The Community-Based
Feeding Team…
Improving the lives of
children and families
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The purpose of a community-based
feeding team is to provide these
needed services to infants and children
and their families close to home:
• Comprehensive interdisciplinary
evaluation of the feeding skills,
including but not limited to oral motor
development; nutritional status;
growth and eating behaviors.
• Development of a family centered
plan for community referrals and/or
intervention
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Participating agencies may
include:
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Children’s Therapy Centers
Elks Therapist
Hospital or Medical Clinic
Infant-Toddler program
Local Health Department
Neurodevelopmental Center
School-based Special Services
WIC Program
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Training and Formation
of Feeding Teams in
Washington State...
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• The first two community feeding
teams were formed in a pilot
training program sponsored by
the Center on Human
Development and Disability
(CHDD) at the University of
Washington and the Washington
State Department of Health
(WSDOH) in 1993.
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•Since 1993, 16 communitybased teams have been
brought together for training.
•Annual updates are provided
for these teams by CHDD and
WSDOH.
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Feeding Teams in Washington
State are located in the
following counties:
Benton-Franklin, Chelan-Douglas,
Cowlitz, Grays Harbor, King ,Kitsap,
Pierce, Skagit, Snohomish, Spokane,
Thurston, Whatcom, Yakima
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Why…
A feeding team?
a little background…
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Successful feeding goes
hand in hand with
developmental progress.
Here are some aspects of
that mutual relationship…
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Feeding supports physical
development and good
health…
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Well nourished infants and
children grow well
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Well nourished infants and
children experience less illness
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Feeding supports social
development…
• It provides an important
opportunity for babies and their
parents or caregivers to bond to
each other
• Meal time may be the only time of
day when the family is together
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Feeding supports speech
development…
• Eating involves movement
patterns similar to those used in
speech
• Good feeding programs develop
the muscles needed for speech
acquisition
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Successful feeding helps
infants and children develop
a sense of autonomy...
Being able to feed
or refuse food
helps
the child develop
a sense of control
over her
environment
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These developmental
tasks require a large
repertoire of feeding
skills…
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A newborn needs a strong
reflexive suck to nurse
successfully.
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Later, the baby must suppress the
sucking reflex in order to develop
the ability to use the tongue to take
food from a spoon and move it in
the mouth…
• from side to side for chewing
• from front to back for safe
swallowing
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The baby must be able to sit in a
stable fashion and open her
mouth to signal readiness
for a spoonful of food.
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The baby must
develop the
ability to pick
up food and
put it in his
mouth in
order to
self feed.
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Later still, the infant will need
to learn…
• to use a spoon,
• to hold and drink from a glass
• to chew textured foods
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The infant and mother/caregiver must
develop a mutually satisfying
relationship that is contingent on the
ability of both to give, read and
interpret the others’ cues.
• The baby must be able to show hunger,
satiety, pleasure and displeasure;
• The mother must be able to interpret the
baby’s cues and act accordingly
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Since the ability to feed her infant is
often seen as an element of nurturing in
a mother, disruption of this feeding
relationship may affect both…
• a mother’s perception
of her ability to
parent; and
• her relationship
with her baby.
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Many children progress
quite naturally and easily
through the various
stages of feeding
development…
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However…
nearly 25% of all infants
and children are affected
by feeding disorders.
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Among infants and children
with developmental
disabilities, as many as
80% may face feeding
challenges.
Here are some of those challenges…
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Primitive reflexes (such as suck,
gag or startle) fade in the typically
developing infant but may remain
in the child with
neuromotor
concerns and
interfere with the
ability to feed.
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Oral defensiveness is
often seen in an infant or
child who has been on a
respirator or has
experienced tube
feeding and may result
in unwillingness to
accept new foods or
textures by mouth.
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Neurological impairment may
interfere with the ability to
give clear hunger or
satiety cues.
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Poor coordination
of oral structures
may interfere with
the ability to move
food in the mouth,
to chew or swallow
in a safe and
effective manner.
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Delayed motor
skills may interfere
with efforts
to self feed.
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Children with feeding
problems such as these are
unlikely to “outgrow” their
abnormal behavior patterns
without intervention.
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Watch for these common
“red flags”…
• Stagnated growth
• Frequent bouts with pneumonia
due to aspiration
• Feedings which exceed 45
minutes in duration
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Which children are likely to
be at risk for feeding
challenges?
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Infants or children who are not
growing appropriately,
or
whose parents are concerned
about the adequacy of their
diet…
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Infants and children with
delayed feeding skills or
abnormal oral motor
patterns…
• inadequate use of utensils
• difficulty in chewing textured
foods
• swallowing difficulties
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Infants or children with
feeding tubes…
• those transitioning from tube feeding to
oral feeding
• those who will continue to need tube
feeds in order to meet nutrient needs, but
– would benefit from the social aspects of
being able to consume some food
orally
– would experience oral feeding as an
enhancement to speech therapy
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Infants or children with
problematic feeding behaviors,
including…
• significant distractibility during
mealtimes
• unclear hunger and appetite signals
• disruptive feeding behaviors such as
throwing food, gorging or rumination
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Medical diagnoses
in which feeding difficulties
are commonly seen include…
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Autism
Cerebral palsy
Cystic Fibrosis
Failure to Thrive
Gastro-esophageal
reflux
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Genetic disorders
Metabolic disorders
Prematurity
Short bowel
syndrome
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“Coming together is the beginning,
Staying together is progress,
Working together is success.”
Henry Ford
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An interdisciplinary feeding
team works with the family
to identify, prioritize and
address feeding concerns.
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The Multidisciplinary
Feeding Team may include…
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Family
Behavioral Psychologist
Dental Hygienist
Nurse
Nutritionist
Occupational Therapist
Parent Advocate
Physical Therapist
Social Worker
Speech Therapist
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School
Health
Department
Birth to Three
Family
and Child
Behavioral
Psych
Physician
Hospital
Therapist
Nutritionist
The Family is at the center of the
team.
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How does the Feeding
Team work?
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Assessment
The interdisciplinary team provides
comprehensive assessment of oral-motor
development, nutrition and eating
behaviors through
• Direct or videotaped observation of
feeding
• Individual assessments by team
members
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Planning, Referral and
Follow-up
• The team works with the family to
make a written plan for intervention
• The team communicates closely with
community professionals already
involved
• Appropriate referrals are made at the
family’s request
• Periodic follow-up is provided to
address changing needs
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The Family Centered Approach is
key to a successful feeding team…
• The team works with the family to
prioritize goals for the child
• The team works together to make
consistent recommendations
• The team helps consolidate
appointments for the family
• Team evaluations and planning are
sensitive to the cultural background of
the family
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Working together, the family
and team produce positive
outcomes…
• Nutritional status and overall health of
the child are improved
• Parent-child interactions are
strengthened
• Developmental progress is enhanced
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Feeding Teams
provide cost
effective
interventions
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A recent study of community feeding
teams in Washington State showed
the following positive outcomes for
Children with Special Health Care
Needs and their families:
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Appropriate growth
Improved dietary intake
Decreased illness and hospitalization
Improved feeding skills
Improved health status
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Medical cost savings for
children studied ranged
from
• $1700 (over a four month period)
• to $8100 (over one year)
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Depending on the location,
reimbursement for feeding team
services may be provided by…
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Medicaid
Third party insurance payments
School district contracts
Part-C funds-US Department of Education
of Individuals with Disabilities Education Act
(IDEA)
• Health department Maternal and Child
Health Programs
• CSHCN Diagnostic and Treatment Funds
• Local community grants
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Credits/References
1. Dietetics in Developmental and Psychiatric Disorders Practice Group,
The American Dietetic Association; Survey of the University Affiliated
Program Feeding Evaluation Teams. The American Dietetic Association,
Chicago, IL, 1998.
2. Goodwin, Annie. Personal Communication, Benton-Franklin Pediatric
Feeding Team, Benton-Franklin Health Department. Kennewick, WA,
2001.
3. Office of Children with Special Health Care Needs, Division of
Community and Family Health, Washington State Department of Health:
Cost Considerations: The benefits of Nutrition Services for a Case
Series of CSHCN in Washington State. Washington Department of
Health, Olympia, WA, 1998.
4. Pipes, P and Lucas B. Guidelines for the Development and Training of
Community-Based Feeding Teams in Washington State, Office of
Children with Special Health Care Needs, Division of Family and
Community Health, Washington Department of Health, Olympia, WA
1994.
5. Position of the American Dietetic Association; Nutrition services for
Children with Special Health Needs. J Am Diet Assoc. 95:809-812,
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1995.
Community and Family Health
August 1, 2001
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