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Good nutrition for the growing infant and toddler is one of the most critical aspects of ensuring proper physical and emotional development, and overall health. Feeding and swallowing issues in the young child can lead to immediate nutritional deficits and longer-term complications if not adequately addressed in a timely manner.
The Feeding and Swallowing Center (FASC) in the Division of Pediatric Gastroenterology, Hepatology, and Nutrition, and the Division of Pediatric Rehabilitation Medicine at UPMC Children’s was initiated more than 10 years ago to provide comprehensive, interdisciplinary care with a family-centric approach for infants and children. The FASC has seen changes and advancements in recent years, beginning with a higher level of collaboration between clinicians in gastroenterology and pediatric rehabilitation medicine, along with elements from dietetics, nursing, occupational therapy, behavioral therapy, and speech-language pathology.
The FASC sees patients for a number of disorders, and also those individuals who have difficulties with limited or poor food intake, food refusal or selectivity, inadequate or slow weight gain, suspected or identified problems with airway protection and swallowing, choking, picky eating, and other difficulties that may not be immediately attributable to an underlying disorder or pathology.
Why an individual, for example, may be a picky eater could involve issues related to food textures and tastes, undiagnosed anatomical anomalies that make chewing or swallowing difficult or painful, conditions such as gastroesophageal reflux disorder, and many more potentialities.
Discovering the cause or causes for feeding and swallowing issues and providing comprehensive, patient- and family-centric plans of care are at the heart of what the FASC does in more than 800 cases every year.
Currently the FASC sees patients in the clinic two days per week. Patients and families are typically triaged into a specific clinic day during the initial appointment request based on whether the probability the child’s issue stems from a GI-related issue or not. During the initial calls, parents are walked through a detailed questionnaire to provide as much information as possible about the symptoms and difficulties their child is having, and also what the parents’ goals are for treatment.
The initial clinic evaluations are thoroughly multidisciplinary, typically take 90 minutes to two hours, and include both the parent(s) and child. FASC team members begin with interviews and questioning to find out more about the problem at hand. They also observe the child as they eat, looking for signs of physical or behavioral issues. Parents are encouraged to bring finger foods or other items the child likes to eat to be used during the evaluation process. The evaluation culminates in a recommendation plan which is given to the parents, and includes any necessary follow-up care suggestions with other specialties as warranted by the team’s evaluation and careful consideration of the patient’s presentation.
Recent changes to the FASC have begun to allow for more, continued follow-up care of patients and families. In its early years and incarnation, its function was more of an evaluation clinic. Leadership at the clinic is now working to build out the necessary infrastructure to allow the clinic to expand into longer-term follow-up care by leveraging advanced practice providers to help manage the additional patient volume, while at the same time setting up the FASC to be able to better track long-term patient outcomes.
Discussions and plans are underway to create a dedicated gastrostomy tube clinic to handle neonatal patients as they get older and can
begin to take in food orally. This effort will bring together elements of neonatology, pediatric surgery, clinical nutrition, and gastroenterology in the FASC to better manage these patients after their discharge from the NICU.
Wednesday Sevilla, MD, MPH, CNSC
Arcangela Lattari Balest, MD
Pediatric Rehabilitation Medicine
Jason Edinger, DO
Dina B. Patterson, MD
Jenny Halper, MSW, LCSW
Nancy Weichler, RN, MSN, CNS
Kelly Fill, MOT, OTR/L
Kim Kubistek, OTD, OTR/L
Reena McCormick, MOT, OTR/L
Nicole Orlando, MOT, OTR/L
Amy Zuraski, MOT, OTR/L
Barbara Horne, RD, LDN
Ann Meyers, MS, RD, LDN
Sharon Strohm, MS, RD, LDN
Stacey Zettle, MS, RD, LDN
Speech Language Pathologists
Lynn Golightly, MA, CCC-SLP
Patricia Kovacs, MA, CCC-SLP
Maxine Orringer, MA, CCC-SLP
Dayna Revetti, MA, CCC-SLP
Insurance Case Manager
Patient Information Coordinator