floor, Hastings WardMile End HospitalBancroft RoadLondon E1 4DGTel: 0208 223 8726Email: Sonja.jacobs@barthealth.nhs.uk; Sonja.jacobs@nhs.net