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Pediatric Feeding SERVICES
sponsored by ROtary Club of Chattanooga


What is a Pediatric Feeding Disorder?

A Pediatric Feeding Disorder is a condition of impaired oral intake that impacts a child’s medical status, growth and nutrition, social and skill development, and daily family functioning. Feeding disorders are different than common feeding challenges in young children that are typically short-lived and do not impact the child’s overall growth and development. For children with more significant feeding disorders, the child may not consume enough volume or variety of food/drink to gain weight and sufficient nutrition for proper growth and development. These mealtime challenges have a significant impact on school placement, social opportunities, and family routines. 


What does a Feeding Disorder look like?

• Eating or drinking very little and not enough for weight gain; concerns about growth.

• Eating only certain food types or textures.

• Delayed oral motor skills like chewing, swallowing, and eating or drinking safely.

• Challenging mealtimes including tantrums, gagging and vomiting.
 
• Dependence on gastrostomy (g-tube), naso-gastric (NG-tube), or supplemental drinks when safe for oral feeding.


Who has Feeding Disorders?

There are a number of medical, nutritional, developmental/skill, and psychosocial factors that can contribute to the onset of a feeding disorder. Some common conditions that co-occur with feeding disorders include:


• Gastroesophageal reflux disease

• Palate defects

• Prematurity

• Esophagitis

• Duodenitis

• Motility disorders

• Food allergies

• Motility disorders

• Behavior challenges

• Developmental Disabilities including Autism Spectrum Disorders

• Failure to Thrive

• Avoidant Restrictive Food Intake Disorder (ARFID)

• Oral motor dysfunction (dysphagia, swallowing problems)

• Gastritis

• Delayed exposure to variety of foods


Our Pediatric Feeding Team

The Pediatric Feeding Team consists of specialists in pediatric feeding from the disciplines of speech-language pathology, occupational therapy, and behavior psychology/behavior analysis. Our interdisciplinary approach and specialized experience brings a unique approach to child health services.  We work closely with other specialists including Gastroenterology, Allergy/Immunology, Neurology, Developmental Pediatricians, and Primary Care Pediatricians to assess factors impacting feeding. 


Our Approach

Siskin Children’s Institute provides Pediatric Feeding Services with an interdisciplinary approach to assess and treat feeding difficulties in children. Children referred to our feeding therapy service are evaluated by one or more of our feeding team members during an initial evaluation. We ask for consent to have active collaboration with other consulting professionals to ensure that the child is medically stable and safe for intervention. Following the initial evaluation, individualized recommendations for treatment are provided. 

Initial Evaluation
This is a single appointment to gather information related to the child’s developmental, medical, feeding, and social history and a family mealtime observation. This will allow us to better understand the current challenges your child and family are facing. We will connect with other relevant medical providers to develop a plan for feeding intervention. Many children will then subsequently receive ongoing therapy from one or more clinicians to work toward improved feeding.

Treatment
Treatment goals are individualized to the child’s needs and family priorities. The team will work with you to identify clear and measurable goals for treatment that will allow you to objectively track treatment progress. 

Common Goals for Treatment

•  Decrease enteral tube feedings

•  Increase oral intake of solids and/or liquids

•  Decrease refusal or problem behavior at mealtime

•  Increase variety and/or texture of solid foods

•  Improve skills, independence and flexibility within the meal routine

•  Caregiver coaching to develop a mealtime structure or routine

Outpatient Services
These services are typically 1-2 appointments per week that occur initially in the clinic for children whose mealtime behavior is challenging but not impacting the child’s nutritional status. These sessions involve a combination of direct therapy with the child to develop routines and skills as well as caregiver coaching/consultation. Telehealth services are may be incorporated following demonstration of treatment gains in clinic and completion of hands-on caregiver training.

Intensive Services - Coming Soon!
These services are typically multiple daily sessions that occur for a 6- to 8-week period designed to help your child overcome feeding barriers. This intensive-level of intervention is offered when weekly outpatient caregiver consultation and coaching is insufficient to address the feeding concerns. These services may be recommended at the outset of therapy or following some period of outpatient services depending on individualized needs of the child. Caregiver training and participation is an important part of this intervention.

Meet Letty and discover how Siskin is helping her reach her goals.

When Letty was first born she didn't eat well. Her parents were worried and knew something was wrong.

At five weeks old Letty was diagnosed with pyloric stenosis. Letty would later develop erosive esophagitis which created a food aversion. By five months old Letty decided that it hurt too much to eat and she wasn't going to eat anymore. Letty's family was worried and needed to find help for the daughter.

Then they were referred to Siskin Children's Institute. At Siskin, Letty's parents worked with the therapy team to get the services they need. Now Letty is showing improvements everyday and has the support she needs to grow.

Learn more about Letty's story, 
watch the video here.


Pediatric Feeding Team

Melissa L. Gonzalez, ph.d., BCBA-D

Clinic Therapy Director
Melissa L. Gonzalez, Ph.D., BCBA-D joined Siskin Children’s Institute as the Clinical Therapy Director in September, 2019. Dr. Gonzalez has previously led the development of an Interdisciplinary Pediatric Feeding Clinic in her home state of Louisiana within a children’s health network. Prior to her stop in Louisiana, she was faculty in the Pediatric Feeding Disorders Program at Kennedy Krieger Institute in Baltimore, Maryland and an Assistant Professor in the Department of Psychiatry and Behavioral Sciences at Johns Hopkins University School of Medicine. Dr. Gonzalez is a clinical psychologist and board-certified behavior analyst with specialized experience in working with individuals with intellectual impairments, autism spectrum disorders, and pediatric feeding disorders. She is excited to serve Tennessee families through supervision of clinical programs and continuing education of community professionals at Siskin Children’s Institute.


THOMAS MULDERINK, PH.D.


Thomas Mulderink, Ph.D. is a psychologist with specific training and expertise in pediatric feeding issues and behavioral parent training. Dr. Mulderink comes to Chattanooga from the Peyton Manning Children’s Hospital Pediatric Feeding Program. He completed a post-doctoral fellowship and internships at the Kennedy Krieger Institute with the Johns Hopkins University School of Medicine where he gained specialized training and experience with Pediatric Feeding Disorders. Tom earned his Ph.D. in School Psychology from Illinois State University as well as his Master of Science in Psychology. He completed his Bachelor of Arts in Psychology from Purdue University.

CONOR OBRIEN, BCBA

NICHOLAS ANDAL, CCC-SLP


QUESTIONS:  Call 423.490.7710

Ask your pediatrician for a referral to Siskin Pediatric Feeding Services today.

If you're a physician or referring provider you can Make A Referral Now.
Pediatric Feeding Services available in Chattanooga, TN location only. 


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Made possible by
the Rotary Club of Chattanooga

The Rotary Club of Chattanooga partnered with Siskin Children’s Institute to provide a pediatric feeding clinic serving children, caregivers, and parents in the ten counties of Southeast Tennessee. On Friday, July 31, a $35,000 check was presented by Rotary President Elaine Swafford to SCI President and CEO, Derek Bullard, for this purpose.


OUR service Area

We serve areas within a 1 hour driving radius of our Chattanooga location.
1101 Carter Street, Chattanooga, TN 37402

Tennessee: Hamilton, Bradley, Marion, Sequatchie, and Rhea. 
Georgia: Dade, Walker, Catoosa, Whitfield, Murray, Gordon, and Chattooga.

A physician referral is required for Feeding Therapy services.