Pediatric Feeding Program
What is the Pediatric Feeding Program at Seattle Children’s Autism Center?
The Pediatric Feeding Program at Seattle Children’s Autism Center evaluates and treats children age 1 to 13, with or without autism, who struggle with eating and drinking in ways that either:
- Put their physical or emotional health at risk
- Seriously affect how they behave
Many complex factors affect if and how a child will eat. Our program includes experts from many areas of healthcare who work closely with each other and with you to:
- Understand your child’s unique feeding problems.
- Understand how feeding problems affect your family.
- Provide targeted treatment that leads to meaningful change.
Our goal is to build healthy feeding patterns that your child and family can keep using at home and in the community.
This program is different from our:
- Intensive Feeding Program (PDF), a 2-week outpatient program for children age 1 or older who are ready to transition from tube feeding to oral feeding
- Growth and Feeding Dynamics Clinic, where dietitians, social workers and occupational and physical therapists treat children ages 9 months to 4 years old who are unable to eat, refuse to eat or have a hard time eating
A feeding disorder means your child struggles with eating or drinking enough to stay healthy and grow. A child’s feeding problems can also cause stress for their family and affect the family’s daily life.
Feeding disorders take many forms, such as:
- Your child has problems with chewing or swallowing.
- Your child doesn’t have a healthy, balanced diet because they eat only a few foods or only some types of food.
- Your child eats or drinks very little and does not gain weight or grow.
- Your child does not eat anything at all and may need to get nutrition in other ways, such as through a tube into their stomach or intestine or through an intravenous (IV) line.
If your child doesn’t get enough calories or doesn’t eat certain types of food, they are at risk for growth or health problems from poor nutrition.
You might hear healthcare providers use the term “feeding difficulties” for feeding disorders or talk about one type of feeding disorder called “avoidant restrictive food intake disorder (ARFID)”.
How will the Pediatric Feeding Program meet my needs?
The Feeding Program brings a team of specialists together in one place to give your child and family the most complete care.
- Unlike most feeding programs, our program combines experts from many areas of healthcare to assess and treat your whole child. The team includes experts in medicine, nutrition, speech and language, psychology, behavior and social work.
- Members of your team have special training not only in their field but also in the unique needs of children who struggle with eating.
- We work together to understand:
- Your child’s skills
- Any sensory or medical challenges your child has related to eating
- How your child has learned and felt about eating
- Your child’s response to feeling hungry or full
- Each child with a feeding problem is different. We work closely with your family to provide treatment custom-made for your child. We understand what it’s like for families to live with daily eating challenges.
- Drawing from a broad range of treatment methods, we make a treatment plan and schedule based on your child’s needs.
- Parents and caregivers are keys to a child’s success. You will take an active part in setting treatment goals, practicing treatment during visits and at home and talking about what works.
- During treatment, you and your child’s team will carefully collect data to learn what is working for your child.
- We ask your child to answer questions about themselves, if they can. We also ask you to answer questions about your child’s behavior and symptoms. You complete data sheets tailored to your family.
- These and other tools help us track your child’s progress and refine their treatment to make it a success.
- The Feeding Program team does research to learn more about the best ways to help children and families with feeding disorders.
- To help ensure every child gets the care they need, we consult with healthcare providers in other programs around Seattle Children’s and teach other healthcare providers about feeding disorders and treatment.
Who can benefit from the Pediatric Feeding Program?
We work with a range of children, including:
- Children who refuse all or almost all foods.
- Children who prefer certain food types or textures.
- Children who get some or all of their nutrition through a G tube, J tube or NG tube.
- Children who struggle with the oral motor skills they need to eat and drink safely. For example, they might struggle with chewing and eating advanced textures.
- Children with sensory sensitivities that make it hard for them to eat a wide range of food types and textures. For example, they might struggle with the way eating or drinking feels or with the taste, smell, texture, bite size or sight of food. They might seem afraid of food coming near their face or mouth.
- Children who learned that eating is unpleasant or difficult.
- Children who felt pain with eating due to a health problem, like gastroesophageal reflux or irritable bowel disease.
- Children who have severe anxiety about mealtimes linked with challenging behaviors. These may include refusing to come to the table for meals, not following directions during meals, having tantrums and being aggressive.
What services do you offer?
We offer a range of services to meet the needs of different families. We start with intake visits to learn what your family’s needs are.
The first step is 2 visits at the Pediatric Feeding Program Intake Clinic. At these visits, team members from many areas of healthcare will:
- Meet you and your child.
- Assess your child’s feeding problems.
- Learn about your family’s goals for treatment.
Then we will recommend a treatment plan. The plan may combine many methods and include many team members. We may recommend:
- Intensive outpatient feeding therapy
- Outpatient feeding therapy with our program or community providers
- Classes for you about feeding disorders in children
- Care options to discuss with the provider who referred you
Children getting this service will be seen in clinic each day from 8 a.m. to 5 p.m., Monday through Friday, for 2 to 3 weeks.
During this time, the care team will work with you and your child on focused treatment custom-made for your child and family. We will teach you treatment methods to practice at home, and we will give you tools to track your child’s progress.
Because this therapy is so intensive, we are able to work with only 1 child and family per month.
Children getting this service will be seen on a regular schedule for many weeks. We may see your child in person at the clinic, or we may see them through telemedicine (using videoconferencing):
- At regional clinics.
- In your home or community through our telemedicine pilot project. This option depends on factors like your child’s needs, the providers your child sees and the insurance you have.
How often and how long we see your child will depend on their treatment plan. The team will set a schedule when treatment starts. A common schedule is once a week for a few months.
Your child will see the experts from our team who match your child’s needs.
We will teach you treatment methods to practice at home and give you tools to track progress. At each clinic visit, we will practice treatments and check progress together.
We offer classes to help parents understand feeding disorders in children and the first steps towards care. Classes are meant for families who are on the waiting list for the intake clinic, intensive outpatient therapy or outpatient therapy. We provide classes:
- In person at the clinic
- Using your tablet, laptop or desktop computer that has a camera so you can take part from home, work or wherever you are
Learn about Feeding First Steps: Parent Education Class (PDF).
What to Expect
Things to do before your appointment
- Complete the family questionnaire that the scheduling team gives you.
- Get your child’s records and test results. Ask your child’s doctor for any test results that relate to their feeding issues. Have your provider fax them to us at 206-987-8081.
Bring to your appointment
- Your completed family questionnaire
- Your completed food diary
- List of your child’s current healthcare providers (with contact information) and treatment goals
- List of medicines and supplements your child is on now (with doses) and any special diet they follow
- Foods and drinks that your child is willing to accept and those they struggle with
What happens during your 60-minute visit
- Complete history of your child’s feeding struggles
- Review of your child’s current treatment plan
- Review of your child’s current food and drink intake patterns and preferences
- Teaching about therapies and approaches your child may need
- Clinical feeding and swallowing evaluation (PDF) (Spanish)
After your Intake Clinic visits
- We will recommend a treatment plan.
- The treatment plan may include a list of care options for you to discuss with the provider who referred you. If your provider has questions, we are happy to talk with them.
Scheduling an Appointment With the Feeding Program
- If you would like a referral to the Feeding Program, talk to your primary care provider.
- They will need to write a referral for the Pediatric Feeding Program at Seattle Children’s Autism Center and fax it to 206-985-3121.
- When we get the referral, we will place your child on our waiting list.
- When a space opens for your child, we will contact you to schedule your intake visits.
- Learn about autism resources such as useful links, videos and recommended reading for you and your family.
When we have your referral, we may contact you and ask for more details, like these:
- Your child’s growth charts from birth to now
- Details about any current medical concerns
- Results of lab tests or diagnostic procedures
- Other evaluations your child has had
- Current treatment plans or progress summaries from therapists (like occupational therapists, speech therapists and psychologists) that your child sees in the community
- Videos of your child eating at home or in therapy
- A food diary to track your child’s eating and drinking over several days
Who’s on the team?
Your child’s care team includes psychiatrists, pediatric and behavioral psychologists, special educators and mental health therapists who are board-certified behavior analysts, advanced registered nurse practitioners, registered dietitians, speech and language pathologist (SLP) and social workers.
Providers in the program include:
- Danielle Dolezal, PhD, BCBA-D, clinical supervisor, Pediatric Feeding Program
- Yaniz Padilla Dalmau, PhD, BCBA-D
Behavioral mental health therapists
- Valori Berends Neiger, MS, BCBA, LBA
- Anna Levin, MEd, BCBA, LBA
- Amber Persons-Geer, MSW, LAICSW, BCaBA, program coordinator
- Blayne Stemple, MEd, LBA, BCBA
- Barb Buchanan, MS, RD, CD
- Lauren Kipp, CCC-SLP
For more information, contact the Feeding Program at 206-987-8080. If you would like an appointment, ask your child’s primary care provider for a referral.
Providers, see how to refer a patient.